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American Academy of Actuaries Defines "Qualified"

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The American Academy of Actuaries (AAA) is trying to get states to use the same approach to defining the term “qualified actuary” in laws and regulations relating to the health insurance rate review provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA).

The AAA, Washington, is a professional association that says part of its mission is to set “qualifications, practice, and professionalism standards for actuaries in the United States.”

Two AAA leaders – Thomas Wildsmith, an AAA vice president at the group’s health practice council, and John Morris, chairperson of the AAA qualifications committee — have sent a letter giving the AAA’s definition of “qualified actuary” to all state insurance commissioners and the chairs of each state house and senate insurance committee, the group says.

The AAA is recommending that states use the following language: “An actuary who is a member of the American Academy of Actuaries and qualified to provide such certifications as described in the U.S. Qualifications Standards promulgated by the American Academy of Actuaries pursuant to the Code of Professional Conduct.”

PPACA calls for federal and state regulators to give requests for big health insurance rate increases extra scrutiny. The U.S. Department of Health and Human Services (HHS) says either it or a state agency should review any request for an increase that exceeds 10%.

States are calling for insurers to provide certification from qualified actuaries indicating that the rates requested are appropriate.

The AAA says it has noticed inconsistencies in how states are using the term “qualified actuary” and wants to take corrective action.

The AAA already has been talking to individual states about its concerns about those states’ use of the term. In February, for example, the AAA health practice council and the AAA qualifications committee suggested that the state should define the term “qualified actuary” in the Arizona Administrative Code, not simply rely on the definition given in the health insurance reserve filing statute.

Later in February, the AAA asked actuaries to contactt the AAA if they learned their states had or were considering adopting “qualified actuary” definitions that differ from the AAA’s suggested definition, according to a health activity notice the AAA posted in February.


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