SOA北美真题精算师往年Course8G（第二块讲义），珍惜美好的学习时光，来的多不容易呀。
　　6. (9 points) You are the group pricing actuary for Wonderful Life Insurance Company.
　　You are preparing a proposal for Bailey Industries which includes an analysis of prior
　　experience. You are given the data in Table BI-1b and the following assumptions:
　　? The only items causing differences in claims costs are plan design and utilization
　　differences caused by plan design.
　　? The average members per contract for both the PPO and HMO plans is 2.2.
　　? Member Cost as a percentage of claims is as follows:
　　Utilization
　　Adjustment Range
　　Member Cost
　　Sharing Range
　　Service Type % of Cost Low High Low High
　　Facility 50.0% 0.0% 5.0% 0.0% 25.0%
　　Professional 30.0% -5.0% 20.0% 0.0% 40.0%
　　Pharmacy 20.0% 0.0% 20.0% 0.0% 25.0%
　　Total 100.0%
　　Average Member Cost Sharing
　　Service Type PPO HMO
　　Facility 17.5% 0.0%
　　Professional 25.0% 5.0%
　　Pharmacy 18.0% 18.0%
　　(a) (3 points) Describe the criteria that Wonderful Life would use to underwrite
　　Bailey Industries.
　　(b) (2 points) Describe the models you might use to predict selection in a multioption
　　environment.
　　(c) (4 points) Calculate the expected change in utilization for the HMO plan using
　　the member utilization cost model. Show your work.
　　COURSE 8: Fall 2005 -7- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Questions 4-7 pertain to the Case Study
　　7. (7 points) You are an actuary at Wonderful Life and have been asked to discuss sources
　　of profit using Group 1 data as an example.
　　In addition to the data in Tables MM-1, MM-2a, MM-2b, and MM-3a, assume:
　　? Single/Family manual rates for 2005 are the result of trending historical manual rates.
　　? Expenses, taxes, and investment income are expressed as the percentages from Table
　　MM-1 for 2004.
　　(a) Discuss major factors affecting financial results for the group line of business.
　　(b) Outline the various sources of profit for group insurance.
　　(c) Calculate profits by source for Group 1 for the experience period. Show your
　　work.
　　COURSE 8: Fall 2005 -8- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　8. (7 points) You are the consulting actuary for ACME, Inc. They are interested in offering
　　a Patient Directed Healthcare Benefit (PDHB) plan with the following structure:
　　Option 1
　　? Multi-plan option plus Flexible Spending Account (FSA),
　　? Employer provides core contribution, offers multiple health plan choices,
　　and sets menu.
　　Option 2
　　? High Deductible Plan plus FSA plus Personal Health Account (PHA),
　　? Employer provides core contribution, access to multiple high deductible
　　plans, and segregated PHA’s.
　　(a) Describe factors that are making consumerism a significant trend.
　　(b) Compare and contrast the key dimensions of PDHB’s as they relate to the two
　　options ACME is considering.
　　(c) Describe the healthcare challenges that can be addressed by PDHB’s with respect
　　to:
　　i. Employees
　　ii. Employers
　　COURSE 8: Fall 2005 -9- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　9. (5 points) You are the pricing actuary for Enamel Insurance Company (EIC). EIC is
　　interested in adding a dental product to its portfolio and has asked you to prepare a report
　　to senior management.
　　(a) Describe ways to control dental claims costs.
　　(b) Describe the underwriting and rating parameters used for dental insurance.
　　COURSE 8: Fall 2005 - 10 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　10. (3 points) You are the Valuation Actuary for Belt and Suspenders Health Insurance
　　Company. Your company offers a variety of health products that may require a variety of
　　methods for determining claim liabilities.
　　(a) Describe considerations which might influence the level of conservatism targeted
　　for a given block of business.
　　(b) Describe approaches to introducing conservatism into each of the common
　　methods used to compute claim liabilities.
　　COURSE 8: Fall 2005 - 11 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　**BEGINNING OF EXAMINATION**
　　HEALTH AND GROUP LIFE SEGMENT
　　Beginning with Question 11
　　11. (4 points) Regarding claims practices for short term disability (STD) coverages:
　　(a) Describe the tools available to challenge questionable STD claims.
　　(b) Discuss methods, including the pros and cons for measuring overall STD claims
　　levels.
　　(c) Describe the sources of information available to a claims examiner regarding STD
　　claims.
　　COURSE 8: Fall 2005 - 12 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　高顿网校之名人哲理：所谓天才，只不过是把别人喝咖啡的功夫都用在工作上了。