ASOP #5. True BUSINESS PowerPoint Presentation Template. Robert Lang, ASA, MAAA Dagny Grillis, ASA, MAAA. Page 1 BEYOND THE NUMBERS PRESENTED BY

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1 BEYOND THE NUMBERS ASOP #5 True BUSINESS PowerPoint Presentation Template 11/16/2018 PRESENTED BY Robert Lang, ASA, MAAA Dagny Grillis, ASA, MAAA Page 1

2 Agenda ASOP 5... ASOP 5... ASOP 5 Page 4

3 ASOP 5 History of Revisions Page 5

4 ASOP 5 History Original ASOP st Revision nd Revision rd Revision th (current) Revision 2017 Page 12

5 ASOP 5 History Original ASOP Provided clarity regarding commonly accepted proper actuarial practice concerning: Plan benefits Trend Determination of Incurral Date Claim Settlement Expenses Time Value of Money In 1990, the standard was reprinted as part of the actuarial standards of practice binder. Available as ASOP No. 5 Doc Page 13

6 ASOP 5 History 1 st Revision ASOP In 1991, the original ASOP 5 was reformatted by the Health Committee of the Actuarial Standards Board (ASB) and adopted by the ASB. Set forth areas of analysis and inquiry that actuaries must consider. Section of definitions was added. Not prescriptive of methods or procedures. Available as ASOP No. 5 Doc Page 14

7 ASOP 5 History 2 nd Revision ASOP Discusses incurred health and disability claims in total (includes paid portion). Explicitly discusses long-term claim products. Removed claim settlement expenses section. Also, explicitly excludes deficiency reserves and policy reserves. Available as ASOP No. 5 Doc Page 15

8 ASOP 5 History 3 rd Revision ASOP Available as ASOP No. 5 Doc Updated for deviation language Which ASOP was this standard updated to refer to? A) ASOP 1 B) ASOP 23 C) ASOP 41 Page 16

9 ASOP 5 History 3 rd Revision ASOP Available as ASOP No. 5 Doc Updated for deviation language Which ASOP was this standard updated to refer to? ASOP 41: Actuarial Communications Page 17

10 ASOP 5 History 4th Revision ASOP Published March ed from the ASB April 27, Applies to work on or after September Available as ASOP No. 5 Doc Updated certain definitions and added others for clarity and for consistency with other standards Page 18

11 ASOP 5 History 4th Revision ASOP Explicitly addresses certain considerations in estimating and analyzing incurred claims, including: behavior of claimants claim seasonality credibility payments and recoveries under government programs, and the purpose and intended use of the unpaid claim estimate. Page 19

12 ASOP 5 History 4th Revision ASOP Expanded guidance regarding provider contractual arrangements. Made standard consistent with the revised guidance in ASOP 1 regarding use of the language should consider. Added a requirement to disclose any explicit provision for adverse deviation. Page 20

13 ASOP 5 History 4th Revision ASOP SCOPE From: This standard applies to actuaries who estimate or review incurred claims under health benefit plans on behalf of insured or noninsured entities To: This standard applies to actuaries who estimate or review incurred claims under health benefit plans on behalf of risk-bearing entities Page 21

14 ASOP 5 History 4th Revision ASOP Section 4 Communications and Disclosures Expanded with reliance on ASOP Actuarial Communications - The actuary should include the following items, as applicable, in an actuarial communication. LIST OF 7 ITEMS FOR INCLUSION Page 22

15 What s Next? Actuarial Standards- Setting Process Final Document Exposure Draft Comments & Review Committee or Task Force Project Proposals Page 23

16 References Page 24

17 ASOP 5 Current Revision Page 25

18 ASOP 5 Overview - Section 1 Purpose: - A guide for estimating or reviewing incurred claims under a health benefit plan Page 26

19 ASOP 5 Overview - Section 1 When does this apply? Applies to actuaries who estimate or Does not apply to actuaries regarding review incurred claims under health reserves such as policy reserves, benefit plans on behalf of risk-bearing premium reserves, or claim settlement entities expense reserves Applies to the actuary only with respect to incurred claim estimates that are communicated as an actuarial finding Page 27

20 ASOP 5 Overview - Section 1 Page 28

21 ASOP 5 Overview - Section 1 Examples 1. Appraisals 2. Cash Flow Testing 3. Financial Analysis, Projections, Reserving, Reporting 4. Group Benefits 5. Product Development, Ratemaking, Pricing 6. Regulatory Filings 7. Reinsurance 8. Social Insurance Page 29

22 ASOP 5 Overview - Section 1 Examples 1. Appraisals 2. Experience Studies 3. Financial Analysis, Projections, Reserving, Reporting 4. Investment-Related Activities 5. Product Development, Pricing Page 30

23 ASOP 5 Overview - Section 1 Examples 1. Financial Analysis and Valuation Services 2. Social Insurance 3. Due Diligence Page 31

24 ASOP 5 Overview - Section 3 Considerations for Estimating Incurred Claims: 1. Health Benefit Plan Provisions and Business Practices 2. Economic and Other External Influences 3. Behavior of Claimants 4. Organizational Claims Administration 5. Claim Seasonality 6. Credibility 7. Risk Characteristics and Organizational Practices 8. Legislative Requirements 9. Carve-Outs 10. Special LTC Considerations Page 32

25 ASOP 5 Overview - Section 3 Analysis of Incurred Claims Considerations: 1. Categories of Incurred Claims 2. Reinsurance 3. Large Claims 4. COB 5. Provider Contractual Arrangements Page 33

26 ASOP 5 Overview - Section 3 Methods for Estimating Incurred Claims 1. Development Method 2. Projection Methods 3. Tabular Method Page 34

27 ASOP 5 Overview - Section 4 Communications Important Dates Limitations Uncertainties PAD Provider Insolvency Risk Follow-up Studies Changes in Assumptions, Procedures, Methods, Models Page 35

28 Page 36

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