Work-Product Actuarial Services To
Self-Funded Health Care Plans
This Web Site (Work-Product Actuarial Services to Self-Funded Health Care Plans) was created and is maintained by:
Self-Funding Actuarial Services, Inc. (SFA) Tel (336) 759-2035
8025 North Point Blvd., Suite 207W Fax (336) 896-0392
Winston-Salem, NC 27106 harker2@earthlink.net
Carlton Harker, FSA, MAAA, Principal See www.self-fundhealth.com
Overview
This Web Site is dedicated to:
· Those service vendors (TPAs, e.g.) or producers (consultants, risk managers, brokers, e.g.)...
· Serving self-funded health care plans or self-insured workers’ compensation arrangements...
· That wish to provide to the plan sponsor (present or prospective) certain actuarial services acting either as a facilitator (arranger or go-between, whereby the actuary is engaged by the client) or as a provider (whereby the actuary is engaged directly by the vendor or producer)...
· Thereby gaining service, convenience and pricing advantages for their clients; marketing advantages for the service vendors or producers; and professional enhancements to the participants, and....
· Where all such actuarial services are work-product based (i.e., no billable time) with a fixed/global price and a pre-determined actuarially-certified work-product which is conditioned only on the receipt of certain requested data or documentation.
The underlying rationale of this Web Site was originally set forth in a trade journal article entitled Actuarial Certifications to Self-Funded Health Care Plan Sponsors.
SFA also offers non-work-product services (consulting, advisory, research, expert witness, mathematical/statistical computations, e.g.) which are described in a companion Web Site (www.self-fund.health.com)
Menu of Actuarial Work-Products
The range of actuarial work-products is as follows:
· Annual Actuarial Report (Recommended Funding, COBRA Rates and Estimated Claim Reserves); a Commentary on COBRA Premiums is provided for user interest and understanding.
· Reserve Certification (FASB 5 or SOP 92-6 Format); a Commentary on Claim Reserves is provided for user interest and understanding.
·
HSA Feasibility Study; an
HSA Commentary is provided
for user interest and understanding.
· Medicare Part D Certifications; an Rx Planning commentary is attached.
· State-Mandated Certifications
Florida Government Entity
Pension Actuary
· Post-Retirement Reserves – FASB 106
· Post-Employment Reserves – GASB 43 and GASB 45; Commentary on GASB 43 and GASB 45 is attached.
Casualty Actuary
·
Workers’ Compensation Claim Reserve
For each of the Work-Products above-listed, the following are set forth on a Sub-Site:
· Overview
· Requisite Data and Documentation
· Fee Schedule
· Communication/Production Considerations
· Sample Work-Product.
Miscellaneous Comments
The service vendor/producer and the plan sponsor are free to contact and/or engage any of the designated actuaries for any work-products as may be in their best economic interest. However the comments may be useful:
· Significant advantages will result if the Pension Actuary in the preparation of the retiree reserves uses the Annual Actuarial Report prepared by the Health Actuary.
· Communication mishaps will be minimized if the orchestration of the various actuarial work-products be done by the Health Actuary at least through the bidding/RFP process.
· Each actuary’s work-product will be under such actuary’s label with such actuary fully responsible in a professional manner to the party engaging such actuary.
Relationships and Activities
Several issues of relationships and activities should be understood:
· No service vendor or producer may be on the roster (maintained by SFA) for any of the offered actuarial services until approved by the relevant actuary.
· Any approved service vendor or producer has both the obligation and privilege to respond to the RFPs or otherwise quote described actuarial serves with assurance of such being valid quotes so long as the terms and conditions set forth in this Web Site are followed. For RFP purposes, the vendor or producer should present itself as a consulting firm with actuarial services where such purely actuarial services are provided by a subcontractor. Such subcontractor services take the form of a standard work-product, fixed/global fees to the vendor or producer and actuary –provided quality guarantees and E & O protection.
· While the relationship of the service vendor or producer to the actuary will be determined on an individual facts/circumstance basis, it is expected that the following general practice will be as follows:
Actuary Relationship of Vendor/Producer
Pension Facilitator only
Life Either facilitator or provider
Health Either facilitator or provider
Casualty Facilitator only
Billings go to, and E & O protection of actuary attaches to, the party engaging the actuary which may be either the plan sponsor or the service vendor/producer.