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　　COURSE8:Fall2004-1-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
　　**BEGINNINGOFEXAMINATION**
　　HEALTH,GROUPLIFE&MANAGEDCARE
　　MORNINGSESSION
　　1.(4points)Youareanactuaryforareinsurancecompany.Abusinessschoolprofessorat
　　alocaluniversityhasinvitedyoutobeaguestlectureronthetopic,“Reinsurance
　　ProgramManagement.”
　　Outlineanddescribethecontentsofyourpresentation,withrespectto:
　　i.informationareinsurancecompanyshouldseekinordertodecidewhetherto
　　offerreinsurancetoacustomer
　　ii.practicesareinsurershouldfollowtomaintainaprofitablereinsuranceportfolio.
　　2.(5points)YouhavebeenaskedbyyourlocalChamberofCommercetospeakonthe
　　topicofpatient-directedhealthcarebenefitprograms(PDHBs).
　　(a)DescribekeyfeaturesoftheprincipaltypesofPDHBs.
　　(b)ContrastvariationsbetweentypesofPDHBswithrespectto:
　　i.extenttowhichconsumersperceivemoneyspentastheirownwhen
　　makinghealthcarecostandvaluejudgments,
　　ii.consumerflexibilityindirectingtheuseofemployer-providedand
　　personalhealthcarefunds,
　　iii.extentofemployerinvolvementinplandesignandadministration.
　　(c)IdentifypossiblechangesintheU.S.taxrulesthatcouldencouragetheuseof
　　PDHBs.
 
　　COURSE8:Fall2004-2-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
　　Questions3–6pertaintotheCaseStudy
　　3.(8points)YouarethepricingactuaryforWonderfulLifeandhavebeenaskedbythe
　　underwriterassignedtoGroup6tohelpherprepareforameetingwiththegroup’sCFO.
　　InadditiontoTablesMM-2bandMM-3b,youhavebeengiventhefollowing
　　information:
　　PriorRatingPeriodData:ExperienceperiodJuly1,2001throughJune30,2002
　　Group6CompositeAge/SexFactor
　　Option11.03
　　Option20.85
　　(a)Describemacro-economicvariablesthatmayaffecthealthcaretrendrates.
　　(b)Describeothertrendcomponentsthatmaycausetrendstovary.
　　(c)Discusstherelationshipofhistoricaltrendsandratingtrendassumptions.
　　(d)CalculatethetotalpercentageincreaseinGroup6’sclaimscostperemployeeand
　　calculatecomponentsoftheirclaimstrendforwhichsufficientdataareavailable.
 
　　COURSE8:Fall2004-3-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
　　Questions3–6pertaintotheCaseStudy
　　4.(6points)YouareanunderwriterforWonderfulLifepreparingaproposalforBailey
　　Industriestoreplacetheircurrentdentalplanwithamanageddentalcareplan.
　　BaileyIndustriesgoalsareasfollows:
　　?  limitcomplexity
　　?  avoidadverseselection
　　?  avoidemployeedissatisfactionduetoproviderdisruption
　　?  maintaincurrentemployercontributionsandplandesign
　　(a)Describethefeaturesforeachofthegeneraltypesofdentalbenefitdelivery
　　systems.
　　(b)Developachartrankingtheplantypesalongthefollowingparameters:premium,
　　patientaccess,benefitrichness,costmanagement,utilization,qualityassurance,
　　andfraudpotential.
　　(c)EvaluatethepossibledeliverysystemsbasedonBaileyIndustriesgoalsandmake
　　arecommendationastoadeliverysystem.Justifyyourresponse.
 
　　COURSE8:Fall2004-4-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
　　Questions3–6pertaintotheCaseStudy
　　5.(9points)YouareanunderwriterwithWonderfulLifepreparingtherenewalfor
　　Group4.
　　AssumethattheretrospectiveformulabalanceinTableMM-3aisasoftheendofthe
　　experienceperiodandthatpricingfactorsasshowninTableMM-2aandMM-2bhave
　　notchanged.
　　(a)CalculateGroup4’sprojectedretrospectiveformulabalanceasofDecember31,
　　2003usingthesameassumptionsaswouldbeusedforrating.Showyourwork.
　　(b)CalculatetheEEonlyandEEandDependentsmonthlyrenewalpremiumsfor
　　2004.Showyourwork.
　　(c)Discusstheprosandconsofvariousfundingarrangements,bothfroman
　　employer’spointofviewandspecificallyforGroup4,
　　i.prospectiveexperiencerating,
　　ii.retrospectiveexperiencerating,
　　iii.self-insurance,and
　　iv.minimumpremiumplans.
　　6.(5points)Youare*uatingWonderfulLife’sreservesusingNon-Hospitalclaimspaid
　　inTablesMM-4candMM-4d.AssumethattheJuly2002completionpatternis
　　representativeofallmonths.
　　(a)CalculatetheincurredclaimsforincurredmonthsJuly2003throughDecember
　　2003usingage-ultimatedevelopmentfactors.Showyourwork.
　　(b)CalculatetheIBNRasofDecember31,2003forincurredmonthsJuly2003
　　throughDecember2003.Showyourwork.
　　(c)RecommendadjustmentstothisapproachwhichmightproducereasonableIBNR
　　results.
 
　　COURSE8:Fall2004-5-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
　　7.(7points)Youarethehealthactuaryreviewingthepricingassumptionsandthefirst
　　threeyearsofexperienceforagivenproduct.Thefollowinginformationisgiven:
　　ClassicalPricingAssumptions
　　ProductDuration:5Years
　　interestrates:0.0%
　　annuallapserate:20.0%
　　targetlossratio:60.0%
　　tabularclaimscost
　　DurationTabularClaimsCostSelectionAdjustment
　　010.0.05
　　111.01.1
　　212.01.1
　　313.01.1
　　414.01.1
　　ExperienceData
　　DurationMbrsActualClaims
　　01,0006,000
　　177010,000
　　265011,000
　　3500-
　　4350-
　　CumulativeAntiselectionTheoryAssumptions
　　K1=-
　　K2=4
　　u0.10
　　(a)(1point)DescribehowCASTdiffersfromclassical(selectandultimate)theory.
　　(b)(2points)Calculatethegrosspremiumusingtheclassicalpricingassumptions.
　　Showyourwork
　　(c)(4points)CalculatethegrosspremiumusingCASTassumptions.Showyour
　　work.
 
　　COURSE8:Fall2004-6-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　MorningSession
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