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13. (5 points) you are the cfo of a start-up insurance company. you are in the process of determining your minimum required surplus and designing a system for measuring capital, profit, and growth. (a) describe the insurance risks that should be considered when setting minimum surplus requirements. (b) discuss the necessary considerations when designing a system for measuring capital, profit, and growth. (c) discuss and illustrate with formulas how capital, profit, and growth inter-relate. course 8: fall 2004 - 10 - go to next page managed care segment afternoon session 14. (5 points) paul and leslie, who are both in their 30’s, were recently married and are meeting with an agent to discuss their financial plans. paul works on contract as a motivational speaker and has no employee benefits. he earns $50,000 a year. leslie works for a financial institution which has a flexible benefits plan including std and ltd. leslie earns a base salary of $50,000 per year and earned a bonus of $5,000 last year. paul is considering the following disability plan: type: individual disability income waiting period: 30 days definition of disability: own occupation to 65 benefit amount: $2500 per month benefit term: 5 years leslie is currently enrolled in the following option in the flex plan: type: ltd std elimination period: 4 months definition of disability: 2 year own occupation, then any occupation to 65 benefit amount: 60% of salary 100% of salary for 2 months, 75% of salary thereafter funded: 100% employee paid indexing: 3% per annum on disability anniversary (a) compare and contrast the underwriting criteria used for individual and group disability policies. (b) describe how these criteria would apply specifically to paul and leslie. (c) describe how benefits would be determined and calculate paul and leslie’s cashflow if they were both injured in a car accident and were unable to work for 5 years. show your work. course 8: fall 2004 - 11 - go to next page managed care segment afternoon session 15. (6 points) you are a consulting actuary for the health insurance company of unaffiliated providers (hicup). the chief actuary of hicup is considering entry into the medicare plus choice (m+c) market in their area and approached you for advice. they want to offer m+c coverage in golden years county where over 70% of residents are of retirement age. there are already two other companies offering m+c policies in this area. since hicup does not have experience in the m+c market, you have been asked to prepare a report to discuss requirements of entry into this market. you have explained that medicare plus choice is now known as medicare advantage and hcfa is now known as cms. although there will be further changes in the program, you have based your initial report on the 2004 rules. (a) outline and provide details of specific rules required by legislation to enter into a m+c contract and decisions hicup will need to make at entry. (b) contrast other product options available to hicup for the senior population and their advantages and disadvantages. (c) outline the cms m+c filing process and payment mechanism with sufficient details for the chief actuary to make a presentation to hicup’s board. 16. (5 points) you are a consulting actuary to abc hmo. the ceo has asked you to provide a report on changes in approaches to addressing behavioral health benefits provided by managed care plans. (a) discuss emerging strategic approaches to managing behavioral health benefits. (b) outline strategies mcos are using to improve clinical outcomes. (c) describe utilization review and case management techniques consistent with these strategies. (d) discuss considerations you would make to determine whether a capitated arrangement to a behavioral health specialty group is appropriate for their business. course 8: fall 2004 - 12 - go to next page managed care segment afternoon session questions 17 – 19 pertain to the case study 17. (5 points) the pcps of ipa 3 are considering joining ipa 1. (a) discuss reimbursement structures for pcps and advantages and disadvantages of each from the pcp’s perspective. (b) discuss advantages and disadvantages for ipa 3 pcps in joining ipa 1 and recommend actions ipa3 pcps could take to address the disadvantages. (c) discuss advantages and disadvantages from the bedford group’s perspective of the potential shift of ipa 3 pcps to ipa 1. course 8: fall 2004 - 13 - go to next page managed care segment afternoon session questions 17 – 19 pertain to the case study   |
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