SOA北美精算师考试2002年11月真题Course8M（五）是高顿网校小编为您8月27日一大清晨为您整理完毕的。
　　18. (5 points) You are an actuary assigned to develop a cost estimate for Medicare to provide
　　a prescription drug benefit to Medicare beneficiaries.
　　You are given the following data and information:
　　?  benefit effective date is 1/1/2003
　　?  all seniors will be covered and any existing drug coverages will be terminated
　　?  annual deductible will be $3,000
　　?  no coinsurance will be charged
　　?  prescription drug per capita spending increases 14.5% per year
　　?  prescription drug spending is uniform within each expenditure range
　　Expenditure Data for Calendar Year 2000 (amounts in millions)
　　Seniors with Drug coverage Seniors without Drug coverage
　　Expenditure
　　Range
　　($)
　　Number
　　of Seniors
　　Drug Cost Number
　　of Seniors
　　Drug Cost
　　Carrier Out of
　　Pocket
　　Carrier Out of
　　Pocket
　　No cost 3 $ 0 $ 0 1 0 $ 0
　　$0-250 5 $ 403 $ 173 2 0 $ 260
　　$251-2,000 11 $9,240 $3,960 5 0 $6,250
　　$2,001-3,000 5 $8,400 $3,600 2 0 $4,820
　　$3,000+ 3 $7,350 $3,150 1 0 $3,600
　　(a) Calculate the 2003 expected drug cost:
　　(i) in total,
　　(ii) for Medicare.
　　(b) Outline comments regarding the ability of the proposed plan to control current and future
　　Medicare drug costs.
　　COURSE 8: Fall 2002 -16- GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
 
　　19. (4 points) The 2002 budget for HMO DEF calls for reduced primary care and specialty
　　physician utilization. An effort is being made to identify the least efficient physicians,
　　and subsequently to change physician behavior, terminate contracts, or redirect care as
　　needed.
　　(a) Describe how you would identify costly practice patterns.
　　(b) List data sources you might access to support this effort.
　　(c) Explain how risk share arrangements may influence utilization.
　　(d) List factors other than utilization patterns that you should consider before
　　requesting termination of a physician.
 
　　20. (4 points) You are a consulting actuary to an insurance company that is considering
　　creating an HMO subsidiary.
　　(a) Describe managed care regulation governing insurance company operations that
　　the company may encounter.
　　(b) Describe obligations to perform medical management activities and consequences
　　of non-compliance with such obligations.
　　COURSE 8: Fall 2002 -17- STOP
　　Health, Group Life & Managed Care
　　Afternoon Session
 
　　21. (5 points) You are the Valuation Actuary for an HMO. Yo u are developing your
　　12/31/2001 reserves for a block of business acquired from another company on July 1,
　　2001. Your company is not responsible for runout on claims incurred prior to July 1,
　　2001. You use the authorization method for developing the hospital inpatient IBNR
　　reserve component. Your company has the following reimbursement schedules through
　　September 2001:
　　Average Per Diem Pct of Days
　　Hospital A $1,000 25%
　　Hospital B $1,100 50%
　　Hospital C $1,200 25%
　　Effective October 1, 2001, Hospitals A and B increased their per diems by 10% and
　　Hospital C increased its per diem by 20%. Your system reports have provided the
　　following information for inpatient services:
　　Authorized
　　Hospital Days
　　Incurred and
　　Paid Claims
　　Completion
　　Factors
　　Authorization
　　Credibility
　　Jul 2001 2,205 $2,475,000 1.00 0
　　Aug 2001 2,200 $1,950,000 .85 0
　　Sep 2001 2,225 $2,150,000 .80 .25
　　Oct 2001 2,050 $1,700,000 .60 .50
　　Nov 2001 2,025 $1,070,000 .35 . 75
　　Dec 2001 1,950 $247,500 .10 1.00
　　(a) (1 point) Create a checklist of managed care issues that you will need to consider
　　in preparing your annual Statement of Opinion.
　　(b) (3 points) Calculate the IBNR reserve as of 12/31/2001 based on the information
　　provided. Show your work.
　　(c) (1 point) List reasons why the authorized hospital days may differ from the
　　incurred days.
　　在真实的生命里，每桩伟业都由信心开始，并由信心跨出*9步。——高顿网校名人心得

 

 
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