考11月北美精算师的学子们赶紧鼠标戳进来，2004年11月份的SOACourse8G真题的第二部分内容揭晓了啦。
　　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 *uating 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 & 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 & 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 & Managed Care
　　Morning Session
　　缺乏真正的朋友及是最纯粹最可怜的孤独；没有友谊则斯世不过是一片荒野。——高顿网校做人道理