We provide actuarial consulting services in the following employee benefits/health and disability areas:
Renewal Pricing for Self Insured Employer Groups
We provide full actuarial support to assist clients in the financial management of their self-insured group medical plan. Deliverable items include:
- Cost projection for the next fiscal year.
- Development of employee contribution strategy.
- Proposed plan design changes and associated cost impact.
Medicare Cost Plus
Sponsors of self-insured group medical plans can realize significant plan savings by utilizing a Medicare Cost Plus reimbursement approach. READ MORE…
Patient Protection and Affordable Care Act (PPACA) Financial Impact Modeling
Our consultants provide employer groups with customized actuarial studies that illustrate, under multiple scenarios, the projected financial impact of PPACA on the client employer group. These studies incorporate specific client plan, rate, and census data.
Retiree Medical Valuations
We can prepare the required ASC 715 and GASB 45 actuarial valuations for entities that offer post-employment benefits other than pensions (OPEB’s) to eligible private and public sector employees. Our consultants can prepare any necessary financial disclosures and consult on how employer groups can manage these liabilities.
Medical Stop Loss
Our health actuaries have experience in providing a full range of actuarial services to captive insurance companies and self-insured employers who issue medical stop loss coverage. We can suggest appropriate plan designs and the applicable insurance rates for these insurers that will meet their risk management objectives.
Captive Insurance & Employee Benefits
Merlinos provides actuarial support for employer groups who are considering using their captive insurance company to reinsure certain employee benefits that are subject to Department of Labor regulation. We can assist employers in designing the right captive insurance program that meets risk objectives and satisfies any associated DOL requirements with respect to benefit enhancement.
Group Medical Captives
We provide actuarial support to employer groups that are sharing their employee benefit risks with employers in a group medical captive.
Self-Insured Feasibility Studies – Group Medical
Merlinos can prepare a customized self-insurance feasibility study for employer groups who currently fund their group medical benefits on a fully insured basis. This study will assist the employer group in understanding the savings opportunities that may exist when converting the group medical plan to a self-insured funding arrangement. Our study will also quantify the level of volatility that employers can expect under such an arrangement.
Long-Term Disability Reserving
Our actuaries can quantify the actuarial value of long-term disability (LTD) case reserves for self-funded employer groups or captive insurance companies who reinsure group LTD benefits.
Our consultants are available to act as Appointed Actuary to health insurance companies and HMOs. We have extensive experience providing Statements of Actuarial Opinion and Actuarial Reserve Reports.
Our consultants have extensive experience providing actuarial assistance to state regulators. This experience includes involvement with 30 HMO examinations in recent years. We also provide actuarial support related to state-level regulations that impact group employee benefits such as Florida Statute 112.08.
We provide actuarial certifications to applicants who are requesting Health Care Innovation Awards funding from The Centers for Medicare & Medicaid Services (CMS).