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7. (7 points) you are an actuary at wonderful life and have been asked to discuss sources of profit using group 1 data as an example. in addition to the data in tables mm-1, mm-2a, mm-2b, and mm-3a, assume: • single/family manual rates for 2005 are the result of trending historical manual rates. • expenses, taxes, and investment income are expressed as the percentages from table mm-1 for 2004. (a) discuss major factors affecting financial results for the group line of business. (b) outline the various sources of profit for group insurance. (c) calculate profits by source for group 1 for the experience period. show your work. course 8: fall 2005 -8- go to next page health, group life & managed care 8. (7 points) you are the consulting actuary for acme, inc. they are interested in offering a patient directed healthcare benefit (pdhb) plan with the following structure: option 1 • multi-plan option plus flexible spending account (fsa), • employer provides core contribution, offers multiple health plan choices, and sets menu. option 2 • high deductible plan plus fsa plus personal health account (pha), • employer provides core contribution, access to multiple high deductible plans, and segregated pha’s. (a) describe factors that are making consumerism a significant trend. (b) compare and contrast the key dimensions of pdhb’s as they relate to the two options acme is considering. (c) describe the healthcare challenges that can be addressed by pdhb’s with respect to: i. employees ii. employers course 8: fall 2005 -9- go to next page health, group life & managed care 9. (5 points) you are the pricing actuary for enamel insurance company (eic). eic is interested in adding a dental product to its portfolio and has asked you to prepare a report to senior management. (a) describe ways to control dental claims costs. (b) describe the underwriting and rating parameters used for dental insurance. course 8: fall 2005 -10- stop health, group life & managed care 10. (3 points) you are the valuation actuary for belt and suspenders health insurance company. your company offers a variety of health products that may require a variety of methods for determining claim liabilities. (a) describe considerations which might influence the level of conservatism targeted for a given block of business. (b) describe approaches to introducing conservatism into each of the common methods used to compute claim liabilities. course 8: fall 2005 - 11 - go to next page managed care segment **beginning of examination** managed care segment beginning with question 11 11. (4 points) regarding claims practices for short term disability (std) coverages: (a) describe the tools available to challenge questionable std claims. (b) discuss methods, including the pros and cons for measuring overall std claims levels. (c) describe the sources of information available to a claims examiner regarding std claims. course 8: fall 2005 - 12 - go to next page managed care segment 12. (4 points) you are an actuary responsible for developing your company’s financial forecast models. recently your company has improved access and quality of data. the chief actuary is now encouraging you to incorporate additional situations in forecast modeling. (a) (3 points) discuss basic principles for designing forecast models. (b) (1 point) outline ways in which forecast modeling can influence company actions to help achieve business objectives. course 8: fall 2005 - 13 - go to next page managed care segment 13. (8 points) you are the chief actuary for abc insurance company. you are considering purchasing an individual insurance block of business but are concerned about abc’s ability to administer such business. (a) discuss the steps an agent goes through in selling and servicing individual health insurance policies. (b) describe considerations in plan design, pricing, and distribution channels. (c) describe the typical underwriting considerations for individual health insurance. (d) describe elements included in rating classification systems. (e) explain types of premium guarantees that could be offered. course 8: fall 2005 - 14 - go to next page managed care segment 14. (4 points) you are the valuation actuary for tat health insurance company. you are concerned about the increase in turn around time for claim payment and have been working with the manager of the claims area to address this concern. (a) describe the basic purposes of claims and benefits administration. (b) discuss the common problems seen in claims and benefits administration and their ramifications. (c) outline the basic principles of inventory management and mechanisms for inventory control. course 8: fall 2005 - 15 - go to next page managed care segment questions 15 – 18 pertain to the case study |
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