June 2014
Intermediate to advanced
280 pages
10h 47m
English
Content preview from ERM - Enterprise Risk Management: Issues and Cases
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10 Case Study: Large Health Insurer in the US
This case is derived from a conversation with a risk manager for a large health insurer in the United States who wanted to remain anonymous. The interview was conducted by Christopher Ketcham, Ph.D., CPCU, CRM, CIC, CFP®, Formerly Visiting Assistant Professor, University of Houston Downtown, Houston, Texas; Garnet Valley, Pennsylvania Date: July 9, 2012
10.1 THE LARGE HEALTH INSURER TODAY
This is a large not-for-profit health insurer in the USA that has been in business for more than seventy years. Presently it has more than 10,000 employees. At the time of this writing (September, 2012), the company had an A.M. Best financial size rating of XV.1 The organization's principal business is to provide health insurance for individuals and organizations in a defined geographical area. The organization provides traditional healthcare products, including products associated with the US Affordable Healthcare Act for which the first major changes will be implemented late 2013 and 2014. Beyond traditional health insurance the insurer offers Preferred Provider Organization (PPO) products, Health Maintenance Organization (HMO) products, and the Federal Health insurance program for seniors called Medicare.
10.2 IMPLICATIONS OF THE AFFORDABLE CARE ACT
The Affordable Care Act passed by Congress in March 2010 will have major implications for how health insurers will do business in the US beginning in late 2013. Approximately forty million uninsured ...
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