Health plan benefit designs are complex. Improve pricing accuracy of ACA health plans through data engineering and claims readjudication.

There are four major “types” of insurance plans: HMO, PPO, EPO, and POS. HMO and PPO are the most popular. EPO and POS are “hybrid” HMO/PPO plans.

Employers have the option of either self-funding or fully-funding the health insurance plan for their employees. What are the key differences?

The Medicaid program provides either free or very low-cost health insurance to eligible poor individuals and families.

Medicare is a federal government health insurance program for elder people, and some disabled individuals.

There are two ways to obtain an ACA-compliant health plan: on-exchange and off-exchange.

Advance Premium Tax Credits (APTC) are a component of the Affordable Care Act. APTCs make healthcare premiums more affordable for people with low incomes.

Cost-Sharing Reduction (CSR) is a component of the Affordable Care Act. CSR make healthcare costs more affordable for people with low incomes.

Actuaries working in the health insurance industry must be intimately familiar with the Affordable Care Act (ACA).

Many factors contribute to rising healthcare costs in the United States. Four of these main factors are utilization, prevalence, unit cost, and drug costs.

There are four key players in the healthcare industry: patients, providers, payers, and vendors.