今天（8月18日下午）高顿网校小编汇总了2003年11月北美精算师经典真题大纲Course8M（最后一块内容），供大家备战11月份月份北美精算师考试用的。
　　18. (6 points) You are the pricing actuary for the Bedford Group and have been asked by the
　　Marketing Director to develop new pharmacy premiums. She is interested in having a
　　more competitively priced product. Yo ur CFO has indicated that your profit goal is 2.5%
　　of premium.
　　Assume the HMO and POS plans have identical plan formularies with the following
　　copays:
　　?  Generic $10
　　?  Formulary Brand $20
　　?  Non-Formulary $40
　　Using 2003 budgeted experience from Table MC-4, information provided on Table MC-7,
　　and assuming AWP = $80, then:
　　(a) Calculate the premium if Bedford:
　　(i) retains all rebates.
　　(ii) uses all rebates to reduce premiums.
　　(b) Describe the purposes of rebates, issues surrounding rebates, and actions which
　　can be taken to increase rebates.
　　COURSE 8: Fall 2003 - 15 - GO TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
 
　　19. (5 points) You are a consulting actuary for an HMO that wishes to control utilization, yet
　　maintain high quality of care.
　　(a) Describe traditional approaches to quality assessment.
　　(b) Review regulatory issues relating to quality assurance and their impact on HMOs.
　　(c) Describe managed care methods used to control medical utilization and the types
　　of services impacted by each method.
　　(d) Review state regulations that may limit an HMOs ability to manage utilization
　　and costs.
 
　　20. (4 points) You serve on a professional task force advising a State Senator on health
　　insurance reform issues. New health reform legislation is being proposed which is
　　intended to meet the following objectives:
　　?  Promote a reduction in the working uninsured population
　　?  Promote job mobility
　　?  Facilitate the ability of individuals and small employers to compare insurance
　　policies offered by different health carriers
　　?  Reduce variation in, and volatility of premium rates charged to different groups
　　(a) Describe key recommendations regarding the above objectives to be included in
　　reform legislation.
　　(b) The legislature is also reviewing risk adjustment mechanisms for Medicaid HMO
　　plans. Compare and contrast methods of risk adjustment and recommend a
　　method to be included in the legislation. Justify your recommendation.
　　COURSE 8: Fall 2003 - 16 - STOP
　　Managed Care Segment
　　Afternoon Session
 
　　21. (5 points) You are a consulting actuary retained by Capitalized Health Plan, a licensed
　　HMO in a state that has passed the NAIC Risk-Based Capital For Health Organizations
　　Model Act (RBC Model). The CFO is unfamiliar with risk-based capital and has asked
　　you to make a presentation to educate him and his staff. In your research, you have
　　extracted the following information from Capitalized HP’s 2002 Statutory Annual
　　Statement:
　　Assets (Non-Affiliated)
　　-  U.S. Government Bonds $ 4.6 million
　　-  Class 1 Bonds $ 9.8 million
　　-  Class 1 Preferred Stock $ 2.2 million
　　-  Common Stock $ 2.0 million
　　Underwriting Revenue/Earned Premium
　　-  Comprehensive Medical & Hospital $45.0 million
　　-  Dental $16.3 million
　　-  ASO Fees $ 5.0 million
　　Claim Payments under:
　　-  capitation (paid directly to providers) $11.0 million
　　-  professional fee schedule $22.7 million
　　-  hospital case rates $10.2 million
　　-  discounted charges $ 8.2 million
　　Underwritten business administrative expenses
　　(excludes premium taxes & commissions)
　　$ 2.1 million
　　(a) Describe regulatory implications of RBC outcomes.
　　(b) Describe other uses of RBC measurements.
　　(c) Review the variables and formula for health RBC after covariance as used in the
　　RBC Model.
　　(d) Recommend ways to reduce the amount of RBC that Capitalized HP must hold.
　　能把在面前行走的机会抓住的人，十有八九都会成功。——高顿网校经典总结

 

 
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