Actuarial Certification Sample Clauses

Actuarial Certification. ✓ See Section 3.

Actuarial Certification. The capitation rates provided with this certification are “actuarially sound” for purposes of 42 CFR 438.4(a), according to the following criteria:  The capitation rates provide for all reasonable, appropriate, and attainable costs that are required under terms of the contract and for the operation of the managed care plan for the time period and population covered under the terms of the contract, and such capitation rates were developed in accordance with the requirements under 42 CFR 438.4(b). To ensure compliance with generally accepted actuarial practices and regulatory requirements, we referred to published guidance from the American Academy of Actuaries (AAA), the Actuarial Standards Board (ASB), the Centers for Medicare and Medicaid Services (CMS), and federal regulations. Specifically, the following were referenced during the rate development:  Actuarial standards of practice applicable to Medicaid managed care rate setting which have been enacted as of the capitation rate certification date, including: ASOP 1 (Introductory Actuarial Standard of Practice); ASOP 5 (Incurred Health and Disability Claims); ASOP 23 (Data Quality); ASOP 25 (Credibility Procedures); ASOP 41 (Actuarial Communications); ASOP 45 (The Use of Health Status Based Risk Adjustment Methodologies); and ASOP 49 (Medicaid Managed Care Capitation Rate Development and Certification).  Actuarial soundness and rate development requirements in the Medicaid and CHIP Managed Care Final Rule (CMS 2390-F) for the provisions effective as of January 1, 2017.  The most recent Medicaid Managed Care Rate Development Guide published by CMS.  Throughout this document and consistent with the requirements under 42 CFR 438.4(a), the term “actuarially sound” will be defined as in ASOP 49: The CY 2017 Opt-In capitation rates were developed from the Opt-Out capitation rates (baseline Medicaid data). The baseline Medicaid data was adjusted for the following factors:  Selection adjustments  Removal of LTSS rebalancing assumption  Application of 4% joint savings as required under demonstration year 3 We reviewed the benefit expense experience between the Opt-Out and Opt-In populations on a regional basis to evaluate whether the Opt-In penetration rate (the percentage of the total MyCare population participating in the dual demonstration) materially impacted the benefit expense relationship between the Opt-In and Opt-Out populations. Because both the Opt- In penetration and cost relationships did not...

Actuarial Certification. I, ▇▇▇▇▇▇▇ ▇▇▇▇▇, Senior Actuary at Optumas and Member of the American Academy of Actuaries (MAAA), am certifying the calculation of the rate ranges shown in Appendix III. I meet the qualification standards established by the American Academy of Actuaries and have followed the practice standards established from time to time by the Actuarial Standards Board. The capitation rates provided with this certification are considered actuarially sound for purposes of the 42 CFR 438.6(c), according to the following criteria: ▪ The capitation rate ranges have been developed in accordance with generally accepted actuarial principles and practices; ▪ The capitation rate ranges are appropriate for the populations to be covered, and the services to be furnished under the contract; and ▪ The capitation rate ranges meet the requirements of 42 CFR 438.6(c). Appendix II(A) contains a crosswalk between the CMS rate setting checklist and this certification letter. The actuarially sound rate ranges that are associated with this certification are effective September 1, 2014 through June 30, 2015 for Colorado’s 1281 Pilot Program. The actuarially sound capitation rate ranges are based on a projection of future events. Actual experience will vary from the experience assumed in any rate picked within the rate ranges. The capitation rates offered may not be appropriate for any specific MCO. An individual MCO should review the rates in relation to the benefits that it is obligated to provide to the covered population. The MCO should evaluate the rates in the context of its own experience, expenses, capital, surplus, and profit requirements prior to agreeing to contract with the State. The MCO may require rates above, within, or below the actuarially sound rate range associated with this certification. Should you have questions on any of the above, please feel free to contact me at ▇▇▇.▇▇▇.▇▇▇▇ for any additional information. Sincerely, ▇▇▇▇▇▇▇ ▇▇▇▇▇, ASA, MAAA Senior Actuary

Actuarial Certification. 56 SECTION 10.5.12 MEEMIC Transactions . . . . . . . . . . . 56 SECTION 10.5.13 Insurance Proceedings . . . . . . . . . . 56 SECTION 10.5.14 Labor Matters . . . . . . . . . . . . . . 56 SECTION 10.5.15 Tax Sharing Agreements. . . . . . . . . . 56 SECTION 10.5.16 Other . . . . . . . . . . . . . . . . . . 57

Actuarial Certification. Certification of an actuary acceptable to Lender as to the adequacy of PICOM and PICOM-III. reserves as set forth in its Annual Statement as of December 31, 1996, substantially in the form of Exhibit E, as delivered to the Lender prior to the date hereof, together with a letter from such firm addressed to the Lender acknowledging the delivery of said appraisal to the Lender and the Lender's reliance thereon.

Actuarial Certification. The results set forth in this report are based on our actuarial valuation of the health and welfare benefit plans of the City of La Quinta ("City") as of July 1, 2014. The valuation was performed in accordance with generally accepted actuarial principles and practices. We relied on census data for active employees and retirees provided to us by the City in October, 2014. We also made use of claims, premium, expense, and enrollment data, and copies of relevant sections of healthcare documents provided to us by the City. The assumptions used in performing the valuation, as summarized in this report, and the results based thereupon, represent our best estimate of the actuarial costs of the program under GASB 43 and GASB 45, and the existing and proposed Actuarial Standards of Practice for measuring post- retirement healthcare benefits. We have assumed no post-valuation mortality improvements, consistent with our belief that there will be no further significant, sustained increases in life expectancy in the United States over the projection period covered by the valuation. Throughout the report, we have used unrounded numbers, because rounding and the reconciliation of the rounded results would add an additional, and in our opinion unnecessary, layer of complexity to the valuation process. By our publishing of unrounded results, no implication is made as to the degree of precision inherent in those results. Clients and their auditors should use their own judgment as to the desirability of rounding when transferring the results of this valuation report to the clients' financial statements. The undersigned actuary meets the Qualification Standards of the American Academy of Actuaries to render the actuarial opinion contained in this report.