*7最权威的北美精算师考试辅导题干和大纲，统统在高顿网校！就如2005年份那一年SOA往年真题荟萃Course8M（一）。
　　Health, Group Life & Managed Care
　　**BEGINNING OF EXAMINATION**
　　HEALTH, GROUP LIFE & MANAGED CARE
　　MORNING SESSION
　　1. (3 points)
　　(a) Explain non-financial uses of reinsurance.
　　(b) Describe limitations of reinsurance.
　　COURSE 8: Fall 2005 -2- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　2. (3 points) You are the actuary for a US health insurance company. You have been asked
　　to make a presentation to your Board of Directors regarding the regulatory environment
　　for your company.
　　(a) Describe goals and objectives of insurance regulation.
　　(b) Describe the legal framework for insurance regulation and means of enforcement.
　　COURSE 8: Fall 2005 -3- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　3. (7 points) You are a consulting actuary retained by an employer group. Following the
　　presentation of renewal rates to the group, you have been asked to attend a meeting to
　　review trend calculations.
　　You are given the following information:
　　? Allowed trend: 15%
　　? Incurred claims: $5,250,000
　　? Average monthly membership of the group: 2,000 members
　　? The current plan is Plan A, but the group is considering Plan B:
　　Plan A Plan B
　　Deductible $250 $1,500
　　Coinsurance 20% 30%
　　Value of the member cost sharing (PMPM) $50 $100
　　? Assume the value of the deductible does not vary from year to year.
　　(a) Describe in detail external sources of trend that you think might be helpful in your
　　trend discussion.
　　(b) Describe common problems in computing trends that you might need to
　　investigate.
　　(c) Calculate the net trend for the two plans and explain why there might be a
　　difference. Show your work.
　　(d) Describe major issues which might need to be addressed if Plans A and B were to
　　both be offered as a dual option.
　　COURSE 8: Fall 2005 -4- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Questions 4-7 pertain to the Case Study
　　4. (7 points) You are the actuary at Wonderful Life and have received a request for
　　proposal from JLB Company (JLB) for a multi-option health quote effective January 1,
　　2005. JLB currently offers only a $100 deductible indemnity plan.
　　Using data found in Tables MM-2a and MM-2b and the following additional information:
　　?? Total claims incurred for July 1, 2003 to June 30, 2004 were $4,063,000.
　　?? Claim amounts in excess of $50,000 were $278,000.
　　?? Average employee enrollment during this period was 500 single and 750 family
　　contracts.
　　?? Wonderful Life’s PPO network discount is 30%.
　　?? In-network utilization is 85%.
　　?? Use of the network reduces utilization by 5% as compared to indemnity.
　　(a) Discuss pricing considerations in a multi-option environment.
　　(b) Calculate 2-tier gross premium rates for a $100 deductible indemnity option, and
　　a $500 deductible PPO option, assuming no selection impact. Show your work.
　　(c) Outline considerations if JLB’s current plan was a managed care plan instead of
　　an indemnity plan.
　　COURSE 8: Fall 2005 -5- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Questions 4-7 pertain to the Case Study
　　5. (9 points) Wonderful Life’s management is *uating the company’s profit and surplus
　　requirements. You are given the data in Table C-1 and the assumption that Risk-Based
　　Capital (RBC) is 18% of premium.
　　(a) (1 point) Discuss methods of measuring profit.
　　(b) (2 points) Discuss distortions that may require adjustment to avoid
　　misrepresentation of profits.
　　(c) (3 points) Describe implications of the following when modeling required surplus
　　for Wonderful Life:
　　i. Reinsurance strategy
　　ii. Dividend philosophy
　　iii. Expense management controls
　　iv. Premium growth
　　(d) (3 points) Determine if Wonderful Life achieved the targeted 12.5% return on
　　equity for 2004. Show your work.
　　COURSE 8: Fall 2005 -6- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Questions 4-7 pertain to the Case Study
　　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
　　不要为已消尽之年华叹息，必须正视匆匆溜走的时光。——高顿网校名人感触