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北美精算师考试SOA：2013年11月份Course8M（*9块）

来源：高顿网校 2014-08-01

　　下面是北美精算师考试SOA：2013年11月份Course8M（*7版），请笑纳。
　　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 evaluating 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
　　高顿网校之名人语录：襟怀纳百川，志越万仞山。目极千年事，心地一平原。——柳青

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