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精选真题November2004Course8G（2）——SOA2014年精算师考试

来源：高顿网校 2014-07-25

　　大家复习全英文的北美精算师考试辛苦么？吃得苦中苦，方为考试合格者！
　　5. (9 points) You are an underwriter with Wonderful Life preparing the renewal for

　　Group 4.

　　Assume that the retrospective formula balance in Table MM-3a is as of the end of the

　　experience period and that pricing factors as shown in Table MM-2a and MM-2b have

　　not changed.

　　(a) Calculate Group 4’s projected retrospective formula balance as of December 31,

　　2003 using the same assumptions as would be used for rating. Show your work.

　　(b) Calculate the EE only and EE and Dependents monthly renewal premiums for

　　2004. Show your work.

　　(c) Discuss the pros and cons of various funding arrangements, both from an

　　employer’s point of view and specifically for Group 4,

　　i. prospective experience rating,

　　ii. retrospective experience rating,

　　iii. self- insurance, and

　　iv. minimum premium plans.

　　6. (5 points) You are evaluating Wonderful Life’s reserves using Non-Hospital claims paid

　　in Tables MM-4c and MM-4d. Assume that the July 2002 completion pattern is

　　representative of all months.

　　(a) Calculate the incurred claims for incurred months July 2003 through December

　　2003 using age-ultimate development factors. Show your work.

　　(b) Calculate the IBNR as of December 31, 2003 for incurred months July 2003

　　through December 2003. Show your work.

　　(c) Recommend adjustments to this approach which might produce reasonable IBNR

　　results.

　　COURSE 8: Fall 2004 - 5 - GO TO NEXT PAGE

　　Health, Group Life & Managed Care

　　Morning Session

　　7. (7 points) You are the health actuary reviewing the pricing assumptions and the first

　　three years of experience for a given product. The following information is given:

　　Classical Pricing Assumptions

　　Product Duration: 5 Years

　　interest rates: 0.0%

　　annual lapse rate: 20.0%

　　target loss ratio: 60.0%

　　tabular claims cost

　　Duration Tabular Claims Cost Selection Adjustment

　　0 10.0 .05

　　1 11.0 1.1

　　2 12.0 1.1

　　3 13.0 1.1

　　4 14.0 1.1

　　Experience Data

　　Duration Mbrs Actual Claims

　　0 1,000 6,000

　　1 770 10,000

　　2 650 11,000

　　3 500 -

　　4 350 -

　　Cumulative Antiselection Theory Assumptions

　　K1 = -

　　K2 = 4

　　u 0.10

　　(a) (1 point) Describe how CAST differs from classical (select and ultimate) theory.

　　(b) (2 points) Calculate the gross premium using the classical pricing assumptions.

　　Show your work

　　(c) (4 points) Calculate the gross premium using CAST assumptions. Show your

　　work.

　　COURSE 8: Fall 2004 - 6 - GO TO NEXT PAGE

　　Health, Group Life & Managed Care

　　Morning Session

　　8. (5 points) LMN Company employees currently utilize two different networks. Both

　　networks use the same pharmacy benefits manager, and detailed pharmacy claims data

　　are available. Network A has additional detailed health claims information. The per

　　capita claims cost for Network A is twice as high as in Network B. You have been asked

　　to determine if the higher costs are caused by differences in the enrollee health status.

　　(a) Describe criteria used for health risk classification.

　　(b) Describe risk assessment models currently available.

　　(c) Recommend a risk assessment method for LMN Company.

　　9. (7 points) You are an actuary who recently accepted a non-traditional role as claims

　　manager for a health carrier. You are concerned about the new inventory standards, as

　　measured by turn-around time (TAT) and their impact on quality. Additionally, you are

　　concerned about common claims problems and the lack of documented procedures and

　　guideline for working with other departments.

　　(a) Regarding TAT:

　　i. Define TAT.

　　ii. Describe considerations used when establishing TAT goals.

　　iii. Describe the tools used for tracking and monitoring TATs.

　　(b) Regarding quality:

　　i. Define the measures of claim quality.

　　ii. List the steps of claim quality review process.

　　iii. Describe the major issues to consider when performing a quality audit.

　　(c) Describe common claims and benefit administration problems.

　　(d) List the items requiring procedures and guidelines for coordination of the claim

　　department with the following departments:

　　i. Enrollment and billing

　　ii. Provider relations

　　iii. Utilization management

　　iv. Member services

　　v. Finance

　　COURSE 8: Fall 2004 - 7 - STOP

　　Health, Group Life & Managed Care

　　Morning Session
　　高顿网校之名人感触：不用相当的独立功夫，不论在哪个严重的问题上都不能找出真理；谁怕用功夫，谁就无法找到真理。 —— 列宁

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