SOA真题Course8G

文章作者 100test 发表时间 2007:02:05 16:09:22
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COURSE 8: Fall 2005 -1- GO TO NEXT PAGE
Health, Group Life &. Managed Care
**BEGINNING OF EXAMINATION**
HEALTH, GROUP LIFE &. MANAGED CARE
MORNING SESSION
1. (3 points)
(a) Explain non-financial uses of reinsurance.
(b) Describe limitations of reinsurance.
COURSE 8: Fall 2005 -2- GO TO NEXT PAGE
Health, Group Life &. Managed Care
2. (3 points) You are the actuary for a US health insurance company. You have been asked
to make a presentation to your Board of Directors regarding the regulatory environment
for your company.
(a) Describe goals and objectives of insurance regulation.
(b) Describe the legal framework for insurance regulation and means of enforcement.
COURSE 8: Fall 2005 -3- GO TO NEXT PAGE
Health, Group Life &. Managed Care
3. (7 points) You are a consulting actuary retained by an employer group. Following the
presentation of renewal rates to the group, you have been asked to attend a meeting to
review trend calculations.
You are given the following information:
•. Allowed trend: 15%
•. Incurred claims: $5,250,000
•. Average monthly membership of the group: 2,000 members
•. The current plan is Plan A, but the group is considering Plan B:
Plan A Plan B
Deductible $250 $1,500
Coinsurance 20% 30%
Value of the member cost sharing (PMPM) $50 $100
•. Assume the value of the deductible does not vary from year to year.
(a) Describe in detail external sources of trend that you think might be helpful in your
trend discussion.
(b) Describe common problems in computing trends that you might need to
investigate.
(c) Calculate the net trend for the two plans and explain why there might be a
difference. Show your work.
(d) Describe major issues which might need to be addressed if Plans A and B were to
both be offered as a dual option.
COURSE 8: Fall 2005 -4- GO TO NEXT PAGE
Health, Group Life &. Managed Care
Questions 4-7 pertain to the Case Study
4. (7 points) You are the actuary at Wonderful Life and have received a request for
proposal from JLB Company (JLB) for a multi-option health quote effective January 1,
2005. JLB currently offers only a $100 deductible indemnity plan.
Using data found in Tables MM-2a and MM-2b and the following additional information:
􀂃. Total claims incurred for July 1, 2003 to June 30, 2004 were $4,063,000.
􀂃. Claim amounts in excess of $50,000 were $278,000.
􀂃. Average employee enrollment during this period was 500 single and 750 family
contracts.
􀂃. Wonderful Life’s PPO network discount is 30%.
􀂃. In-network utilization is 85%.
􀂃. Use of the network reduces utilization by 5% as compared to indemnity.
(a) Discuss pricing considerations in a multi-option environment.
(b) Calculate 2-tier gross premium rates for a $100 deductible indemnity option, and
a $500 deductible PPO option, assuming no 0selection impact. Show your work.
(c) Outline considerations if JLB’s current plan was a managed care plan instead of
an indemnity plan.
COURSE 8: Fall 2005 -5- GO TO NEXT PAGE
Health, Group Life &. Managed Care
Questions 4-7 pertain to the Case Study
5. (9 points) Wonderful Life’s management is evaluating the company’s profit and surplus
requirements. You are given the data in Table C-1 and the assumption that Risk-Based
Capital (RBC) is 18% of premium.
(a) (1 point) Discuss methods of measuring profit.
(b) (2 points) Discuss distortions that may require adjustment to avoid
misrepresentation of profits.
(c) (3 points) Describe implications of the following when modeling required surplus
for Wonderful Life:
i. Reinsurance strategy
ii. Dividend philosophy
iii. Expense management controls
iv. Premium growth
(d) (3 points) Determine if Wonderful Life achieved the targeted 12.5% return on
equity for 2004. Show your work.
COURSE 8: Fall 2005 -6- GO TO NEXT PAGE
Health, Group Life &. Managed Care
Questions 4-7 pertain to the Case Study