下面是【SOA】真题Course8M（1）——北美精算师历年考试，请记熟各章节的要点和难点，大纲搞搞熟。
　　COURSE8:Fall2005-1-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　**BEGINNINGOFEXAMINATION**
　　HEALTH,GROUPLIFE&MANAGEDCARE
　　MORNINGSESSION
　　1.(3points)
　　(a)Explainnon-financialusesofreinsurance.
　　(b)Describelimitationsofreinsurance.
 
　　COURSE8:Fall2005-2-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　2.(3points)YouaretheactuaryforaUShealthinsurancecompany.Youhavebeenasked
　　tomakeapresentationtoyourBoardofDirectorsregardingtheregulatoryenvironment
　　foryourcompany.
　　(a)Describegoalsandobjectivesofinsuranceregulation.
　　(b)Describethelegalframeworkforinsuranceregulationandmeansofenforcement.
 
　　COURSE8:Fall2005-3-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　3.(7points)Youareaconsultingactuaryretainedbyanemployergroup.Followingthe
　　presentationofrenewalratestothegroup,youhavebeenaskedtoattendameetingto
　　reviewtrendcalculations.
　　Youaregiventhefollowinginformation:
　　Allowedtrend:15%
　　Incurredclaims:$5,250,000
　　Averagemonthlymembershipofthegroup:2,000members
　　ThecurrentplanisPlanA,butthegroupisconsideringPlanB:
　　PlanAPlanB
　　Deductible$250$1,500
　　Coinsurance20%30%
　　Valueofthemembercostsharing(PMPM)$50$100
　　Assumeth*ueofthedeductibledoesnotvaryfromyeartoyear.
　　(a)Describeindetailexternalsourcesoftrendthatyouthinkmightbehelpfulinyour
　　trenddiscussion.
　　(b)Describecommonproblemsincomputingtrendsthatyoumightneedto
　　investigate.
　　(c)Calculatethenettrendforthetwoplansandexplainwhytheremightbea
　　difference.Showyourwork.
　　(d)DescribemajorissueswhichmightneedtobeaddressedifPlansAandBwereto
　　bothbeofferedasadualoption.
 
　　COURSE8:Fall2005-4-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　Questions4-7pertaintotheCaseStudy
　　4.(7points)YouaretheactuaryatWonderfulLifeandhavereceivedarequestfor
　　proposalfromJLBCompany(JLB)foramulti-optionhealthquoteeffectiveJanuary1,
　　2005.JLBcurrentlyoffersonlya$100deductibleindemnityplan.
　　UsingdatafoundinTablesMM-2aandMM-2bandthefollowingadditionalinformation:
　　TotalclaimsincurredforJuly1,2003toJune30,2004were$4,063,000.
　　Claimamountsinexcessof$50,000were$278,000.
　　Averageemployeeenrollmentduringthisperiodwas500singleand750family
　　contracts.
　　WonderfulLife’sPPOnetworkdiscountis30%.
　　In-networkutilizationis85%.
　　Useofthenetworkreducesutilizationby5%ascomparedtoindemnity.
　　(a)Discusspricingconsiderationsinamulti-optionenvironment.
　　(b)Calculate2-tiergrosspremiumratesfora$100deductibleindemnityoption,and
　　a$500deductiblePPOoption,assumingnoselectionimpact.Showyourwork.
　　(c)OutlineconsiderationsifJLB’scurrentplanwasamanagedcareplaninsteadof
　　anindemnityplan.
 
　　COURSE8:Fall2005-5-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　Questions4-7pertaintotheCaseStudy
　　5.(9points)WonderfulLife’smanagementis*uatingthecompany’sprofitandsurplus
　　requirements.YouaregiventhedatainTableC-1andtheassumptionthatRisk-Based
　　Capital(RBC)is18%ofpremium.
　　(a)(1point)Discussmethodsofmeasuringprofit.
　　(b)(2points)Discussdistortionsthatmayrequireadjustmenttoavoid
　　misrepresentationofprofits.
　　(c)(3points)Describeimplicationsofthefollowingwhenmodelingrequiredsurplus
　　forWonderfulLife:
　　i.Reinsurancestrategy
　　ii.Dividendphilosophy
　　iii.Expensemanagementcontrols
　　iv.Premiumgrowth
　　(d)(3points)DetermineifWonderfulLifeachievedthetargeted12.5%returnon
　　equityfor2004.Showyourwork.
 
　　COURSE8:Fall2005-6-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　Questions4-7pertaintotheCaseStudy
　　6.(9points)YouarethegrouppricingactuaryforWonderfulLifeInsuranceCompany.
　　YouarepreparingaproposalforBaileyIndustrieswhichincludesananalysisofprior
　　experience.YouaregiventhedatainTableBI-1bandthefollowingassumptions:
　　Theonlyitemscausingdifferencesinclaimscostsareplandesignandutilization
　　differencescausedbyplandesign.
　　TheaveragememberspercontractforboththePPOandHMOplansis2.2.
　　MemberCostasapercentageofclaimsisasfollows:
　　Utilization
　　AdjustmentRange
　　MemberCost
　　SharingRange
　　ServiceType%ofCostLowHighLowHigh
　　Facility50.0%0.0%5.0%0.0%25.0%
　　Professional30.0%-5.0%20.0%0.0%40.0%
　　Pharmacy20.0%0.0%20.0%0.0%25.0%
　　Total100.0%
　　AverageMemberCostSharing
　　ServiceTypePPOHMO
　　Facility17.5%0.0%
　　Professional25.0%5.0%
　　Pharmacy18.0%18.0%
　　(a)(3points)DescribethecriteriathatWonderfulLifewouldusetounderwrite
　　BaileyIndustries.
　　(b)(2points)Describethemodelsyoumightusetopredictselectioninamultioption
　　environment.
　　(c)(4points)CalculatetheexpectedchangeinutilizationfortheHMOplanusing
　　thememberutilizationcostmodel.Showyourwork.
 
　　COURSE8:Fall2005-7-GOTONEXTPAGE
　　Health,GroupLife&ManagedCare
　　Questions4-7pertaintotheCaseStudy
　　高顿网校之名人思想：走向最远的方向，哪怕前路迷茫；抱着*5的希望，哪怕山穷水尽；坚持最强的意志，哪怕刀山火海；做好最坏的打算，哪怕从头再来。