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Regulatory Issues in Health Reserving

Regulatory Issues in Health Reserving. Julia T. Philips, FSA, MAAA Life and Health Actuary Minnesota Department of Commerce. Requirements and Guidance. State Statutes and Regulations. Statutory Reporting Minimum Reserve Standards Actuarial Opinion.

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Regulatory Issues in Health Reserving

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  1. Regulatory Issues in Health Reserving Julia T. Philips, FSA, MAAA Life and Health Actuary Minnesota Department of Commerce

  2. Requirements and Guidance

  3. State Statutes and Regulations • Statutory Reporting • Minimum Reserve Standards • Actuarial Opinion

  4. National Association of Insurance Commissioners • Model Laws and Regulations: Standard Valuation Law, Actuarial Opinion and Memorandum Regulation, Health Insurance Reserves Model Regulation • Accounting Practices and Procedures • Actuarial Guidelines

  5. National Association of Insurance Commissioners • Examiner’s Handbook • Codification: AP&P Manual with SSAP’s, Appendices • Health Reserves Guidance Manual: Draft available on NAIC Web Site

  6. American Academy of Actuaries • Actuarial Standards of Practice: ASOP No. 5, ASOP No. 9, ASOP No. 14, ASOP No. 16, ASOP No. 20, ASOP No. 22, ASOP No. 28, ASOP No. 36, and ??? • Code of Professional Conduct • Qualification Standards for Prescribed Statements of Actuarial Opinion • Practice Notes

  7. ASOP No. 5 Revision Timetable • Current standard adopted 1991 • Revised standard exposed 9/99 • Comments were due 3/00 • Proposed final revision to be reviewed at ASB 9/00

  8. ASOP No. 5 Revisions • New format as of May, 1996 • Includes paid claims, not just unpaid • Long-term products: cancer, LTC, DI, LTD • Not included in ASOP: Settlement expenses, deficiency reserves, and policy reserves.

  9. Regulatory Issues in Health Reserving • Conservatism • Provider contracts • Credibility • Follow-up studies • Premium deficiency reserves

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