以下为高顿网校小编给全国考生准备的考前大纲——2011北美考区精算师NovemberCourse8I（*9堂课）。
　　Health and Managed Care
　　Morning Session
　　November 2001- Course 8M
　　Society of Actuaries
　　**BEGINNING OF EXAMINATION**
　　MORNING SESSION
　　Questions 1 – 6 pertain to the Case Study
 
　　1. (6 points) You have been provided the claims department statistics for Wonderful Life as
　　shown in Tables MM – 5a and MM – 5b.
　　(a) Explain why keeping claims inventory records is important for Wonderful Life.
　　(b) Assess the strengths and weaknesses of Wonderful Life’s claim status reports.
　　(c) Describe potential e-commerce functions and technologies that Wonderful Life
　　might implement to increase claims processing efficiency.
　　(d) Describe critical factors for the successful implementation of an e-commerce
　　strategy.
　　COURSE 8: November 2001 -2- STOP
　　Health and Managed Care
　　Morning Session
　　Questions 1 – 6 pertain to the Case Study
 
　　2. (8 points) You were recently hired as the financial actuary for Wonderful Life. Your first
　　project with the company involves a 3-year financial forecast.
　　In addition to information in the case study, you are given the following:
　　Annual Claims Trend = 15.4%
　　Monthly Claims Trend = 1.2%
　　July Seasonal Factor = .90
　　Seasonal Normalization Factor = 1.000
　　Projected Premium for January 2001 = $165,000,000
　　Projected Members for January 2001 = 980,000
　　Assumed Loss Ratio = .78
　　(a) Discuss phases of a sound financial management process.
　　(b) Describe methods commonly used to project claims costs and the conditions
　　under which each method may be appropriate.
　　(c) Calculate the Per Member Per Month (PMPM) claims cost for January 2001
　　under each of the four commonly used methods.
　　(d) Recommend one of the four methods for Wonderful Life to develop their
　　financial forecasts. Justify your recommendation.
　　COURSE 8: November 2001 -3- STOP
　　Health and Managed Care
　　Morning Session
　　Questions 1 – 6 pertain to the Case Study
 
　　3. (13 points) You are a group underwriter for Wonderful Life in the Major Medical
　　Division. You have obtained the following data for Groups 2 and 3 in addition to the
　　information already included in Table MM – 2 and MM – 3:
　　Additional Data for Experience Period July 1, 1999 through June 30, 2000
　　Annual Exposure
　　Total EEs
　　Total Claims
　　Group 2 120 $216,000
　　Group 3 225 $518,000
　　Total claims have not been reduced for large claims greater than $50,000.
　　(a) Describe various methods of pooling claims experience data that could be used in
　　developing experience rates.
　　(b) Discuss considerations involved in determining the credibility of a group’s
　　experience in the rate setting process.
　　(c) Calculate the composite renewal premium rate per employee for each of Group 2
　　and Group 3 using only the data in the case study. Show your work.
　　(d) Recalculate the composite renewal premium rate for each of Group 2 and Group 3
　　using a multi-year approach. Use the additional claims data provided above and
　　assume an equal weighting for each year of data. Show your work.
　　(e) Describe other considerations applicable when underwriting a particular employer
　　group that could affect the accuracy of your rate calculations.
　　COURSE 8: November 2001 -4- STOP
　　Health and Managed Care
　　Morning Session
　　Questions 1 – 6 pertain to the Case Study
 
　　4. (7 points) You are the Valuation Actuary for the Major Medical Division of Wonderful
　　Life.
　　(a) Describe common methods you might apply to estimate medical claim reserves.
　　(b) Calculate the outstanding liability as of December 31, 2000, for hospital claims
　　incurred from October 2000 through December 2000. Assume the claims
　　payment pattern for hospital claims incurred in January 1998 is representative of
　　future payment patterns. Show your work.
　　(c) Calculate the portion of the above outstanding liability expected to be paid by
　　March 31, 2001. Use the same assumptions as in (b) above. Show your work.
 
　　5. (6 points) For the past few years, Wonderful Life has seen its claim expenses grow at a
　　faster rate than its premium revenue, leading to a decreasing operating margin. In this
　　competitive environment, measuring claim cost trends and forecasting future trends in the
　　health insurance industry is crucial to accurate pricing.
　　You have been asked by the President of Wonderful Life to provide additional
　　information on medical expense trend to help him understand the situation.
　　(a) Define trend, its use, and its components.
　　(b) Discuss various techniques which can be used to analyze trend and common
　　problems encountered in trend analysis.
　　(c) Calculate the component of total trend attributable to deductible leveraging given
　　that total projected 2001 medical trend is 12%. Assume that the mix of business
　　by plan in Table MM – 3 and base manual claim rate in Table MM – 2a are
　　representative of all of Wonderful Life’s major medical business and are not
　　expected to change. Show your work.
　　COURSE 8: November 2001 -5- STOP
　　Health and Managed Care
　　Morning Session
　　Questions 1 – 6 pertain to the Case Study
 
　　6. (5 points) The Chief Operations Officer at Wonderful Life has returned from a seminar
　　where she attended a session on C-2, Insurance Risk. She is concerned about the impact
　　risk-based capital can have on growth. As the Chief Actuary at Wonderful Life you have
　　been asked to discuss these issues with the COO.
　　(a) Discuss characteristics used to determine the level of required surplus for
　　insurance risk
　　(i) for insurance companies in general, and
　　(ii) specifically for the four primary business divisions of Wonderful Life
　　(b) Discuss the relationships among growth, profit, and required surplus for C-2
　　Insurance Risk.
　　COURSE 8: November 2001 -6- STOP
　　Health and Managed Care
　　Morning Session
　　当你将信心放在自己身上时，你将永远充满力量。——高顿网校经典总结

 

 
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