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历年北美真题November2003Course8M（三）——SOA精算师考试

来源：高顿网校 2014-07-18

　　高顿网校会为你及时更新北美精算师的*7考试大纲和真题的信息，敬请保持关注！
　　’s reserves and believe the claim lag pattern

　　may have recently changed.

　　(a) Calculate the age-to-age development factors based on 9/2001 to 12/2002

　　emerging experience using claims paid in the most recent two months on Table

　　MM-4b.

　　(b) Estimate incurred claims for December 2002 assuming all claims are complete

　　after 15 months.

　　(c) Describe considerations involved in using age-to-age development factors to

　　estimate incurred claims.

　　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 evaluation 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

　　12. (4 points) ABC Company is considering acquiring ITSA, a managed care organization

　　that services a number of major cities. You are the head of the claims department in the

　　Major Medical division and you’ve been asked to evaluate claims operations at ITSA,

　　including systems used to process the claims.

　　(a) Describe measures of claims quality.

　　(b) Outline basic steps you would expect to find in the ITSA claims adjudication

　　process.

　　(c) Describe specific internal data sources you should include as part of your claims

　　review.

　　(d) Describe issues that should be considered in performing an audit.

　　13. (4 points) You have been asked by your client at BEST HMO to create a presentation that

　　will enable her to convince management to establish new methods for physician

　　compensation.

　　(a) Describe traditiona l and new, alternative forms of capitation and their suitability

　　for specific types of physicians.

　　(b) Describe traditional and new, alternative forms of incentive plans.

　　COURSE 8: Fall 2003 - 10 - GO ON TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　14. (5 points) You are a consultant hired by TeethFerry.com, a company hoping to use the

　　Internet to market dental plans. They have created a marketing communication to be sent

　　to companies that do not currently have a benefits program.

　　From: TeethFerry
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