Glossary

A method under which historical claim data, such as the number and amount of claims for the subject block of business, are grouped into the time periods in which claims were incurred and the time periods in which they were processed. The processing date is typically the date the claim is received, adjudicated, or paid by the claim payer. The method uses these groupings to create a claims processing or development pattern, which is used to help estimate the unprocessed portion of incurred claims. (ASOP No. 5)

The expected future lifetime of an insured. There are two primary types of life expectancies, mean and median, are reported by LE providers in the life settlement market. (Exposure Draft, Proposed ASOP Life Settlements Mortality)

An entity that applies medical underwriting analysis to determine a mortality assumption or life expectancy. (ASOP No. 48)

A third party that the actuary relies on to interpret the law and regulations related to the regulatory filing. For regulatory actuaries, this could be the legal authority designated or authorized to provide such advice for the government organization to which the actuary is responsible. (Revision of ASOP No. 8, Regulatory Filings for Health Plan Entities, to Include Specific Issues Related to the Accountable Care Act and Additional Guidance on Rating)

Varying degrees of care based on a resident’s or member’s health status. Typical levels of care include independent living, assisted living, nursing care, and memory care. The levels of care may be dictated by state licensure.

A measure of the relative amount of risk to which capital is exposed, typically expressed as the ratio of an exposure measure (such as premium or liabilities) to the capital amount. (ASOP No. 30)

Any commitment by, or requirement of, an insurer that can reduce revenue or generate disbursement cash flows.

An accrued obligation to policyholders that relates to insured events, such as death or disability, measured as the present value of future policy benefits minus the present value of future GAAP net premiums.

A CCRC in which nursing care is provided for life without increasing the periodic fee on account of a change in health. (ASOP No. 3)

The expected future lifetime of an insured. There are two primary types of life expectancies, mean and median, are reported by LE providers in the life settlements market. (ASOP No. 48)

An entity that applies medical underwriting analysis to determine a mortality assumption or life expectancy. (ASOP No. 48)

The life insurance policy or policies sold to an investor.  The term “life settlement” includes viatical and other life settlements.  Generally, a viatical life settlement is any life settlement where the insured has a life expectancy of less than two to three years depending on state regulation. (ASOP No. 48)

As each is defined in SFAS No. 97, & 6-14. (ASOP No. 10)

The rights (if any) that a member of a mutual company has upon liquidation of the company. (ASOP No. 37)

The risk stemming from limited marketability of an investment. (Draft Proposed Revision of ASOP No. 20)

The various living quarters of a CCRC, including independent living units and health center units.

A requirement to continue using original basis assumptions (as set at issue, acquisition, or prior redetermination due to a premium deficiency). (ASOP No. 10)

An insurance policy or other financial arrangement that establishes health-related obligations for an extended period of time. Benefits may begin several years after plan inception and may extend for several years. Benefits may be on a reimbursement, indemnity, or service benefit basis. Examples of long-duration health benefit plans include long-term disability income, long-term care, critical illness, and accidental death and dismemberment insurance.

A period long enough to discern the general pattern and level of future costs.

A wide array of health and other support services for people who suffer a loss of functional capacity that results in the need for continual one-to-one assistance of another person in the activities of daily living, such as walking, dressing, eating, toileting, or mobility. (ASOP No. 6)

A wide range of health and social services, which may include adult day care, custodial care, home care, hospice care, intermediate nursing care, respite care, and skilled nursing care, but generally not care in a hospital. Long-term care is sometimes referred to as long-term services and supports or LTSS.

A policy, contract, or arrangement providing LTC benefits, either on a stand-alone basis or as part of a plan that provides other benefits as well (except where the LTC benefits are an immaterial feature). The plan may describe requirements for benefit eligibility, covered services, benefit amount, benefit payment duration (including short-term and long-term), maximum benefit amount, and other coverage features.

A policy, contract, or arrangement providing LTC benefits, either on a stand-alone basis or as part of a plan that provides other benefits as well (except where the LTC benefits are an immaterial feature). The plan will usually describe requirements for benefit eligibility, covered services, benefit amount, benefit payment duration, maximum benefit amount, and other coverage features. (ASOP No. 18)

A health benefit plan that provides medical or disability benefits for an extended period of time. Some examples are cancer, long-term care, and long-term disability policies. The plan’s benefits may not begin for several years after policy purchase and claims usually extend beyond the valuation date.

The cost that is associated with an event that has taken place and that is subject to coverage. It is also known as “claim amount.” The term “loss” may include loss adjustment expenses as appropriate.

The cost of administering, determining coverage for, settling, or defending claims even if it is ultimately determined that the claim is invalid. It is also known as “claims adjustment expense.” (ASOP No. 28)

A wide range of health and social services, which may include adult day care, custodial care, home care, hospice care, intermediate nursing care, respite care, and skilled nursing care, but generally not care in a hospital. Long-term care is sometimes referred to as long-term services and supports or LTSS.

A policy, contract, or arrangement providing LTC benefits, either on a stand-alone basis or as part of a plan that provides other benefits as well (except where the LTC benefits are an immaterial feature). The plan may describe requirements for benefit eligibility, covered services, benefit amount, benefit payment duration (including short-term and long-term), maximum benefit amount, and other coverage features.

A policy, contract, or arrangement providing LTC benefits, either on a stand-alone basis or as part of a plan that provides other benefits as well (except where the LTC benefits are an immaterial feature). The plan will usually describe requirements for benefit eligibility, covered services, benefit amount, benefit payment duration, maximum benefit amount, and other coverage features. (ASOP No. 18)