Prepared by a joint work group of the American Academy of Actuaries and the Society of Actuaries TECHNICAL REPORT October 30, 2009 Karl N. Lewis, MAAA, ASA Jay C. Ripps, MAAA, FSA Sara C. Teppema, MAAA, FSA, FCA Shari A. Westerfield, MAAA, FSA The members of the work group are: S TART - UP C APITAL C OSTS FOR HEALTH CARE C O - OPS AND A P UBLIC P LAN ii S TART - UP C APITAL C OSTS FOR HEALTH CARE C O - OPS AND A P UBLIC P LAN iii