精算师

’s reserves and believe the claim lag pattern

may have recently changed.

(a) Calculate the age-to-age development factors based on 9/2001 to 12/2002

emerging experience using claims paid in the most recent two months on Table

MM-4b.

(b) Estimate incurred claims for December 2002 assuming all claims are complete

after 15 months.

(c) Describe considerations involved in using age-to-age development factors to

estimate incurred claims.

9. (5 points) You are the pricing actuary for the division of LTDC Life Insurance selling

group long term disability and group long term care products. Given the recent

fluctuations in the experience, you are considering implementing a reinsurance agreement

but must convince your Vice-President that it is needed.

(a) Explain the different approaches LTDC Life can use to reinsure its Group LTD

and LTC products.

(b) Explain risk characteristics of each product line that make the use of reinsurance

attractive.

**END OF EXAMINATION*

MORNING SESSION

COURSE 8: Fall 2003 - 7 - GO ON TO NEXT PAGE

Managed Care Segment

Afternoon Session

**BEGINNING OF EXAMINATION**

MANAGED CARE SEGMENT

AFTERNOON SESSION

Beginning With Question 10

10. (3 points) You have been asked to summarize the report of the SOA Medical

Effectiveness Task Force.

(a) Explain the importance of measuring medical effectiveness.

(b) Explain the main health plan performance evaluation categories.

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

Managed Care Segment

Afternoon Session

11. (4 points) Your company offers an insurance product with the following equally likely

events.

Severity of Claim Given Event Occurs

Event

Frequency of Claim

Given Event Occurs Probability Claim Size

1 25% 75%

25%

1,000

500

2 50% 50%

50%

1,000

500

3 75% 10%

90%

1,000

500

You are also given the following additional information:

???7 years of claims history for one individual

Year Claims

1 -

2 500

3 -

4 -

5 1,000

6 1,000

7 -

???Expected Value of the Process Variance = 133,581

???Target Loss Ratio = 80%

???Ignore the impact of trend

(a) Calculate the expected gross premium for this product. Show your work.

(b) Calculate the credibility. Show your work.

(c) Calculate the credibility weighted total premium for this individual. Show

your work.

COURSE 8: Fall 2003 - 9 - GO ON TO NEXT PAGE

Managed Care Segment

Afternoon Session

12. (4 points) ABC Company is considering acquiring ITSA, a managed care organization

that services a number of major cities. You are the head of the claims department in the

Major Medical division and you’ve been asked to evaluate claims operations at ITSA,

including systems used to process the claims.

(a) Describe measures of claims quality.

(b) Outline basic steps you would expect to find in the ITSA claims adjudication

process.

(c) Describe specific internal data sources you should include as part of your claims

review.

(d) Describe issues that should be considered in performing an audit.

13. (4 points) You have been asked by your client at BEST HMO to create a presentation that

will enable her to convince management to establish new methods for physician

compensation.

(a) Describe traditiona l and new, alternative forms of capitation and their suitability

for specific types of physicians.

(b) Describe traditional and new, alternative forms of incentive plans.

COURSE 8: Fall 2003 - 10 - GO ON TO NEXT PAGE

Managed Care Segment

Afternoon Session

14. (5 points) You are a consultant hired by TeethFerry.com, a company hoping to use the

Internet to market dental plans. They have created a marketing communication to be sent

to companies that do not currently have a benefits program.

From: TeethFerry

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