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北美精算师——SOA真题系列精选2003年度11月Course8M（一）

来源：高顿网校 2014-08-01

　　北美精算师——SOA真题系列精选2003年度11月Course8M（一），这是我们高顿网校小编给大家罗列的。

　　Subject: Quality Dental Coverage with 3 Months at No Charge

　　Affordable Dental Coverage

　　? save up to 60% on all your dental needs

　　? choose from 15 of the finest nationwide and regional plans

　　? pay premiums, submit claims, get the latest information, all on your desktop!

　　(a) List the general types of delivery systems for dental plans and their major

　　features.

　　(b) Outline plan provisions and claim practices that dental insurers can use to

　　limit cost and anti-selection.

　　(c) Describe challenges that e-commerce companies must overcome to be

　　successful.

　　COURSE 8: Fall 2003 - 11 - GO TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　Questions 15 - 18 pertain to the case study

　　15. (4 points) The Bedford Group is exploring alternatives to acute inpatient care. A study

　　by Bedford’s Medical Director indicates the MCO might benefit from a program to

　　encourage patients with conditions requiring less intensive treatment to be moved from

　　acute care facilities to a Skilled Nursing Facility (SNF). The initiative would transfer

　　acute care patients to the SNF at Hospital ID1 and is expected to result in the following

　　changes:

　　Reduction in

　　Medical Acute Days

　　Reduction in

　　Surgical Acute Days

　　Hosp ID1 1.0% 0.5%

　　Hosp ID2 2.0% 2.0%

　　Hosp ID3 1.5% 1.0%

　　(a) Assuming the above reductions are realized, and based on Table MC-2, calculate

　　the expected change in medical, surgical and SNF days/1000 and the change in

　　medical/surgical length of stay in 2002 for the MCO. Show your work.

　　(b) Describe behavioral health channeling mechanisms available to direct individuals

　　to the appropriate type of care.

　　COURSE 8: Fall 2003 - 12 - GO TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　Questions 15 - 18 pertain to the case study
　　高顿网校之名人思想：每个人的生命都是一只小船，梦想是小船的风帆。

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