SOA真题November2001Course8I

COURSE 8: November 2001 -1- STOP
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