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SOA真题系列Course8M——2005年度北美精算师（第二大点）

来源：高顿网校 2014-08-07

　　全国所有的北美地区的考友们，大家请把目光转移到高顿网校哦。下面是SOA真题系列Course8M——2005年度北美精算师（第二大点）。
　　7. (7 points) You are an actuary at Wonderful Life and have been asked to discuss sources

　　of profit using Group 1 data as an example.

　　In addition to the data in Tables MM-1, MM-2a, MM-2b, and MM-3a, assume:

　　? Single/Family manual rates for 2005 are the result of trending historical manual rates.

　　? Expenses, taxes, and investment income are expressed as the percentages from Table

　　MM-1 for 2004.

　　(a) Discuss major factors affecting financial results for the group line of business.

　　(b) Outline the various sources of profit for group insurance.

　　(c) Calculate profits by source for Group 1 for the experience period. Show your

　　work.

　　COURSE 8: Fall 2005 -8- GO TO NEXT PAGE

　　Health, Group Life & Managed Care

　　8. (7 points) You are the consulting actuary for ACME, Inc. They are interested in offering

　　a Patient Directed Healthcare Benefit (PDHB) plan with the following structure:

　　Option 1

　　? Multi-plan option plus Flexible Spending Account (FSA),

　　? Employer provides core contribution, offers multiple health plan choices,

　　and sets menu.

　　Option 2

　　? High Deductible Plan plus FSA plus Personal Health Account (PHA),

　　? Employer provides core contribution, access to multiple high deductible

　　plans, and segregated PHA’s.

　　(a) Describe factors that are making consumerism a significant trend.

　　(b) Compare and contrast the key dimensions of PDHB’s as they relate to the two

　　options ACME is considering.

　　(c) Describe the healthcare challenges that can be addressed by PDHB’s with respect

　　to:

　　i. Employees

　　ii. Employers

　　COURSE 8: Fall 2005 -9- GO TO NEXT PAGE

　　Health, Group Life & Managed Care

　　9. (5 points) You are the pricing actuary for Enamel Insurance Company (EIC). EIC is

　　interested in adding a dental product to its portfolio and has asked you to prepare a report

　　to senior management.

　　(a) Describe ways to control dental claims costs.

　　(b) Describe the underwriting and rating parameters used for dental insurance.

　　COURSE 8: Fall 2005 -10- STOP

　　Health, Group Life & Managed Care

　　10. (3 points) You are the Valuation Actuary for Belt and Suspenders Health Insurance

　　Company. Your company offers a variety of health products that may require a variety of

　　methods for determining claim liabilities.

　　(a) Describe considerations which might influence the level of conservatism targeted

　　for a given block of business.

　　(b) Describe approaches to introducing conservatism into each of the common

　　methods used to compute claim liabilities.

　　COURSE 8: Fall 2005 - 11 - GO TO NEXT PAGE

　　Managed Care Segment

　　**BEGINNING OF EXAMINATION**

　　MANAGED CARE SEGMENT

　　Beginning with Question 11

　　11. (4 points) Regarding claims practices for short term disability (STD) coverages:

　　(a) Describe the tools available to challenge questionable STD claims.

　　(b) Discuss methods, including the pros and cons for measuring overall STD claims

　　levels.

　　(c) Describe the sources of information available to a claims examiner regarding STD

　　claims.

　　COURSE 8: Fall 2005 - 12 - GO TO NEXT PAGE

　　Managed Care Segment

　　12. (4 points) You are an actuary responsible for developing your company’s financial

　　forecast models. Recently your company has improved access and quality of data. The

　　Chief Actuary is now encouraging you to incorporate additional situations in forecast

　　modeling.

　　(a) (3 points) Discuss basic principles for designing forecast models.

　　(b) (1 point) Outline ways in which forecast modeling can influence company

　　actions to help achieve business objectives.

　　COURSE 8: Fall 2005 - 13 - GO TO NEXT PAGE

　　Managed Care Segment

　　13. (8 points) You are the chief actuary for ABC Insurance Company. You are considering

　　purchasing an individual insurance block of business but are concerned about ABC’s

　　ability to administer such business.

　　(a) Discuss the steps an agent goes through in selling and servicing individual health

　　insurance policies.

　　(b) Describe considerations in plan design, pricing, and distribution channels.

　　(c) Describe the typical underwriting considerations for individual health insurance.

　　(d) Describe elements included in rating classification systems.

　　(e) Explain types of premium guarantees that could be offered.

　　COURSE 8: Fall 2005 - 14 - GO TO NEXT PAGE

　　Managed Care Segment

　　14. (4 points) You are the valuation actuary for TAT Health Insurance Company. You are

　　concerned about the increase in turn around time for claim payment and have been

　　working with the manager of the claims area to address this concern.

　　(a) Describe the basic purposes of claims and benefits administration.

　　(b) Discuss the common problems seen in claims and benefits administration and

　　their ramifications.

　　(c) Outline the basic principles of inventory management and mechanisms for

　　inventory control.

　　COURSE 8: Fall 2005 - 15 - GO TO NEXT PAGE

　　Managed Care Segment

　　Questions 15 – 18 pertain to the Case Study
　　人的一生，是很短的，短暂的岁月要求我好好领会生活的进程——高顿网校经典总结

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