ACT 420 · Year 4 · Semester 2 · 3 credits · Actuarial
Health Insurance, Reinsurance & Catastrophe Modelling
From community rating to extreme tail value-at-risk: engineering resilience across healthcare systems, reinsurance treaties, and planetary catastrophe.
Solvency Horizon
When regional carrier Aegis Mutual faces catastrophic health pool selection and unmodeled climate shocks, newly promoted capital actuary Maya Lin must rebuild the insurer's pricing, catastrophe architecture, and reinsurance treaties before AM Best strips their rating.
At 7:14 AM on a rainy Tuesday, Maya Lin walks into an emergency executive session to find Chief Actuary Dan Mercer staring at a negative twelve-million-dollar state risk adjustment invoice. Aegis Mutual's newly acquired small-group commercial health block is bleeding cash because healthy lives deserted to a digital competitor while high-cost chronic patients stayed.
Transcript
At 7:14 AM on a rainy Tuesday, Maya Lin walks into an emergency executive session to find Chief Actuary Dan Mercer staring at a negative twelve-million-dollar state risk adjustment invoice. Aegis Mutual's newly acquired small-group commercial health block is bleeding cash because healthy lives deserted to a digital competitor while high-cost chronic patients stayed.
- Formulate per-member-per-month (PMPM) health claims using utilization, unit cost trends, and benefit design parameters
- Derive and calculate commercial health risk scores using Hierarchical Condition Categories (HCC)
- Compute zero-sum risk adjustment transfers under the ACA HHS-HCC payment methodology
- Apply credibility blending between group historical experience and manual rating schedules under ASOP No. 12 and ASOP No. 45