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  #121  
Old 11-01-2018, 04:39 PM
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SnareSound SnareSound is offline
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BTW, I just used copay / coins for dental Q as well. And I couldn't rack my brain for MCOs in Medicaid cards and went with FFS and Capitated, though I was super nonspecific. No heart to look up answers as those cards are staying put for at least 6 weeks.
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  #122  
Old 11-01-2018, 04:43 PM
gary786 gary786 is offline
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Originally Posted by SnareSound View Post
BTW, I just used copay / coins for dental Q as well. And I couldn't rack my brain for MCOs in Medicaid cards and went with FFS and Capitated, though I was super nonspecific. No heart to look up answers as those cards are staying put for at least 6 weeks.
For some reason I guess I didnít understand the question and felt the need to write a page about the incredible benefits of LTSS Medicaid managed care.
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  #123  
Old 11-01-2018, 04:44 PM
GSUACT GSUACT is offline
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does anyone remember those minor dental question,
the first one(1-pt question) is asking types of dental product(indemnity, ppo, hmo etc)
then it ask why choose PPO(1-point question)?

then another question(2-point question) is the risk associated the two things: entering the market, price the product(cann't remember well),
how to approach this one? are we supposed to say about those factors affecting dental costs(such as min group size, participation rate, exclude certain industry, new business vs transfer business, waiting period, group with other courage, incentive coins etc) or are we supposed to say dental is quite elective, so has bad adverse selection risk
just feel the question isn't quite clear.
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  #124  
Old 11-01-2018, 04:49 PM
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They were asking to describe the differences between dental delivery systems and the PPO question on why it was a good choice. I actually gave plenty of consideration reasons for the risk associated to each before I had to go back and identify which was applied to which (i or ii). So a bit disjointed. They were pretty specific saying things like "pricing risk." I felt like plenty of them were ambiguous on exactly what portion they were asking, so in those cases I tried to take them very literally.
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  #125  
Old 11-01-2018, 05:16 PM
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WillTreaty WillTreaty is offline
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Originally Posted by gary786 View Post
1. What were some alternatives to step therapy? I put UM programs and drug adherence programs, but not sure that was applicable in that situation to reduce costs.

2. For the dental with both copays/coins, I did the max of coins and copay, similar to how it might be done for pharmacy, but not sure how we were supposed to handle that one.

3. What is the difference between MHPAEA for Medicaid vs. commercial? I knew Medicare was excluded from MHPAEA but didn't ever see anything on medicaid.

4. For the one that asks for types of actuarial statements of opinion, were we just supposed to describe Qualified/Unqualified/Adverse/Inconclusive?

5. What were the two main types of Medicaid Managed care?

6. Is it bad that any yes/no recommendations for Dr. No, I put No, and my reasoning was his name?

7. Was anyone sad not to see a CPD and/or Cafeteria Plan Nondiscrimination testing question? I was so ready for it!

8. The market for viatical settlements actually looks quite lucrative upon googling.


#3. In thinking about this and looking at the notes, Im GUESSING we were supposed to put nothing. I cant find anything specific in the TIA summaries and I found some CMS regulations describing Medicaid as it relates to MHPAEA. I would guess you could of written what is excluded (VA, Medicare, SG<50) and say Medicaid is not on the list. Not sure though

#5 I put MCO - Capitation and PCCM -FFS (I think I mis-named this though, called it patient centered care mgmt. or something) whoops.

#7 YES. I studied a fair bit on those problems.

Last edited by WillTreaty; 11-01-2018 at 05:31 PM..
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  #126  
Old 11-01-2018, 05:59 PM
imareal1 imareal1 is offline
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Didn't they ask for just one alternative to contain drug utilization?
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  #127  
Old 11-01-2018, 06:05 PM
BigBlackBen BigBlackBen is offline
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Originally Posted by imareal1 View Post
Didn't they ask for just one alternative to contain drug utilization?
I think they asked for one alternate besides step therapy.
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  #128  
Old 11-01-2018, 07:22 PM
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Sredni Vashtar Sredni Vashtar is offline
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Originally Posted by Captain Spectacular View Post
Feeling very "viatical" about this one......


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Originally Posted by rhertz View Post
ok but what about that dental plan that had a copay, coinsurance, and a deductible...did you guys make an assumption about how to evaluate plan liability?
Yeah. One of them was major, which had a deductible, copay, and coinsurance all at the same time. I think I randomly said the deductible overlapped the copay but that's obviously wrong. I was just so brain-dead tired at that point. My guess is you apply the deductible first, then the copay, then the coinsurance to the remainder, but don't know.

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Originally Posted by RTJR412 View Post
This is what I'm wondering too, what needed to be done to merit 6 points? I could only think of adjusting the few items based on the reserve change, but maybe there is more I am missing.

I find it hard to believe it'd be 6 points for mostly copying things from one page to another that didn't change. However, I may be talking myself into that since for my "revised" statements I wrote in the new values for stuff that changed, but then wrote *No changes to this section* for the remaining items and totaled up the new value.
Yeah. That one was nuts. I wonder if anyone got it "right".

I also really didn't know what to do with the statement! Were we to assume the unpaid claims were a new expense??? Seemed unlikely given the word reserve.

I DO KNOW that somehow we had to balance the balance sheet. You can't just add a liability, right? It has to add up, so either new assets (current assets?) or less equities (retained earnings?). No idea though.

And then also it was a 6 point-question, where 12 of the 18 minutes were spent wondering why there is no 2015.


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Originally Posted by GSUACT View Post
what's that traditional MLR, is it just clm/premium?
Yes, I think so. I'm not sure there's even an exact definition.

Quote:
does the self-insured Large group exempt from all the MLR calculation, i just left it out for all calculation(only do SG ACA and SG GF combined, and do LG FI)
I think so? I did the calcs.

I strongly suspect one of the SG's was missing a 0 as well, since the MLR was like 1000%.


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Originally Posted by bemused View Post
I think the worst part of this test is how much of it's anti-knowledge doesn't even get tested
Yup. I'm angry I missed the only Canada question despite knowing provincial details for no good reason. Along with LTC and obscure Life Riders and the (dis)functional method of selecting employee benefits.

Quote:
I realize this doesn't really relate to this sitting but there's a concerning lack of whining in this thread so I figured I'd pull double duty
WOULD YOU LIKE RED OR WHITE BECAUSE HERE IS MORE WHINING.

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Originally Posted by SnareSound View Post
Did anyone try to interpolate the life question in the afternoon from the case study where the age ranges in the question were off by a year from the manual rates? I laughed out loud and wrote something about the time constraints of the work at hand dictating the accuracy here. It already was too much time to work that problem vs the allotted points.
Nope. I meant to bump the counts by 1/5 up the ladder, but was so bone-dead brain-dead tired that I didn't even make a note there.

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Originally Posted by GSUACT View Post
agree that problem #3 related to case study is such a crap, initially i thought we should say going from Statutory(as shown in goldfinger Balance sheet) reserve to GAAP reserve by removing those consertative standard(lapse, prescribed asset value, interest rate, DAC, expense allowance etc). then i think the case study doesnt have any related info to resolve this, so i think i am thinking in the wrong way.
in the end i just wrote that that the GAAP reserve should be the best estimate plus PAD(provision for adverse deviation).
it's a terrible question. but i think it looks like everyone is struggle with this one. can someone who know how to approach this question plz stand up on this forum?
I did the same, but I think that's wrong, since the question explicitly said that it was already a best estimate. So it seemed to defeat the whole-- "make it a better estimate" answer.

Maybe they were fishing for mandatory interest rates though? I don't know. I guess that would affect unpaid claim reserves. I don't think any other STAT rule does.

I think it was one of those times they want you to know a note-card, but they don't want to make it obvious which card they're asking for, so they make it too vague to be realistic. Very frustrating meta-game.

Quote:
Originally Posted by GSUACT View Post
does anyone remember those minor dental question,
the first one(1-pt question) is asking types of dental product(indemnity, ppo, hmo etc)
then it ask why choose PPO(1-point question)?
I answered this one honestly. Something like-- "well we are a big insurance company so we can already do all the PPO stuff well."

Quote:
then another question(2-point question) is the risk associated the two things: entering the market, price the product(cann't remember well),
how to approach this one? are we supposed to say about those factors affecting dental costs(such as min group size, participation rate, exclude certain industry, new business vs transfer business, waiting period, group with other courage, incentive coins etc) or are we supposed to say dental is quite elective, so has bad adverse selection risk
just feel the question isn't quite clear.
Yeah, you're right. I think it was a super vague way of asking you to vomit up two specific Mate cards, and I have no idea which ones. Probably a good idea to just spit them all.

Quote:
Originally Posted by mm9262 View Post
In Q1 of the morning session about calculating the APBO for 4 different employees, the question said the trend rate decreases annually from 8% to 5%, but the cumulative trend factors provided in the table went down to 4%. I couldn't tell if that was intended to be a trick or if it was just another typo
Quote:
Originally Posted by ylee70 View Post
I was thinking exactly the same thing. At this point, after seeing issues on #3 and all, I can’t tell if it was a trick or another oversight.

Noticing that, I had to do all of the tedious trend projection and PV calculation.. thought it was a huge waste of time
I think it was an oversight. It's not like 8 years of trends/discounts was enough to answer the question anyway. Also yes, it just made the already dumb long question even dumber and longer. I remember getting to the end of a calculation and my calculator didn't have space for the last exponent... And I

I really just regret not explaining what I was doing there, since there's no way in hell I got the numbers all right.

Quote:
Originally Posted by gary786 View Post
1. What were some alternatives to step therapy? I put UM programs and drug adherence programs, but not sure that was applicable in that situation to reduce costs.
ditto

Quote:
3. What is the difference between MHPAEA for Medicaid vs. commercial? I knew Medicare was excluded from MHPAEA but didn't ever see anything on medicaid.
I put medicaid was excluded since medicaid is so weird and government plans always get those kinds of breaks.... But yeah you're probably right. Trick question.

Quote:
4. For the one that asks for types of actuarial statements of opinion, were we just supposed to describe Qualified/Unqualified/Adverse/Inconclusive?
Yeah? Seemed like a lot of points for being like: "Adverse means my opinion is quite adverse."

Quote:
5. What were the two main types of Medicaid Managed care?
I think there's like an HMO thing... called something... MCO maybe? MMCO?
And something else that's just PCP capitation with fees for everything else...
PCPPOHMOBBQFTW. probably.

Quote:
6. Is it bad that any yes/no recommendations for Dr. No, I put No, and my reasoning was his name?
Dr. No that's not bad.

Is it bad I answered the viatical question with "lol what?"
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Last edited by Sredni Vashtar; 11-02-2018 at 10:42 AM..
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  #129  
Old 11-01-2018, 07:26 PM
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Sredni Vashtar Sredni Vashtar is offline
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OH finally dumb question-- what was with the 2nd APBO question in the morning?

Something about the plan changing, so prior service I assume?

But I couldn't think of any way to calculate the new APBO given the like 3 assumptions they offered.
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  #130  
Old 11-01-2018, 07:30 PM
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SnareSound SnareSound is offline
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I presumed that the SF group in the MLR question that it was just as it said: that was fees only. So you had to add claims to that for traditional denominator. Which is definitely claims / prems.
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