HEALTH, LONG TERM CARE, DISABILITY, EMPLOYEE BENEFITS

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.

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.

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.

Appointed Actuary

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.

Regulatory

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).

Long Term Care and Supplemental Products

Our consultants have extensive experience providing actuarial consulting services related to long term care and supplemental insurance. Our experience includes:

  • Developing nationwide product rollouts.
  • Managing insurance company actuarial functions supporting LTX, cancer, critical illness, Medicare  supplement, and other supplemental products.
  • Serving as a reinsurance marketing actuary for LTC, disability, and Medicare supplement blocks of business.
  • Rehabilitating Medicare supplement blocks of business.
  • Assisting state regulatory authorities with financial examinations and rate filing reviews related to LTC and health insurance companies.

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.

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.

 

 

Our Team