这就是北美精算师SOA往年真题集中：November2002Course8G（一），大家用心记在脑子里呀，内容很多，可分批去消化。
　　Health, Group Life & Managed Care
　　Morning Session
　　Fall 2002
　　Society of Actuaries
　　**BEGINNING OF EXAMINATION 8**
　　HEALTH, GROUP LIFE & MANAGED CARE
　　MORNING SESSION
 
　　1. (5 points) You are the COO of ABC Insurance Company. You are considering
　　outsourcing the claim and benefit administration function.
　　(a) Describe common claims and benefit administration problems and their effects.
　　(b) Describe measures of claim quality and methods to increase quality.
　　(c) Describe methods commonly used to control claims costs and claims
　　administrative expense.
　　(d) Review circumstances under which you might outsource claims administration.
　　Course 8G
　　COURSE 8: Fall 2002 -2- GO ON TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
 
　　2. (5 points) A company has successfully implemented a flexible benefits program for its
　　salaried employees with the following benefits:
　　Basic Coverage
　　Non-hospital and drug: $300 deductible, 75% coinsurance
　　Hospital: Semi-private room, $150 maximum per day
　　Out-of-country: $50,000 maximum per year
　　$500,000 lifetime maximum
　　Vision: No coverage
　　Enhanced Coverage
　　Non-hospital and drug: $100 deductible, 90% coinsurance
　　Hospital: Semi-private room, $250 maximum per day
　　Out-of-country: $80,000 maximum per year
　　$1,000,000 lifetime maximum
　　Vision: $200 maximum per year
　　Employee Palpatine incurred the following medical expenses over a one-year period:
　　Apr. 5 formulary drug prescription of $125
　　Jun. 10 formulary drug prescription of $180
　　Jul. 18 hospital stay, semi-private room at $180
　　Jul. 19 hospital stay, semi-private room at $180
　　Jul. 20 hospital stay, semi-private room at $180
　　Sept. 22 formulary drug prescription of $60
　　Dec. 5 new glasses at $280
　　(a) Identify and address the concerns the union might have with the company’s
　　proposal to offer this program to union members. Include design alternatives that
　　could be substituted.
　　(b) Explain the general principles regarding selection that should be considered when
　　implementing a flexible benefits program.
　　(c) Calculate the out-of-pocket expenses Palpatine would have paid under the Basic
　　and the Enhanced options.
　　COURSE 8: Fall 2002 -3- GO ON TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　Questions 3 – 8 pertain to the Case Study
 
　　3. (5 points) Wonderful Life‘s small group block of business is experiencing deteriorating
　　profits. The Chief Actuary believes part of this deterioration is due to the wearing off of
　　underwriting. You have been asked to design a durational study for Wonderful Life’s
　　closed block of small group business using the data found in Table MM-7.
　　(a) (1 point) Describe the information that would be required to compile this study.
　　(b) (1 point) Describe the potential limitations of the data used in a durational study
　　and the factors you should consider in adjusting the data.
　　(c) (3 points) Calculate the annual durational factors for Wonderful Life’s closed
　　block of small group experience using the data in table MM-7 and other relevant
　　information on the small group block discussed in the case study. Show your
　　work.
　　COURSE 8: Fall 2002 -4- GO ON TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　Questions 3 – 8 pertain to the Case Study
 
　　4. (10 points) Wonderful Life is considering the purchase of medical reinsurance that is a
　　combination of quota share and specific excess. The quote they have received is as
　　follows:
　　Specific excess
　　?  100% of claims in excess of $50,000
　　?  Covers claims incurred from July 1, 2000 through June 30, 2001
　　?  Reinsurance premium = $20.00 Per Employee Per Month
　　Quota share reinsurance
　　?  30% of claims incurred up to $50,000
　　?  Ceding allowance: 20% of ceded premium
　　?  Covers premium earned and claims incurred from July 1, 2000 through June
　　30, 2001
　　Wonderful Life’s management has set a pre-tax ROE target of 25% while holding riskbased
　　capital at 30% of premium. Current operating expenses are 15.1% of premium and
　　pre-tax investment income is 3.0% of premium.
　　(a) (4 points) Calculate Wonderful Life’s total pre-tax operating gain using the data
　　in table MM-3 assuming Wonderful Life purchases this reinsurance coverage.
　　Show your work.
　　(b) (4 points) Determine if Wonderful Life would have met its pre-tax ROE
　　objectives:
　　(i) Without the reinsurance coverage.
　　(ii) With the reinsurance coverage.
　　(c) (2 points) Describe the other profit measures you could use in analyzing this
　　business.
　　COURSE 8: Fall 2002 -5- GO ON TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　Questions 3 – 8 pertain to the Case Study
　　知识不是某种完备无缺、纯净无瑕、僵化不变的东西。它永远在创新，永远在前进。——高顿网校金玉良言

 

 
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