COURSE 8: Fall 2004 - 1 - GO TO NEXT PAGE
Health, Group Life & Managed Care
Morning Session
**BEGINNING OF EXAMINATION**
HEALTH, GROUP LIFE & MANAGED CARE
MORNING SESSION
1. (4 points) You are an actuary for a reinsurance company. A business school professor at
a local university has invited you to be a guest lecturer on the topic, “Reinsurance
Program Management.”
Outline and describe the contents of your presentation, with respect to:
i. information a reinsurance company should seek in order to decide whether to
offer reinsurance to a customer
ii. practices a reinsurer should follow to maintain a profitable reinsurance portfolio.
2. (5 points) You have been asked by your local Chamber of Commerce to speak on the
topic of patient-directed healthcare benefit programs (PDHBs).
(a) Describe key features of the principal types of PDHBs.
(b) Contrast variations between types of PDHBs with respect to:
i. extent to which consumers perceive money spent as their own when
making healthcare cost and value judgments,
ii. consumer flexibility in directing the use of employer-provided and
personal healthcare funds,
iii. extent of employer involvement in plan design and administration.
(c) Identify possible changes in the U.S. tax rules that could encourage the use of
PDHBs.
COURSE 8: Fall 2004 - 2 - GO TO NEXT PAGE
Health, Group Life & Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study
3. (8 points) You are the pric ing actuary for Wonderful Life and have been asked by the
underwriter assigned to Group 6 to help her prepare for a meeting with the group’s CFO.
In addition to Tables MM-2b and MM-3b, you have been given the following
information:
Prior Rating Period Data: Experience period July 1, 2001 through June 30, 2002
Group 6 Composite Age/Sex Factor
Option 1 1.03
Option 2 0.85
(a) Describe macro-economic variables that may affect health care trend rates.
(b) Describe other trend components that may cause trends to vary.
(c) Discuss the relationship of historical trends and rating trend assumptions.
(d) Calculate the total percentage increase in Group 6’s claims cost per employee and
calculate components of their claims trend for which sufficient data are available.
COURSE 8: Fall 2004 - 3 - GO TO NEXT PAGE
Health, Group Life & Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study
4. (6 points) You are an underwriter for Wonderful Life preparing a proposal for Bailey
Industries to replace their current dental plan with a managed dental care plan.
Bailey Industries goals are as follows:
•limit complexity
•avoid adverse selection
•avoid employee dissatisfaction due to provider disruption
•maintain current employer contributions and plan design
(a) Describe the features for each of the general types of dental benefit delivery
systems.
(b) Develop a chart ranking the plan types along the following parameters: premium,
patient access, benefit richness, cost management, utilization, quality assurance,
and fraud potential.
(c) Evaluate the possible delivery systems based on Bailey Industries goals and make
a recommendation as to a delivery system. Justify your response.
COURSE 8: Fall 2004 - 4 - GO TO NEXT PAGE
Health, Group Life & Managed Care
Morning Session
Questions 3 – 6 pertain to the Case Study

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