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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 5. (9 points) you are an underwriter with wonderful life preparing the renewal for group 4. assume that the retrospective formula balance in table mm-3a is as of the end of the experience period and that pricing factors as shown in table mm-2a and mm-2b have not changed. (a) calculate group 4’s projected retrospective formula balance as of december 31, 2003 using the same assumptions as would be used for rating. show your work. (b) calculate the ee only and ee and dependents monthly renewal premiums for 2004. show your work. (c) discuss the pros and cons of various funding arrangements, both from an employer’s point of view and specifically for group 4, i. prospective experience rating, ii. retrospective experience rating, iii. self- insurance, and iv. minimum premium plans. 6. (5 points) you are evaluating wonderful life’s reserves using non-hospital claims paid in tables mm-4c and mm-4d. assume that the july 2002 completion pattern is representative of all months. (a) calculate the incurred claims for incurred months july 2003 through december 2003 using age-ultimate development factors. show your work. (b) calculate the ibnr as of december 31, 2003 for incurred months july 2003 through december 2003. show your work. (c) recommend adjustments to this approach which might produce reasonable ibnr results. course 8: fall 2004 - 5 - go to next page health, group life & managed care morning session 7. (7 points) you are the health actuary reviewing the pricing assumptions and the first three years of experience for a given product. the following information is given: classical pricing assumptions product duration: 5 years interest rates: 0.0% annual lapse rate: 20.0% target loss ratio: 60.0% tabular claims cost duration tabular claims cost selection adjustment 0 10.0 .05 1 11.0 1.1 2 12.0 1.1 3 13.0 1.1 4 14.0 1.1 experience data duration mbrs actual claims 0 1,000 6,000 1 770 10,000 2 650 11,000 3 500 - 4 350 - cumulative antiselection theory assumptions k1 = - k2 = 4 u 0.10 (a) (1 point) describe how cast differs from classical (select and ultimate) theory. (b) (2 points) calculate the gross premium using the classical pricing assumptions. show your work (c) (4 points) calculate the gross premium using cast assumptions. show your work. course 8: fall 2004 - 6 - go to next page health, group life & managed care morning session  |
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