2021 Accounting and Reporting for Accident and Health Claims
Virtual Training Seminar

October 12, 2021
All Times Eastern Standard Time
Presenters: Brian Neader/Karen Foster
Agenda
Agenda

10:30am – 10:45am

Welcome and Introduction

10:45am – 11:30am

Introduction to Accounting and Reporting for Health Insurance Claims
This session provides an overview of the actuarial liabilities and reserves reported by health insurance companies, commonly referred to as “Accident and Health Reserves”. A general discussion of the accounting and reporting requirements, differences in GAAP and Statutory accounting and reporting, and the regulatory oversight that is directed towards claim reserves are covered in this session.

11:30am – 12:15pm

Accounting & Reporting for A&H Claim Reserves
This session provides a discussion and analysis of the Statement of Statutory Accounting Principles (SSAPs) that provide the foundation and fundamental concepts for the accounting, recognition, and allocation of claims reserves and liabilities, collectively referred to as “Accident and health (A&H) reserves.” This session addresses the reporting for unpaid claim reserves with an in-depth discussion of the preparation of the Underwriting and Investment (U&I) Exhibit Part 2D. A discussion is also provided on the impact and preparation of related statutory financial statements and supporting schedules.

The session addresses claim reserves, premium deficiency reserves, policy reserves, advance premiums and unearned premiums and addresses the distinctions between policy and claim reserves pursuant to SSAP No. 54R.

The SSAPs discussed in this session include:

  • SSAP No. 47 – Uninsured Plans
  • SSAP No. 50 – Classifications of Insurance or Managed Care Contracts In Force
  • SSAP No. 54R – Individual and Group Accident and Health Contracts, Revised
  • SSAP No. 66 – Retrospectively Rated Contracts
  • SSAP No. 107 – Risk Sharing Provisions of the Affordable Care Act

The Schedules and Exhibits covered in this session include:

  • Underwriting and Investment Exhibit, Part 2D – Aggregate Reserve for Accident and Health Contracts

12:15pm – 12:30pm

Break

12:30pm – 1:15pm

Accounting & Reporting for A&H Claim Liabilities
This session provides a discussion and analysis of the SSAPs that provide the foundation and fundamental concepts for the accounting, and recognition of claim liabilities, claim adjustment expenses and the impact of health care receivables on claim liabilities. This session also addresses the reporting for unpaid claim liabilities with an in-depth discussion of the preparation of the Underwriting and Investment (U&I) Exhibits Parts 2 and, 2A.

The Schedules and Exhibits covered in this session include:

  • Underwriting and Investment Exhibit, Part 2 – Claims Incurred During the Year
  • Underwriting and Investment Exhibit, Part 2A – Claim Liability End of Current Year

The SSAPs discussed in this session include:

  • SSAP No. 35R – Guaranty Fund and Other Assessments
  • SSAP No. 55 – Unpaid Claims, Losses and Loss Adjustment Expenses
  • SSAP No. 84 – Health Care Receivables and Government Insured Plan Receivables

1:15pm – 1:45pm

Accounting and Reporting for Claim Adjustment Expenses
This session provides a discussion and analysis of the SSAPs that provide the foundation and fundamental concepts for the accounting, recognition, and allocation of claims’ administrative expenses. An extended discussion also addresses the accounting and allocation of cost containment expenses.

The SSAPs discussed in this session include:

  • SSAP No. 70 – Allocation of Expenses
  • SSAP No. 55 – Unpaid Claims, Losses and Loss Adjustment Expenses

1:45pm – 2:30pm

Impact of Reinsurance on Claims Accounting and Reporting
This session addresses the impact of reinsurance on claims accounting and reporting. A brief overview of the purpose of reinsurance and the accounting for different types of reinsurance is provided along with an overview of Schedule S and its impact on the financial statements.

The SSAPs discussed in this session include:

  • SSAP No. 61R – Life, Deposit-Type, and Accident and Health Reinsurance
  • SSAP No. 62R – Property and Casualty Reinsurance

2:30pm – 2:45pm

Break

2:45pm – 3:30pm

Analyzing A&H Claim Liabilities and Reserves
This session addresses the reporting of the U&I Exhibits used to analyze unpaid and paid claim liabilities and claim reserves. This session also covers the development of the data and the preparation of the U&I Exhibits Part 2B and 2C. An illustrative example is used to demonstrate the concepts presented in this session.

The Exhibits covered in this session include:

  • Underwriting & Investment Exhibit, Part 2B – Analysis of Claims Unpaid Prior Year – Net of Reinsurance
  • Underwriting & Investment Exhibit, Part 2C – Development of Incurred Claims

3:30pm – 4:15pm

Reporting Other Miscellaneous Claim Schedules and Exhibits
This session provides an overview of other operational and financial Exhibits and Schedules impacted by claim liabilities, claim reserves and policy reserves.

The Pages and Exhibits covered in this session include:

  • Page 3 – Liabilities, Capital, and Surplus
  • Page 4 – Statement of Revenue and Expenses
  • Analysis of Operations by Line of Business
  • Exhibit of Premiums, Utilization, and Enrollment
  • Cash Flow
  • Exhibit 3 – Health Care Receivables
  • Exhibit 4 – Claims Payable (Reported and Unreported)
  • Exhibit 7 – Exhibit 7 - Part 1 - Summary of Transactions with Providers
  • General Interrogatories
  • Notes to the Financial Statements
  • Five-Year Historical Data
  • Exhibit of Premiums, Utilization and Enrollment
  • Risk-Based Capital Report
  • A&H Policy Experience Exhibit (Claim Lines)

4:15pm – 4:30pm

Final Comments and Adjournment