有正在浏览此页的精算师滴童鞋咩？高顿网校邀您来看【2014北美精算师】*7整理SOA真题Course8M（最后一部分）。
　　18.(6points)YouareanactuaryfortheBedfordGroup,themanagedcaredivisionof
　　WonderfulLifeInsuranceCompany.TheCFOhascommittedtotheBoardthat
　　contributiontosurpluswillgrowby20%.
　　YouaregiventhefollowinginadditiontoinformationinTablesMC-1,MC-3,
　　andMC-6:
　　Ending2004Surplus=$100million.
　　Theaveragepremiumincreaseis7%from2004to2005.
　　Claimtrendfor2005isestimatedtobe8%formedicaland15%forprescription
　　drugs.
　　Nochangeinproviderliabilityfrom2004to2005
　　Aone-time$3,000,000expensechargeforSarbanes-OxleyandHIPAAcompliance
　　in2005wasimmediatelyexpensed.
　　AdministrativeandFacilitycostswerethesameasin2004.
　　NoITcapitalexpenditureswerepaidin2004norexpectedfor2005.
　　MIS&ITcostsin2004were30%higherthanexpectedduetonon-recurring
　　consultantfees.
　　Salariesandotheradministrativecostsincreasedonaverage3.5%from2004.
　　2005totalmembershipdidnotchangefrom2004.
　　CommissionsandPremiumTaxasapercentofpremiumisasshownin
　　TableMC-1.
　　CorporateTaxesareexpectedtobe37.5%ofOperatingEarningsbeforeTaxes.
　　NoOtherIncomewasrecordedin2005.
　　(a)(5points)Calculatetheexpected2005investmentincomebasedontheabove
　　assumptionswhichwouldbeneededtomeettheCFO’scontributiontosurplus
　　targetandcommentonthereasonablenessoftheCFO’scommitment.Showyour
　　work.
　　(b)(1point)Describeactionsthatcanbetakentoincreasesurplus.
　　COURSE8:Fall2005-20-GOTONEXTPAGE
　　ManagedCareSegment
 
　　19.(4points)WhitecoatHealthPlan(WHP)payslaboratoryprovidersatafixedpercentage
　　ofbilledcharges.Overthelasttwoyears,costsfortheseserviceshaveescalatedrapidly,
　　andWHPhasdecidedtointroduceafeescheduleforsomeprovidertypesandservices.
　　EffectiveJanuary2006,WHPwillcontractwithoneclinicallabforspecificlab
　　proceduresataflatfeeperprocedure.Youhavebeengiventhefollowinginformation:
　　2006Rateper
　　Service
　　3/1/2004–
　　2/28/2005Billed
　　Charges
　　3/1/2004–
　　2/28/2005
　　Procedures
　　Procedure1$20$7,361,770146,067
　　Procedure2$17$10,226,250252,500
　　Procedure3$30$6,841,76685,844
　　WHPcurrentlyreimburseslaboratoryservicesat70%ofbilledcharges.
　　Annualtrendforbilledchargesperserviceis4%.
　　Totalbilledchargesareexpectedtoincreaseby15%peryear.
　　AllservicesforthethreeproceduresareexpectedtobedeliveredthroughWHP.
　　(a)Calculatewhetherthearrangementfor2006willproducesavingsoverthecurrent
　　reimbursement.Showyourwork.
　　(b)DiscussothermethodsWHPcanemploytoreduceancillarycosts.
　　COURSE8:Fall2005-21-GOTONEXTPAGE
　　ManagedCareSegment
 
　　20.(6points)Wrinkle-Be-GoneCosmetics(WBGC),alargeemployergrouphas
　　approachedyourPrescriptionBenefitManager(PBM)toquotetheirself-fundedretiree
　　drugplan.Youweregiventheircurrentandproposedbenefitplans.
　　BenefitPercentage
　　ClaimsCostCurrentPlanNewPlan
　　$0-$3,00075%75%
　　$3,001-$5,00050%0%
　　$5,001-$7,50050%50%
　　$7,501-$10,0000%90%
　　$10,001+0%90%
　　Theplanisaclosedformularydrugplan
　　Administrationfeesaretargetedtobe$1.50PMPM
　　Allclaimcostsindicatedbelowarebilledchargesnetofdiscounts,butbeforemember
　　costsharing.
　　AnnualRx
　　Costs
　　MembersAvgno.of
　　scripts
　　Annualcost
　　permember
　　Percent
　　Generic
　　Percent
　　Brand
　　$0-$3,0002,22012.5$61580%20%
　　$3,001-$5,00092544$3,21665%35%
　　$5,001-$7,50037068$6,01830%70%
　　$7,501-$10,00011184$8,12710%90%
　　$10,001+74110$12,3750%100%
　　WBGCwillremainself-insuredandproposestopaynoadministrativefeestothePBM,
　　butthePBMwillretainrebatesastheirfee.Assumethatallmembersinthegrouphave
　　atleastonescriptperyear.RebatesarepaidtothePBMforbranddrugsonlyatarateof
　　$1.20perscript.
　　(a)(1point)Describetheeffectsofbenefitmaximumsandtheiradvantagesand
　　disadvantagesaspartofaprescriptiondrugplandesign.
　　(b)(3points)CalculatethedifferenceinexpectedcoststoWBGCunderthecurrent
　　andproposedplandesigns.Showyourwork.
　　(c)(2points)Calculatetheprojectedrebatesundertheproposedplandesignto
　　determineiftheproposalmeetsthetargetedadministrativefee.Showyourwork.
　　COURSE8:Fall2005-22-STOP
　　ManagedCareSegment
 
　　21.(3points)
　　(a)Describethestepsneededtodevelopaclinicalpathwayforaninpatientepisode.
　　(b)Describealternativeformatsusedforinformationdisplaysofclinicalpathways
　　andtheadvantagesanddisadvantagesofeach.
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