8. (6 points) You are evaluating Wonderful Life’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

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