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OF SELF-FUNDED HEALTH PLANS
 
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TABLE OF CONTENTS

Introduction

Topic 1 – Authorship, Copyright and Publisher

Topic 2 – Scope of Plans and Benefits

Topic 3 – Scope of Practitioner Interests

Topic 4 – Two Computational Protocols Discussed

Topic 5 – Taxes and Regulatory Considerations

Taxes

Regulatory

Proposed Changes

Section One – Motivational Issues

Part 1 – Trade and Commerce Laws

Part 2 - Enterprise Risk Management

Part 3 – New Uses of Claim Reserves

Part 4 – Increased Importance of Self-Funding

Section Two – Claim Reserve Work-Product Changes

Part 1- Margin-of-Error Presentation

Part 2 – Run-out Presentation

Part 3 – Two-Part Claim Reserve (Amendment)

Part 4 – Modified Database

Section Three – Computational or Procedural Protocols

Part 1 – Trifurcation of Duties and Responsibilities

Part 2 – User Friendliness

Part 3 – New Millennial Changes

 

Commentary

Introduction

Accuracy-of-Computation Tests

Experience Monitoring of Self-Funded Health Plans

Idealized Database

New Computational Protocol

New Millennial Changes

Outlier Claims

Reserve Amendment

Tax-Deductibility Issues

 

 

Attachments

 

Topic A: Work-Products

A.1 – Sample Claim Reserve Work-Product (basic Stochastic Model)

A.2 – Sample Claim Reserve Amendment

A.3 – Comparison of Stochastic and Deterministic Computational Protocols

A.4 – Basic Reserve (Background Reading)

A.5 – Reserve Amendment (Background Reading)

 

Topic B: Professional and Industry Regulations

B.1 – Comparisons of IBNR Methods (SOA)

B.2 – AAA SOP 5 – Incurred Health and Disability Claims

B.3 – NAIC Model Regulation – Health Insurance Reserves

B.4 – NAIC Guidance Manual – Health Reserves

 

Topic C: Technical

C.1 – Syllabus of Related Reading

 

Topic D: Trade and Commerce

D.1 – Trade and Commerce Laws

 

Topic E: Enterprise Risk Management

 

Topic F: Taxes

F.1 – The Depths of IRC 419 and 419A

F.2 – VEBA

F.3 – Participant Tax-Related Issues

F.4 – Tax Deductibility of Unpaid Employee Welfare Claims

 

Topic G: Accountant Involvement

G.1 – Accounting Considerations (Text IFEBP)

G.2 – Health and Welfare Employee Benefit Plans (AICPA)

G.3 – Reserve Calculation and Analysis

G.4 – Notes to Financial Statements

 

Topic H: Procedural and Administrative

 

Topic I: User Friendliness

I.1 – New Delivery Protocol for Claim Reserves of Self-Funded Health Plans

 

Topic J: Judicial Regulations

 

Appendices

Acronyms, Glossary and Definitions