下面是历年SOA真题Course8G（一）——SOA精算师考试，请尽快吸收，因为这只是考试其中一部分，还有更多需要记忆哦。
　　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 selection 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 *uating 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
 
　　6. (9 points) You are the group pricing actuary for Wonderful Life Insurance Company.
　　You are preparing a proposal for Bailey Industries which includes an analysis of prior
　　experience. You are given the data in Table BI-1b and the following assumptions:
　　? The only items causing differences in claims costs are plan design and utilization
　　differences caused by plan design.
　　? The average members per contract for both the PPO and HMO plans is 2.2.
　　? Member Cost as a percentage of claims is as follows:
　　Utilization
　　Adjustment Range
　　Member Cost
　　Sharing Range
　　Service Type % of Cost Low High Low High
　　Facility 50.0% 0.0% 5.0% 0.0% 25.0%
　　Professional 30.0% -5.0% 20.0% 0.0% 40.0%
　　Pharmacy 20.0% 0.0% 20.0% 0.0% 25.0%
　　Total 100.0%
　　Average Member Cost Sharing
　　Service Type PPO HMO
　　Facility 17.5% 0.0%
　　Professional 25.0% 5.0%
　　Pharmacy 18.0% 18.0%
　　(a) (3 points) Describe the criteria that Wonderful Life would use to underwrite
　　Bailey Industries.
　　(b) (2 points) Describe the models you might use to predict selection in a multioption
　　environment.
　　(c) (4 points) Calculate the expected change in utilization for the HMO plan using
　　the member utilization cost model. Show your work.
　　COURSE 8: Fall 2005 -7- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Questions 4-7 pertain to the Case Study
 
　　7. (7 points) You are an actuary at Wonderful Life and have been asked to discuss sources
　　of profit using Group 1 data as an example.
　　In addition to the data in Tables MM-1, MM-2a, MM-2b, and MM-3a, assume:
　　? Single/Family manual rates for 2005 are the result of trending historical manual rates.
　　? Expenses, taxes, and investment income are expressed as the percentages from Table
　　MM-1 for 2004.
　　(a) Discuss major factors affecting financial results for the group line of business.
　　(b) Outline the various sources of profit for group insurance.
　　(c) Calculate profits by source for Group 1 for the experience period. Show your
　　work.
　　COURSE 8: Fall 2005 -8- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
 
　　8. (7 points) You are the consulting actuary for ACME, Inc. They are interested in offering
　　a Patient Directed Healthcare Benefit (PDHB) plan with the following structure:
　　Option 1
　　? Multi-plan option plus Flexible Spending Account (FSA),
　　? Employer provides core contribution, offers multiple health plan choices,
　　and sets menu.
　　Option 2
　　? High Deductible Plan plus FSA plus Personal Health Account (PHA),
　　? Employer provides core contribution, access to multiple high deductible
　　plans, and segregated PHA’s.
　　(a) Describe factors that are making consumerism a significant trend.
　　(b) Compare and contrast the key dimensions of PDHB’s as they relate to the two
　　options ACME is considering.
　　(c) Describe the healthcare challenges that can be addressed by PDHB’s with respect
　　to:
　　i. Employees
　　ii. Employers
　　COURSE 8: Fall 2005 -9- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
 
　　9. (5 points) You are the pricing actuary for Enamel Insurance Company (EIC). EIC is
　　interested in adding a dental product to its portfolio and has asked you to prepare a report
　　to senior management.
　　(a) Describe ways to control dental claims costs.
　　(b) Describe the underwriting and rating parameters used for dental insurance.
　　COURSE 8: Fall 2005 - 10 - GO TO NEXT PAGE
　　Health and Group Life Segment
 
　　10. (3 points) You are the Valuation Actuary for Belt and Suspenders Health Insurance
　　Company. Your compan
　　y offers a variety of health products that may require a variety of
　　methods for determining claim liabilities.
　　(a) Describe considerations which might influence the level of conservatism targeted
　　for a given block of business.
　　(b) Describe approaches to introducing conservatism into each of the common
　　methods used to compute claim liabilities.
　　COURSE 8: Fall 2005 - 11 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　**BEGINNING OF EXAMINATION**
　　HEALTH AND GROUP LIFE SEGMENT
　　Beginning with Question 11
 
　　11. (4 points) Regarding claims practices for short term disability (STD) coverages:
　　(a) Describe the tools available to challenge questionable STD claims.
　　(b) Discuss methods, including the pros and cons for measuring overall STD claims
　　levels.
　　(c) Describe the sources of information available to a claims examiner regarding STD
　　claims.
　　COURSE 8: Fall 2005 - 12 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　12. (4 points) You are an actuary responsible for developing your company’s financial
　　forecast models. Recently your company has improved access and quality of data. The
　　Chief Actuary is now encouraging you to incorporate additional situations in forecast
　　modeling.
　　(a) (3 points) Discuss basic principles for designing forecast models.
　　(b) (1 point) Outline ways in which forecast modeling can influence company
　　actions to help achieve business objectives.
　　COURSE 8: Fall 2005 - 13 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　13. (8 points) You are the chief actuary for ABC Insurance Company. You are considering
　　purchasing an individual insurance block of business but are concerned about ABC’s
　　ability to administer such business.
　　(a) Discuss the steps an agent goes through in selling and servicing individual health
　　insurance policies.
　　(b) Describe considerations in plan design, pricing, and distribution channels.
　　(c) Describe the typical underwriting considerations for individual health insurance.
　　(d) Describe elements included in rating classification systems.
　　(e) Explain types of premium guarantees that could be offered.
　　COURSE 8: Fall 2005 - 14 - GO TO NEXT PAGE
　　Health and Group Life Segment
 
　　14. (4 points) You are the valuation actuary for TAT Health Insurance Company. You are
　　concerned about the increase in turn around time for claim payment and have been
　　working with the manager of the claims area to address this concern.
　　(a) Describe the basic purposes of claims and benefits administration.
　　(b) Discuss the common problems seen in claims and benefits administration and
　　their ramifications.
　　(c) Outline the basic principles of inventory management and mechanisms for
　　inventory control.
　　COURSE 8: Fall 2005 - 15 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　Question 15 pertains to the Case Study
　　15. (5 points) A benefits consultant has approached Wonderful Life about insuring her
　　client’s employer-sponsored Group Long Term Disability (GLTD) coverage. The GLTD
　　coverage has a 180-day elimination period. There are 1,100 employees eligible for
　　GLTD coverage with the following age distribution:
　　Age Employees
　　18-24 400
　　25-29 300
　　30-34 200
　　35-39 -
　　40-44 100
　　45-49 -
　　50-54 100
　　55-59 -
　　60-64 -
　　Total 1,100
　　You estimate that the group’s incidence rate will be 150% of the male incidence rates
　　found in Table GLD-6A. The group has supplied prior experience based on 5,000 life
　　years that produces an aggregate experience claim rate of $0.98 per $100 of monthly
　　benefit.
　　Wonderful Life’s profit requirement on GLTD business is 5.0% of premium. Total
　　expense will follow Wonderful Life’s actual financials for the most recent year as found
　　in Table GLD-3A.
　　(a) Calculate the group’s composite manual monthly gross premium rate per $100 of
　　monthly benefit, assuming
　　an average reserve of $54 per open claim per $1 of
　　benefit. Show your work.
　　(b) Calculate the blended monthly gross premium rate using a credibility formula of
　　N/(N+5,000). Show your work.
　　(c) Discuss the different types of reserves that Wonderful Life will hold for this
　　coverage, and how they are determined.
　　COURSE 8: Fall 2005 - 16 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　16. (8 points) You are a group benefits consultant at NOVA Design Inc. One of your
　　Canadian clients has the following group benefits plan:
　　Benefits Coverage Monthly
　　premium rates Volume
　　Life insurance 3 × salary $0.32 per
　　$1,000 benefit $46,200,000
　　Long–term
　　disability
　　75% of monthly
　　salary
　　$1.05 per $100
　　benefit $962,500
　　Medical
　　No deductible
　　100% coinsurance
　　for all services
　　Single: $ 50
　　Family: $125
　　Single: 120
　　Family: 280
　　Dental
　　No deductible
　　90% coinsurance
　　for all services
　　Single: $30
　　Family: $75
　　Single: 120
　　Family: 280
　　The employer pays 100% of the cost for all benefits.
　　Your client wants to review its plan design and introduce a Health Care Expense Account
　　(HCEA). The new plan design has to be cost neutral in the first year. Your client expects,
　　however, to save some cost over time through maintaining a fixed HCEA credit formula.
　　You are proposing the following design:
　　Benefits Coverage
　　Life insurance 1 × salary
　　Long –term disability 66.7% of monthly salary
　　Medical No deductible
　　80% coinsurance for all services
　　Dental No coverage
　　HCEA Offered
　　(a) (1 point) Describe the advantages of an HCEA.
　　(b) (2 points) Describe how the HCEA can be funded and the decisions your client
　　must make in setting it up.
　　(c) (3 points) Calculate the money available to fund the HCEA pool, develop a credit
　　formula to allocate credits to employees, and explain the pros and cons of your
　　formula. Show your work.
　　(d) (2 points) Calculate aggregate savings for your client’s next renewal, assuming
　　medical and dental inflation of 15% and 7.5% respectively, and an average
　　increase in salaries of 3%. Show your work.
　　COURSE 8: Fall 2005 - 17 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　17. (3 points) You are the chief group underwriter at a major insurance company in the U.S.
　　A number of your underwriters will be retiring shortly, and you must train junior staff to
　　fill these positions. Your group line of business products include life insurance, longterm
　　disability, and long-term care. Outline underwriting considerations for each of these
　　products.
　　COURSE 8: Fall 2005 - 18 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　18. (6 points) You are a valuation actuary for The World’s Best Insurance Company. You
　　have been asked to estimate expected claim costs for non-institutional long-term care
　　(LTC) benefits for a 62-year old male. You have the following information for your
　　company’s LTC product:
　　Benefit Amount: $100/day
　　Benefit Trigger: 2 Activities of Daily Living (ADL) or
　　Cognitive Impairment (CI)
　　Benefit Period: 24 months
　　Elimination Period: 6 months
　　Lapse rate information:
　　Duration Lapse Rate
　　Anti-selective
　　lapse factor
　　0 6% 0.8
　　1 5% 0.7
　　2 4% 0.6
　　3 3% 0.5
　　4 2% 0.4
　　You are also given the following information specific to a 62-year old male:
　　Annual Incidence per $1,000: 10.15
　　Non-Institutional Disability Day Average: 882
　　Published industry experience tabular data on the distribution of non-institutional claim
　　durations for males age 62:
　　Non-institutional Disability Days by Duration from Incurral and ADL/CI Status
　　Age 62 Male
　　Percentage of Non-institutional Days Beyond Duration
　　No CI With CI
　　Duration in
　　months 0 ADL 1 ADL 2 ADL 3+ ADL 0 ADL 1 ADL 2 ADL 3+ ADL
　　0 n/a 40.88 10.85 11.85 31.49 2.34 1.28 1.
　　65
　　6 n/a 31.90 8.96 9.70 30.67 2.15 1.18 1.52
　　24 n/a 14.28 4.73 4.78 28.06 1.65 0.91 1.13
　　30 n/a 10.82 3.78 3.79 27.19 1.51 0.84 1.02
　　(a) (3 points) Calculate the estimated non-institutional claim cost per month. Show
　　your work.
　　(b) (2 points) Discuss how voluntary lapse rates are used in individual LTC valuation
　　methods, and how they relate to anti-selection.
　　(c) (1 point) Calculate the morbidity load at duration 4. Show your work.
　　COURSE 8: Fall 2005 - 19 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　19. (6 points) You are the consultant for BigFish Inc., who recently acquired LittleFish Inc.
　　BigFish Inc. has a flexible benefits plan, while LittleFish Inc. has a traditional plan.
　　BigFish and LittleFish operate in separate markets. Nemo, the President of BigFish Inc.
　　has asked you to prepare a report on transitioning LittleFish’s plan to BigFish’s plan.
　　Current pricing information is shown in the table below:
　　BigFish Inc. Plan Information:
　　Price Tags Relative Value
　　Medical Dental
　　Plan Option Single Family Single Family Medical Dental
　　A $100 $250 $105 $280 60% 80% 世纪考试网版权所有
　　B $200 $500 $150 $400 100% 100%
　　C $350 $875 $225 $600 150% 125%
　　? Credits: $350 for Single Coverage
　　$900 for Family Coverage
　　LittleFish Inc. Plan Information:
　　Medical Dental
　　Single Family Single Family
　　Current Costs $225 $550 $140 $420
　　Expected Participation in Little Fish Flex Plan
　　Medical Dental
　　Plan Option Single Family Single Family
　　A 5% 10% 10% 5%
　　B 25% 30% 25% 40%
　　C 10% 20% 5% 15%
　　? The current medical plan is 20% richer than the BigFish medical
　　flex plan Option B.
　　? The current dental plan is 10% less rich than the BigFish dental
　　flex plan Option B.
　　? LittleFish pays 100% of the costs.
　　? The enrollment is 40% Single and 60% Family
　　(a) (4 points) Calculate the impact to BigFish’s cost of moving LittleFish into
　　BigFish’s flex plan, without change. Show your work.
　　(b) (2 points) Discuss why BigFish may want to maintain a separate benefits pricing
　　structure from LittleFish, and the advantages and disadvantages of doing so.
　　COURSE 8: Fall 2005 - 20 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　20. (3 points) You are an actuarial consultant hired by XYZ Corporation to help them
　　redesign their medical plan. XYZ Corporation is a manufacturing company that has
　　3,000 active employees and 500 retirees. All employees are located in a single
　　metropolitan area. The Human Resources (HR) manager at XYZ Corporation has told
　　you that she wants to redesign the medical plan options to encourage employee
　　responsibility and consumerism.
　　(a) Describe factors which would make a patient directed healthcare benefit approach
　　appropriate for XYZ.
　　(b) Outline next steps the HR manager could take to implement this type of plan.
　　COURSE 8: Fall 2005 - 21 - GO TO NEXT PAGE
　　Health and Group Life Segment
　　21. (5 points) You have been asked to review the impact of changing the specific deductible
　　for the aggregate stop loss arrangement of one of your client’s self-funded plans.
　　You are given the following information for the most recent plan year:
　　Stop Loss Information
　　Expected total losses (PEPM) $400
　　Expected Monthly Employees 240
　　Aggregate Attachment Factor 120% of expected total losses
　　Minimum At
　　高顿网校之考试箴言放送：青年的形象应该是纯洁、热情、有正确批评能力的。——池田大作