Work-Products Summarized
Here are summaries of all our work-products.
Claim Reserves
Health Care Plans - Traditional (A1a )
Such reserve (on a claims-paid basis) shows both the actuarially-determined claim reserve and also the estimated in course of settlement liability; confidence limits appropriate to the computations are shown; also, claims run-out experience appropriate to prior reserves are shown.
Health Care Plans - SOP 01-02 (A1b)
In process of preparation.
Workers’ Compensation (A2)
This Actuarial Work-Product provides the state-required, claims-made, claims reserve for self-insured workers’ compensation funds.
Long Term Disability (A3)
This Actuarial Work-Product provides the claims-paid claims reserve for long-term disability plans regardless of the manner of funding. Computation includes both the present value of future benefits and the incurred but not paid reserve.
Monte Carlo Simulations
Claim Fluctuation Measures Without Specific Stop-Loss (B1a)
This Actuarial Work-Product provides the statistical variance of the projected plan sponsor-paid claims, including claims above the specific stop-loss limit, for the indicated twelve-month plan period.
Claim Fluctuation Measures With Specific Stop-loss (B1b)
This Actuarial Work-Product provides the statistical variance of the projected plan sponsor-paid claims, including claims above the specific stop-loss limit, for the indicated twelve-month plan period.
Economic Value of Stop-Loss - Specific-Only (B2a)
This Actuarial Work-Product provides the economic value of the specific-only stop-loss when applied to the projected plan sponsor-paid claims, including claims above such specific stop-loss for the indicated twelve-month plan period.
Economic Value of Stop-Loss - Specific and Aggregate (B2b)
This Actuarial Work-Product provides the economic value of the specific and aggregate only stop-loss when applied to the projected plan sponsor-paid claims, including claims above such specific stop-loss for the indicated twelve-month plan period.
Economic Value of Stop-Loss - Aggregate-Only (Variable Corridors) (B2c)
This Actuarial Work-Product provides the economic value of the aggregate-only stop-loss with a variable corridor when applied to the projected plan sponsor-paid claims, excluding claims above the specific stop-loss (if any) for the indicated twelve-month plan period.
Economic Value of Plan Benefits and Managed Care Arrangements (B3)
This Actuarial Work-Product provides the monetary value of the benefits, stop-loss terms, and managed care terms trifurcated between participant plan sponsor and stop-loss carrier for the subject health care plan.
Government Entity Certifications
Florida (C1)
FS §112.08 requires self-funded health plans of government entities to submit an annual filing demonstrating actuarial soundness.
Iowa (C2)
IAC title 905A requires self-funded health care plans of government entities to submit an annual filing demonstrating actuarial soundness.
Ohio (C3)
ORS §9.833requires self-funded health care plans of government entities to submit an annual filing demonstrating actuarial soundness.
Medicare Part D- Subsidy Feasibility Analysis (D1)
This Actuarial Work-Product provides (a) an actuarial certification that the Rx benefits provided by the Plan Sponsor to its retirees with Medicare eligibility are actuarially equivalent to those of Medicare Park D and (b) a feasibility analysis which quantifies the amount of economic advantage (or disadvantage) to the Plan Sponsor in electing the subsidy or the wraparound.
Medicare Part D- Creditable Coverage Certification (D2)
This Actuarial Work-Product provides the actuarial certification that the Rx benefits provided by the Plan Sponsor to its active participants who either have, or might become eligible for, Medicare Part D are actuarially equivalent thereto. The safe harbor rule may or may not be used.
Annual Actuarial Report
Recommended Funding (E)
For the projected (upcoming) plan year the annual Actuarial Report provides three useful health plan-related data:
1. Recommended Funding Factors
2. COBRA Rates
3. Claim Reserves (Claims Made Basis) (Estimated)
Those items maybe divided as follows as may be requested.
1. Tiering (I, P/C, P/S, P+1, F, e.g.)
2. Benefit (M, Rx, D.V, e.g.)
3. Plan Option (Gold, Silver, Bronze, e.g.)
4. Risk Pool (Active, Retirees, e.g.)
Consumer-Driven Health Care
HSA Option ( F)
This Work-Product quantifies the monetary savings to the Plan Sponsor of re-trifurcating the total plan-covered health care, expenses from the present (non-HSA) to the new (HSA) with the new entity called the HDHP. The costs of the three entities (participant, Plan Sponsor and stop-loss carrier) are all measured.
The result is the amount which the Plan Sponsor could deposit into the HSA so as to maintain financial parity.
Federal Income Tax Issues
Discrimination (G1)
The purpose of this Work-Product is to provide the Eligible User with the amount of the gross economic value of the subject health care plan for the subject fiscal year which value will serve as the basis for the accountant-prepared IRS Form W-2 with respect to those highly-compensated individuals who receive discriminatory plan terms or benefits.
Self-Employed (G2)
The purpose of this Work-Product is to provide the economic value of the subject Health Plan benefits as prescribed herein to the Plan Sponsor to be used in the preparation of the requisite needed IRS Form 1099 for certain self-employed participants.
Accountant-Related
FASB 112 Calculations (H1)
The purpose of this Work-Product is to determine the present value of a stream of future health care benefits for purposes of FASB 112. Some, but not necessarily all of the variables used in the calculation include the following: age, health status, sex, benefits, interest, mortality and morbidity.
Alternatives to Retired Life Reserves - FASB 106 (H2a)
This Work-Product eliminates the need for an FASB 106 determination by reclassifying retirees under age 65 to a COBRA participants if and only if, the health plan is appropriately amended.
Alternatives to Retired Life Reserves - GASB 43 and 45 (H2b)
This Work-Product eliminates the need for a GASB 43 and 45 determination by subdividing the risk pools and making the retiree risk pool participant-pay-all.
Product-Development-Related
Self-Funded Death Benefits (I1)
This Work-Product provides the recommended funding factors and the requisite reserving factors for such benefits which may be self-funded through a VEBA trust.
Self-Funded Long Term Disability Benefits (I2)
This Work-Product provides the recommended funding factors for such benefits which are self-funded.
Workplace-Based and Employee-Pay All (I3)
This Work-Product provides the recommended funding factors for such benefits. The format for offering such benefits are of two types:
· Self-Funded with 100% stop-loss (or the equivalent)
· Fully insured with all similar plans/groups fully-pooled.
Topic-Specific Critiques
Risk Management Related - Plan Benefits Design (J1a)
This Actuarial Work-Product provides a checklist of proposed health care plan changes either in benefits or design, which will impact on the expected plan claims experience. Such proposed changes are risk management and in nature. Approximate profiling of the effect on plan costs is included.
Risk Management Related - Plan Administration (J1b)
This Actuarial Work-Product provides a checklist of proposed health care plan administration changes, which will impact on the expected plan claims experience. Such proposed changes are risk management and in nature. Approximate profiling of the effect on plan costs is included.
Risk Management Related - Age-Graded and Gender-Graded Plan Funding (J1c)
This Actuarial Work-Product provides (a) alternate plan funding that is age-graded and gender-graded and (b) separate plan funding levels by risk pools (dependent children, actives/COBRA/spouses and retirees). Both (a) and (b) may be stratified by benefit (hospital, Rx, dental, etc.). Such Work-Product meets ADEA, ERISA and IRC discrimination standards.
Risk Management Related - Geographic-Graded Plan Funding (J1d)
Such finding variations are quite proper if (a) supportable by an actuarial certification of parity, (b) the health plan is appropriately amended and (c) there is no de facto discrimination (a) against the protected group or (b) in favor of the prohibited group.
Risk Management Related - Self-Funding Appropriateness Test (J1e)
This Work-product is a self-appraisal exercise by which a user may gain an index measuring the suitability of self-funding to a particular prospective plan sponsor with a given set of facts or documentation.
Health Risk Appraisal (J2)
Being developed
Claims Processing Guide (J3)
Being developed
Litigation-Related - Fact Critique and Review (J4)
This Work-Product is a critique and review of the facts of a particular litigation (actual or proposed) which is of a consultative or advisory nature and not of an expert opinion nature. The actuary’s response may be (a) verbal or (b) written; such will typically be based on the actuary’s review of the facts as contained in the critical court filings or depositions.
