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Froogle 1.1.1.7
Froogled By:
Elias Makere, FSA, MAAA
Last Froogled:

ASOP 5 | §1.2 | SCOPE

This standard applies to actuaries who estimate or review incurred claims under health benefit plans on behalf of risk-bearing entities, such as managed-care entities, self-funded employer plans, health care providers, government-sponsored plans or risk contracts, or government agencies. This standard does not provide guidance to actuaries regarding reserves such as policy reserves, premium reserves, or claim settlement expense reserves, although such reserves may be required for financial reporting. This standard does not address interpretations of statutory or generally accepted accounting practices.

This standard applies to the actuary only with respect to incurred claim estimates that are communicated as an actuarial finding (as described in ASOP No. 41, Actuarial Communications). Actions taken by the actuary’s principal regarding the use of such estimates are beyond the scope of this standard.

If the actuary departs from the guidance set forth in this standard in order to comply with applicable law (statutes, regulations, and other legally binding authority) or for any other reason the actuary deems appropriate, the actuary should refer to section 4.
ASOP 5 | Commentary Section 1.2 | COMMENT ON SECTION 1.2
Section 1.2, Scope
CommentResponse
One commentator suggested identifying “principal” as coming from ASOP No. 41, Actuarial Communications, and as defined in the Code of Professional Conduct.The reviewers believe the context makes this reference clear and made no change.
One commentator suggested adding “self-funded employer plans” to the list of risk-bearing entities in section 1.2.The reviewers agree and made the change.
One commentator suggested removing “regulatory agencies” from the list of risk-bearing entities in section 1.2.The reviewers changed this item to “government agencies” in order to clarify the meaning.
One commentator suggested moving the list of risk-bearing entities to the definition section.The reviewers believe the list is appropriately included in section 1.2.
One commentator suggested removing the words “insured or non-insured” in section 1.2.The reviewers agree and made the change.
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