2004年度11月份SOA北美精算师历届真题Course8M（第3节），北美精算师考试并不是想象中的那么攻不可破哦，那为什么也有很多前辈考出来了？
　　13. (5 points) You are the CFO of a start-up insurance company. You are in the process of
　　determining your minimum required surplus and designing a system for measuring
　　capital, profit, and growth.
　　(a) Describe the insurance risks that should be considered when setting minimum
　　surplus requirements.
　　(b) Discuss the necessary considerations when designing a system for measuring
　　capital, profit, and growth.
　　(c) Discuss and illustrate with formulas how capital, profit, and growth inter-relate.
　　COURSE 8: Fall 2004 - 10 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　14. (5 points) Paul and Leslie, who are both in their 30’s, were recently married and are
　　meeting with an agent to discuss their financial plans.
　　Paul works on contract as a motivational speaker and has no employee benefits. He earns
　　$50,000 a year. Leslie works for a financial institution which has a flexible benefits plan
　　including STD and LTD. Leslie earns a base salary of $50,000 per year and earned a
　　bonus of $5,000 last year.
　　Paul is considering the following disability plan:
　　Type: Individual Disability Income
　　Waiting Period: 30 days
　　Definition of Disability: Own occupation to 65
　　Benefit Amount: $2500 per month
　　Benefit Term: 5 years
　　Leslie is currently enrolled in the following option in the flex plan:
　　Type: LTD STD
　　Elimination Period: 4 months
　　Definition of Disability: 2 Year Own Occupation,
　　then Any Occupation to 65
　　Benefit Amount: 60% of salary 100% of salary for 2
　　months, 75% of salary
　　thereafter
　　Funded: 100% Employee paid
　　Indexing: 3% per annum on disability
　　anniversary
　　(a) Compare and contrast the underwriting criteria used for individual and group
　　disability policies.
　　(b) Describe how these criteria would apply specifically to Paul and Leslie.
　　(c) Describe how benefits would be determined and calculate Paul and Leslie’s
　　cashflow if they were both injured in a car accident and were unable to work for 5
　　years. Show your work.
　　COURSE 8: Fall 2004 - 11 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　15. (6 points) You are a consulting actuary for the Health Insurance Company of
　　Unaffiliated Providers (HICUP). The Chief Actuary of HICUP is considering entry into
　　the Medicare Plus Choice (M+C) market in their area and approached you for advice.
　　They want to offer M+C coverage in Golden Years County where over 70% of residents
　　are of retirement age. There are already two other companies offering M+C policies in
　　this area. Since HICUP does not have experience in the M+C market, you have been
　　asked to prepare a report to discuss requirements of entry into this market. You have
　　explained that Medicare Plus Choice is now known as Medicare Advantage and HCFA is
　　now known as CMS. Although there will be further changes in the program, you have
　　based your initial report on the 2004 rules.
　　(a) Outline and provide details of specific rules required by legislation to enter into a
　　M+C contract and decisions HICUP will need to make at entry.
　　(b) Contrast other product options available to HICUP for the senior population and
　　their advantages and disadvantages.
　　(c) Outline the CMS M+C filing process and payment mechanism with sufficient
　　details for the Chief Actuary to make a presentation to HICUP’s Board.
　　16. (5 points) You are a consulting actuary to ABC HMO. The CEO has asked you to
　　provide a report on changes in approaches to addressing behavioral health benefits
　　provided by managed care plans.
　　(a) Discuss emerging strategic approaches to managing behavioral health benefits.
　　(b) Outline strategies MCOs are using to improve clinical outcomes.
　　(c) Describe utilization review and case management techniques consistent with these
　　strategies.
　　(d) Discuss considerations you would make to determine whether a capitated
　　arrangement to a behavioral health specialty group is appropriate for their
　　business.
　　COURSE 8: Fall 2004 - 12 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 17 – 19 pertain to the Case Study
　　17. (5 points) The PCPs of IPA 3 are considering joining IPA 1.
　　(a) Discuss reimbursement structures for PCPs and advantages and disadvantages of
　　each from the PCP’s perspective.
　　(b) Discuss advantages and disadvantages for IPA 3 PCPs in joining IPA 1 and
　　recommend actions IPA3 PCPs could take to address the disadvantages.
　　(c) Discuss advantages and disadvantages from the Bedford Group’s perspective of
　　the potential shift of IPA 3 PCPs to IPA 1.
　　COURSE 8: Fall 2004 - 13 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 17 – 19 pertain to the Case Study
　　在你不害怕的时间去斗牛，这不算什么；在你害怕时不去斗牛，也没有什么了不起；只有在你害怕时还去斗牛才是真正了不起。——高顿网校考试箴言