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2001年北美精算师S真题系列November：Course8M（一）

来源：高顿网校 2014-08-22

　　下边是2001年北美精算师S真题系列November：Course8M（一），大家用心记在脑子里呀，保证能过北美精算师考试这道关。
　　Health and Managed Care

　　Morning Session

　　November 2001- Course 8M

　　Society of Actuaries

　　**BEGINNING OF EXAMINATION**

　　MORNING SESSION

　　Questions 1 – 6 pertain to the Case Study

　　1. (6 points) You have been provided the claims department statistics for Wonderful Life as

　　shown in Tables MM – 5a and MM – 5b.

　　(a) Explain why keeping claims inventory records is important for Wonderful Life.

　　(b) Assess the strengths and weaknesses of Wonderful Life’s claim status reports.

　　(c) Describe potential e-commerce functions and technologies that Wonderful Life

　　might implement to increase claims processing efficiency.

　　(d) Describe critical factors for the successful implementation of an e-commerce

　　strategy.

　　COURSE 8: November 2001 -2- STOP

　　Health and Managed Care

　　Morning Session

　　Questions 1 – 6 pertain to the Case Study

　　2. (8 points) You were recently hired as the financial actuary for Wonderful Life. Your first

　　project with the company involves a 3-year financial forecast.

　　In addition to information in the case study, you are given the following:

　　Annual Claims Trend = 15.4%

　　Monthly Claims Trend = 1.2%

　　July Seasonal Factor = .90

　　Seasonal Normalization Factor = 1.000

　　Projected Premium for January 2001 = $165,000,000

　　Projected Members for January 2001 = 980,000

　　Assumed Loss Ratio = .78

　　(a) Discuss phases of a sound financial management process.

　　(b) Describe methods commonly used to project claims costs and the conditions

　　under which each method may be appropriate.

　　(c) Calculate the Per Member Per Month (PMPM) claims cost for January 2001

　　under each of the four commonly used methods.

　　(d) Recommend one of the four methods for Wonderful Life to develop their

　　financial forecasts. Justify your recommendation.

　　COURSE 8: November 2001 -3- STOP

　　Health and Managed Care

　　Morning Session

　　Questions 1 – 6 pertain to the Case Study

　　3. (13 points) You are a group underwriter for Wonderful Life in the Major Medical

　　Division. You have obtained the following data for Groups 2 and 3 in addition to the

　　information already included in Table MM – 2 and MM – 3:

　　Additional Data for Experience Period July 1, 1999 through June 30, 2000

　　Annual Exposure

　　Total EEs

　　Total Claims

　　Group 2 120 $216,000

　　Group 3 225 $518,000

　　Total claims have not been reduced for large claims greater than $50,000.

　　(a) Describe various methods of pooling claims experience data that could be used in

　　developing experience rates.

　　(b) Discuss considerations involved in determining the credibility of a group’s

　　experience in the rate setting process.

　　(c) Calculate the composite renewal premium rate per employee for each of Group 2

　　and Group 3 using only the data in the case study. Show your work.

　　(d) Recalculate the composite renewal premium rate for each of Group 2 and Group 3

　　using a multi-year approach. Use the additional claims data provided above and

　　assume an equal weighting for each year of data. Show your work.

　　(e) Describe other considerations applicable when underwriting a particular employer

　　group that could affect the accuracy of your rate calculations.

　　COURSE 8: November 2001 -4- STOP

　　Health and Managed Care

　　Morning Session

　　Questions 1 – 6 pertain to the Case Study

　　4. (7 points) You are the Valuation Actuary for the Major Medical Division of Wonderful

　　Life.

　　(a) Describe common methods you might apply to estimate medical claim reserves.

　　(b) Calculate the outstanding liability as of December 31, 2000, for hospital claims

　　incurred from October 2000 through December 2000. Assume the claims

　　payment pattern for hospital claims incurred in January 1998 is representative of

　　future payment patterns. Show your work.

　　(c) Calculate the portion of the above outstanding liability expected to be paid by

　　March 31, 2001. Use the same assumptions as in (b) above. Show your work.

　　5. (6 points) For the past few years, Wonderful Life has seen its claim expenses grow at a

　　faster rate than its premium revenue, leading to a decreasing operating margin. In this

　　competitive environment, measuring claim cost trends and forecasting future trends in the

　　health insurance industry is crucial to accurate pricing.

　　You have been asked by the President of Wonderful Life to provide additional

　　information on medical expense trend to help him understand the situation.

　　(a) Define trend, its use, and its components.

　　(b) Discuss various techniques which can be used to analyze trend and common

　　problems encountered in trend analysis.

　　(c) Calculate the component of total trend attributable to deductible leveraging given

　　that total projected 2001 medical trend is 12%. Assume that the mix of business

　　by plan in Table MM – 3 and base manual claim rate in Table MM – 2a are

　　representative of all of Wonderful Life’s major medical business and are not

　　expected to change. Show your work.

　　COURSE 8: November 2001 -5- STOP

　　Health and Managed Care

　　Morning Session

　　Questions 1 – 6 pertain to the Case Study
　　友谊要像爱情一样才温暖人心，爱情要像友谊一样才牢不可破。——高顿网校名人思想

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