以下是高顿网校小编花了45分钟为您整理的考前珍贵资料：2002年度11月份北美精算师考试真题November2002Course8M（四）。
　　13. (5 points) You are a product development actuary working for a multi- line insurance
　　company. The company is developing an individual medical insurance product.
　　(a) Outline the types of premium rate and renewal guarantees that may be used and
　　characteristics of each.
　　(b) Describe factors that influence the level of lapsation rates for these types of
　　policies.
　　(c) Explain the differences between underwriting life insurance and underwriting for
　　major medical insurance.
　　(d) Describe sources of information the underwriter might utilize.
 
　　14. (3 points) You are an actuary for JKL Life which has recently decided to enter the group
　　medical line of business. You have been asked to lead a project to design the needed
　　management information system.
　　(a) Review the challenges of producing management information reports.
　　(b) Describe information/reports that would be useful to analyze claims and expenses.
　　COURSE 8: Fall 2002 -12- GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 15 – 17 pertain to the Case Study
 
　　15. (6 points) You are an actuary for the Bedford Group. In a meeting with the VP of
　　Provider Contracts, you are told that IPA1 and IPA3 are considering consolidating
　　operations and would like to meet next week to formulate a new contract.
　　Your CEO is concerned that this consolidation would impact physician contracts. She
　　wants to hold physician costs for all IPA’s prior to any risk-share arrangements to 125%
　　of 2000 Medicare RBRVS.
　　Using Tables MC-5 and MC-7:
　　(a) Review the advantages and disadvantages of different contracting arrangements
　　between physician entities and managed care companies.
　　(b) Describe the legal structure of an IPA and explain why IPA1 and IPA3 may or
　　may not want to consolidate.
　　(c) Calculate the overall percentage of 2000 Medicare RBRVS paid in 2001.
　　Show your work.
　　(d) Calculate the percentage of 2000 Medicare RBRVS that must be negotiated with
　　the consolidated IPA in order to meet the CEO’s requirements. Show your work.
　　COURSE 8: Fall 2002 -13- GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 15 – 17 pertain to the Case Study
 
　　16. (4 points) You are an actuary for the Bedford Group. Hospital ID 1 has been
　　successful with its Maternity case rate and would like to consider moving to a
　　case rate or capitation reimbursement for its Medical and Surgical services.
　　Using Tables MC-2 and MC-7:
　　(a) Explain differences between case rate, capitation and per diem reimbursement
　　arrangements and provide reasons why Hospital ID 1 may want to consider
　　changing.
　　(b) Calculate a combined case rate for all Medical and Surgical inpatient services for
　　Hospital ID 1 using 2001 experience. Show your work.
　　(c) Describe the financial issues that Hospital ID 1 should consider prior to revising
　　its current contract.
　　COURSE 8: Fall 2002 -14- GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　Questions 15 – 17 pertain to the Case Study
 
　　17. (12 points) You are the Chief Actuary for the Bedford Group and have been approached
　　by a vendor offering demand management programs. You have determined that these
　　programs can save 5% per year on Hospital ID 1 inpatient medical and surgical claims at
　　a cost of $150,000 per year in administrative expenses.
　　In recent years Hospital ID 1 has been approaching full capacity of its inpatient
　　beds. They are considering implementing a clinical pathways program. The
　　hospital estimates that by implementing the program, it can reduce its medical and
　　surgical inpatient days by 10%. Implementation cost for the program is estimated
　　to be $250,000. Hospital ID 1 has approached you to share in half the
　　implementation cost and to increase their reimbursement by 5% to recognize the
　　improvement in care.
　　In addition to inpatient claims, the Bedford Group paid $57,960,000 in outpatient
　　claims to Hospital ID 1 in 2001. Assume no other contract provisions change and
　　membership and utilization remain at 2001 levels.
　　Using Tables MC-2, MC-3, MC-7, and MC-8:
　　(a) (2 points) Compare and contrast disease management and demand manageme nt.
　　(b) (2 points) Describe clinical pathways and their possible uses.
　　(c) (6 points) Calculate the expected impact on 2001 revenue to Hospital ID 1 from
　　the Bedford Group for the following programs:
　　(i) clinical pathways
　　(ii) demand management
　　(d) (2 points) Due to limited resources, only one of the two programs may be
　　implemented. Recommend which program you would choose. Support your
　　recommendation and show any related work.
　　COURSE 8: Fall 2002 -15- GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　人生的奋斗可以分五个阶段：为了生存下来，立足社会。改善生活，提高品质。有点成就，需要炫耀，让更多人知道自己的成功。阅历多了，开始追求感觉的东西。归朴还真，上升到精神的境界。——高顿网校名人心语

 

 
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