| SOA真题November2004Course8M |
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COURSE 8: Fall 2004 - 1 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
**BEGINNING OF EXAMINATION**
HEALTH, GROUP LIFE %26amp; MANAGED CARE
MORNING SESSION
1. (4 points) You are an actuary for a reinsurance company. A business school professor at
a local university has invited you to be a guest lecturer on the topic, “Reinsurance
Program Management.”
Outline and describe the contents of your presentation, with respect to:
i. information a reinsurance company should seek in order to decide whether to
offer reinsurance to a customer
ii. practices a reinsurer should follow to maintain a profitable reinsurance portfolio.
2. (5 points) You have been asked by your local Chamber of Commerce to speak on the
topic of patient-directed healthcare benefit programs (PDHBs).
(a) Describe key features of the principal types of PDHBs.
(b) Contrast variations between types of PDHBs with respect to:
i. extent to which consumers perceive money spent as their own when
making healthcare cost and value judgments,
ii. consumer flexibility in directing the use of employer-provided and
personal healthcare funds,
iii. extent of employer involvement in plan design and administration.
(c) Identify possible changes in the U.S. tax rules that could encourage the use of
PDHBs.
COURSE 8: Fall 2004 - 2 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study
3. (8 points) You are the pric ing actuary for Wonderful Life and have been asked by the
underwriter assigned to Group 6 to help her prepare for a meeting with the group’s CFO.
In addition to Tables MM-2b and MM-3b, you have been given the following
information:
Prior Rating Period Data: Experience period July 1, 2001 through June 30, 2002
Group 6 Composite Age/Sex Factor
Option 1 1.03
Option 2 0.85
(a) Describe macro-economic variables that may affect health care trend rates.
(b) Describe other trend components that may cause trends to vary.
(c) Discuss the relationship of historical trends and rating trend assumptions.
(d) Calculate the total percentage increase in Group 6’s claims cost per employee and
calculate components of their claims trend for which sufficient data are available.
COURSE 8: Fall 2004 - 3 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study
4. (6 points) You are an underwriter for Wonderful Life preparing a proposal for Bailey
Industries to replace their current dental plan with a managed dental care plan.
Bailey Industries goals are as follows:
%26#8226;%26#61472;%26#61472;limit complexity
%26#8226;%26#61472;%26#61472;avoid adverse selection
%26#8226;%26#61472;%26#61472;avoid employee dissatisfaction due to provider disruption
%26#8226;%26#61472;%26#61472;maintain current employer contributions and plan design
(a) Describe the features for each of the general types of dental benefit delivery
systems.
(b) Develop a chart ranking the plan types along the following parameters: premium,
patient access, benefit richness, cost management, utilization, quality assurance,
and fraud potential.
(c) Evaluate the possible delivery systems based on Bailey Industries goals and make
a recommendation as to a delivery system. Justify your response.
COURSE 8: Fall 2004 - 4 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study
5. (9 points) You are an underwriter with Wonderful Life preparing the renewal for
Group 4.
Assume that the retrospective formula balance in Table MM-3a is as of the end of the
experience period and that pricing factors as shown in Table MM-2a and MM-2b have
not changed.
(a) Calculate Group 4’s projected retrospective formula balance as of December 31,
2003 using the same assumptions as would be used for rating. Show your work.
(b) Calculate the EE only and EE and Dependents monthly renewal premiums for
2004. Show your work.
(c) Discuss the pros and cons of various funding arrangements, both from an
employer’s point of view and specifically for Group 4,
i. prospective experience rating,
ii. retrospective experience rating,
iii. self- insurance, and
iv. minimum premium plans.
6. (5 points) You are evaluating Wonderful Life’s reserves using Non-Hospital claims paid
in Tables MM-4c and MM-4d. Assume that the July 2002 completion pattern is
representative of all months.
(a) Calculate the incurred claims for incurred months July 2003 through December
2003 using age-ultimate development factors. Show your work.
(b) Calculate the IBNR as of December 31, 2003 for incurred months July 2003
through December 2003. Show your work.
(c) Recommend adjustments to this approach which might produce reasonable IBNR
results.
COURSE 8: Fall 2004 - 5 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
7. (7 points) You are the health actuary reviewing the pricing assumptions and the first
three years of experience for a given product. The following information is given:
Classical Pricing Assumptions
Product Duration: 5 Years
interest rates: 0.0%
annual lapse rate: 20.0%
target loss ratio: 60.0%
tabular claims cost
Duration Tabular Claims Cost Selection Adjustment
0 10.0 .05
1 11.0 1.1
2 12.0 1.1
3 13.0 1.1
4 14.0 1.1
Experience Data
Duration Mbrs Actual Claims
0 1,000 6,000
1 770 10,000
2 650 11,000
3 500 -
4 350 -
Cumulative Antiselection Theory Assumptions
K1 = -
K2 = 4
u 0.10
(a) (1 point) Describe how CAST differs from classical (select and ultimate) theory.
(b) (2 points) Calculate the gross premium using the classical pricing assumptions.
Show your work
(c) (4 points) Calculate the gross premium using CAST assumptions. Show your
work.
COURSE 8: Fall 2004 - 6 - GO TO NEXT PAGE
Health, Group Life %26amp; Managed Care
Morning Session
8. (5 points) LMN Company employees currently utilize two different networks. Both
networks use the same pharmacy benefits manager, and detailed pharmacy claims data
are available. Network A has additional detailed health claims information. The per
capita claims cost for Network A is twice as high as in Network B. You have been asked
to determine if the higher costs are caused by differences in the enrollee health status.
(a) Describe criteria used for health risk classification.
(b) Describe risk assessment models currently available.
(c) Recommend a risk assessment method for LMN Company.
9. (7 points) You are an actuary who recently accepted a non-traditional role as claims
manager for a health carrier. You are concerned about the new inventory standards, as
measured by turn-around time (TAT) and their impact on quality. Additionally, you are
concerned about common claims problems and the lack of documented procedures and
guideline for working with other departments.
(a) Regarding TAT:
i. Define TAT.
ii. Describe considerations used when establishing TAT goals.
iii. Describe the tools used for tracking and monitoring TATs.
(b) Regarding quality:
i. Define the measures of claim quality.
ii. List the steps of claim quality review process.
iii. Describe the major issues to consider when performing a quality audit.
(c) Describe common claims and benefit administration problems.
(d) List the items requiring procedures and guidelines for coordination of the claim
department with the following departments:
i. Enrollment and billing
ii. Provider relations
iii. Utilization management
iv. Member services
v. Finance
COURSE 8: Fall 2004 - 7 - STOP
Health, Group Life %26amp; Managed Care
Morning Session
10. (4 points) As a result of the new Medicare Prescription Drug Improvement and
Modernization Act of 2003 it may be necessary for a plan sponsor to perform an actuarial
valuation to determine actuarial equivalence between the sponsor’s plan with the basic
Medicare benefit.
Assume that costs over age 65 for the sponsor’s plan are $1,500 per year and plan costs,
on the average, increase by 3% per year above 65. Assume that the demographics are as
follows:
Demographics
Age Group Number
65 to 69 200
70 to 74 400
75 to 79 300
80 to 84 100
Total 1,000
(a) Outline the assumptions needed to perform an actuarial valuation of the sponsor’s
plans.
(b) Develop the sponsor’s plan costs by age group.
(c) Describe the financial impact to the plan sponsor of the three possible outcomes
when determining actuarial equivalence.
**END OF EXAMINATION**
MORNING SESSION
COURSE 8: Fall 2004 - 8 - GO TO NEXT PAGE
Managed Care Segment
Afternoon Session
**BEGINNING OF EXAMINATION**
MANAGED CARE SEGMENT
AFTERNOON SESSION
Beginning With Question 11
11. (4 points)
(a) Describe the types of claim liabilities and reserves. For each, provide an example
of an event which would require such a liability or reserves to be established.
(b) Describe common methods used to estimate claim reserves.
12. (6 points) Company XYZ management has decided it is time to invest resources into
developing better reporting and analytical systems.
(a) (2 points) Describe ways data compiled in the claim adjudication process can be
used for reporting and analysis.
(b) (3 points) Compare and contrast types of data structures and physical media used
to store data in computer systems.
(c) (1 point) Describe considerat[1] [2] 下一页 |
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