高顿网校会为你及时更新北美精算师考试SOA——November2003年度Course8M（4），请认真看大纲。
　　9. (5 points) You are the pricing actuary for the division of LTDC Life Insurance selling
　　group long term disability and group long term care products. Given the recent
　　fluctuations in the experience, you are considering implementing a reinsurance agreement
　　but must convince your Vice-President that it is needed.
　　(a) Explain the different approaches LTDC Life can use to reinsure its Group LTD
　　and LTC products.
　　(b) Explain risk characteristics of each product line that make the use of reinsurance
　　attractive.
　　**END OF EXAMINATION*
　　MORNING SESSION
　　COURSE 8: Fall 2003 - 7 - GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　**BEGINNING OF EXAMINATION**
　　MANAGED CARE SEGMENT
　　AFTERNOON SESSION
　　Beginning With Question 10
 
　　10. (3 points) You have been asked to summarize the report of the SOA Medical
　　Effectiveness Task Force.
　　(a) Explain the importance of measuring medical effectiveness.
　　(b) Explain the main health plan performance *uation categories.
　　COURSE 8: Fall 2003 - 8 - GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
 
　　11. (4 points) Your company offers an insurance product with the following equally likely
　　events.
　　Severity of Claim Given Event Occurs
　　Event
　　Frequency of Claim
　　Given Event Occurs Probability Claim Size
　　1 25% 75%
　　25%
　　1,000
　　500
　　2 50% 50%
　　50%
　　1,000
　　500
　　3 75% 10%
　　90%
　　1,000
　　500
　　You are also given the following additional information:
　　?  7 years of claims history for one individual
　　Year Claims
　　1 -
　　2 500
　　3 -
　　4 -
　　5 1,000
　　6 1,000
　　7 -
　　?  Expected Value of the Process Variance = 133,581
　　?  Target Loss Ratio = 80%
　　?  Ignore the impact of trend
　　(a) Calculate the expected gross premium for this product. Show your work.
　　(b) Calculate the credibility. Show your work.
　　(c) Calculate the credibility weighted total premium for this individual. Show
　　your work.
　　COURSE 8: Fall 2003 - 9 - GO ON TO NEXT PAGE
　　Managed Care Segment
　　Afternoon Session
　　COURSE 8: Fall 2003 -1- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　**BEGINNING OF EXAMINATION**
　　HEALTH, GROUP LIFE & MANAGED CARE
　　MORNING SESSION
　　1. (4 points) Your CEO is departing for a meeting to discuss the marketing strategy for a
　　new managed care product. He has asked you to brief him on the following topics:
　　(a) With regard to distribution models
　　(i) Describe traditional and alternative distribution models.
　　(ii) Describe considerations relative to the major constituent groups that
　　influence the distribution process.
　　(b) Describe market segments commonly used for managed care products.
　　Questions 2 – 8 pertain to the Case Study
　　2. (9 points) You have been asked to analyze the claim experience for Wonderful Life in
　　Tables MM-6a and MM-6b of the case study.
　　(a) Describe the impact on trend of company-specific care management initiatives.
　　(b) Calculate the year-over- year quarterly rolling trend for 3Q02 and 4Q02.
　　(c) Recommend baseline trends for Hospital, Non-Hospital and Total Medical Costs.
　　Assume the last half of 2002 is predictive of future trends. Justify your answer.
　　(d) Based on the following assumptions:
　　?  On January 1, 2003, 50% of the hospitals will accept 10% discount off the
　　2003 Hospital contracted rate.
　　?  These hospitals deliver 1/3 of your facility care.
　　?  The remaining hospital contract costs will increase as expected.
　　?  Utilizatio n does not change.
　　Calculate a revised estimate of Hospital and Total Medical Trend. Show your
　　work.
　　(e) Marketing has just sold a large group with 5,000 employees (12,000 members).
　　All of the group members will only use hospitals that accept the 10% discount.
　　Calculate a revised estimate of Total Medical Trend. Show your work.
　　COURSE 8: Fall 2003 -2- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　Questions 2 – 8 pertain to the Case Study
　　3. (13 points) You are a consultant for Bailey Industries. Bailey has been struggling to
　　balance increased medical costs against emplo yee demand for more choice in coverage.
　　Bailey is considering the adoption of a new medical plan with patient-directed benefits.
　　In addition to Table B-1, you are given the following claims probability distribution and
　　proposed benefit options:
　　Claims Range Percentage of Employees
　　with claims cost in range
　　Average claims cost per
　　employee in range
　　$0 15% 0
　　$1 - $1,000 40% $400
　　$1,000 - $2,000 15% $1,500
　　$2,000 - $5,000 15% $3,500
　　$5,000+ 15% $25,000
　　Option A Option B
　　Deductible $1,000 $2,000
　　Coinsurance 10% 20%
　　Annual Employee
　　Premium $0 $0
　　Employer funds placed
　　in Employees PHA
　　$500 $1,250
　　(a) (1 point) Describe problematic aspects of the current employer-sponsored system
　　for employers and employees.
　　(b) (3 points) Describe key implementation considerations for an employer adopting a
　　PDHB approach and how they would apply to Bailey Industries.
　　(c) (3 points) Describe models used to predict selection costs for the medical options.
　　Identify and explain why certain models are not appropriate for *uating costs
　　for Bailey Industries.
　　(d) (6 points) Assume a group of all single employees who, absent choice, would be
　　equally distributed between the two options. Assume PHA (Personal Health
　　Account) funds are expenses to Bailey Industries.
　　(i) Construct a choice model for Options A&B and calculate maximum
　　adverse selection cost.
　　(ii) Explain why adverse selection will be less than the amount calculated by a
　　choice model.
　　(iii) Describe methods to manage adverse selection in PDHB models.
　　COURSE 8: Fall 2003 -3- GO TO NEXT PAGE
　　Health, Group Life & Managed Care
　　Morning Session
　　Questions 2 – 8 pertain to the Case Study
　　高顿网校之名人心得：风度表现着一个人的文化教养，是一个人审美观念和精神世界凝成的晶体。——金马