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Contact Person: |
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Gayle Neuman |
Review Requirements Checklist |
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217-524-6497 |
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Effective as of 8/25/06
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Line(s) of
Business |
Code(s) |
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___MEDICAL
MALPRACTICE |
11.0000 |
***This checklist is
for rate/rule |
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___Claims Made |
11.10000 |
filings only. |
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___Occurrence |
11.2000 |
See separate form checklist. |
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Line(s) of Insurance |
Code(s) |
Line(s) of Insurance |
Code(s) |
Line(s) of Insurance |
Code(s) |
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___Acupuncture |
11.0001 |
___Hospitals |
11.0009 |
___Optometry |
11.0019 |
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___Ambulance Services |
11.0002 |
___Professional Nurses |
11.0032 |
___Osteopathy |
11.0020 |
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___Anesthetist |
11.0031 |
___Nurse – Anesthetists |
11.0010 |
___Pharmacy |
11.0021 |
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___Assisted Living Facility |
11.0033 |
___Nurse – Lic. Practical |
11.0011 |
___Physical Therapy |
11.0022 |
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___Chiropractic |
11.0003 |
___Nurse – Midwife |
11.0012 |
___Physicians & Surgeons |
11.0023 |
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___Community |
11.0004 |
___Nurse – Practitioners |
11.0013 |
___Physicians Assistants |
11.0024 |
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___Dental Hygienists |
11.0005 |
___Nurse – Private Duty |
11.0014 |
___Podiatry |
11.0025 |
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___Dentists |
11.0030 |
___Nurse – Registered |
11.0015 |
___Psychiatry |
11.0026 |
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___Dentists – General Practice |
11.0006 |
___Nursing Homes |
11.0016 |
___Psychology |
11.0027 |
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___Dentists – Oral Surgeon |
11.0007 |
___Occupational Therapy |
11.0017 |
___Speech Pathology |
11.0028 |
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___Home Care Service Agencies |
11.0008 |
___Ophthalmic Dispensing |
11.0018 |
___Other |
11.0029 |
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Product
Coding Matrix
Link |
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NAIC
Uniform Transmittal Form |
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If insurers wish to use
the NAIC Uniform Transmittal form in lieu of a cover letter/explanatory
memorandum, the Department will accept such form, as long as all information
required in the “Cover Letter & Explanatory Memorandum”
section below are properly included. |
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NAIC Self-Certification
Pilot Program |
Newsletter Article regarding Department's Participation |
If an authorized
company officer completes the Self-Certification form, and submits such form
as the 1st page of the filing, the Department will expedite review
of the filing ahead of all other filings received to date. The Department will track company compliance
with the laws, regulations, bulletins, and this checklist and report such
information to the NAIC. |
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Location of Standard
within Filing Column |
See checklist format
below. |
To expedite review of
your filing, use this column to indicate location of the standard within the
filing (e.g. page #, section title, etc.)
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Description of Review
Standards Requirements Column |
See checklist format
below. |
These
brief summaries do not include all requirements of all laws, regulations,
bulletins, or requirements, so review actual law, regulation, bulletin, or
requirement for details to ensure that forms are fully compliant before
filing with the Department of Insurance. |
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FILING
REQUIREMENTS FOR FORM FILINGS |
REFERENCE |
DESCRIPTION OF REVIEW STANDARD REQUIREMENT
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See separate form
filing checklist. |
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To assist insurers in
submitting compliant medical liability rate/rule filings as a result of
newly-passed PA94-677 (SB475), the Department has created this separate,
comprehensive rate/rule filing checklist for medical liability filings.
Please see the separate
form filing checklist for requirements related to medical liability forms. |
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GENERAL
FILING REQUIREMENTS FOR ALL RATE/RULE FILINGS |
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LINE
OF AUTHORITY |
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Must have proper Class
and Clause authority to conduct this line of business in |
To write Medical Liability
insurance in
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RATES
AND RULES REQUIRED TO BE FILED |
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Rates/Rules Must be Filed Separately from Forms |
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Insurers shall make
separate filings for rate/rules and for forms/endorsements, etc. |
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The laws and regulations
for medical liability forms/endorsements and the laws for medical liability
rates/rules are different and each must be reviewed according to its own set
of laws/regulations/procedures. Therefore,
insurers are required to file forms and rates/rules separately. For requirements
regarding form filings, see separate form filing checklist. |
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New Insurers |
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New insurers must file
their rates, rules, plans for gathering statistics, etc. upon commencement of
business. |
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“New
Insures” are insurers who are: ·
New to ·
New writers of
medical liability insurance in ·
Writing a new
Line of Insurance listed on Page 1 of this checklist, New
insurers must file the following: a) Medical liability insurance rate manual,
including all rates. b) Rules, including underwriting rule manuals
which contain rules for applying rates or rating plans, c) Classifications and other such schedules
used in writing medical liability insurance.
d) Statement regarding whether the insurer: ·
Has its own plan
for the gathering of medical liability statistics; or ·
Reports its
medical liability statistics to a statistical agent (and if so, which agent). The
Director, at any time, may request a copy of the insurer’s statistical
plan or request the insurer to provide written verification of membership and
reporting status from the insurer’s reported statistical agency. Insurers
are instructed to review all requirements in this checklist, including the
requirements for applicable actuarial documentation, as well as all medical
liability laws and regulations, to ensure that the filing contains all
essential elements before submitting the filing to the Department. |
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Amendments to Initial Rate/Rule Filings |
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After a new insurer has
filed the rates/rules/information described above, insurers must file
rates/rules, or advise of changes to statistical plans, as often as they are
amended. |
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After
a new insurer has filed the rates/rules/information described above, insurers
must file rates/rules/rating schedules (as described above for new business)
as often as such filings are changed or amended, or when any new rates or
rules are added. Any change in premium to the company's insureds as a result of
a change in the company's base rates or a change in its increased limits
factors shall constitute a change in rates and shall require a filing with
the Director. Insurers
shall also advise the Director if its plans for the gathering of statistics
has changed, or if the insurer has changed statistical agents. The
Director, at any time, may request a copy of the insurer’s statistical
plan or request the insurer to provide written verification of membership and
reporting status from the insurer’s reported statistical agency. Insurers
are instructed to review all requirements in this checklist, including the
requirements for applicable actuarial documentation, as well as all medical
liability laws and regulations, to ensure that the filing contains all
essential elements before submitting the filing to the Department. |
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EFFECTIVE DATES OF RATE/RULE FILINGS |
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A rate/rating plan/rule
filing shall go into effect no earlier than the date the filing is received
by the Department of Insurance, Property & Casualty Compliance Section,
except as otherwise provided in Section 155.18. |
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ADOPTIONS OF ADVISORY ORGANIZATION FILINGS |
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Insurer must file all
rates and rules on its own behalf. |
Although Rule 929
allows for insurers to adopt advisory organization rule filings, advisory
organizations no longer file rules in |
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COPIES,
RETURN ENVELOPES, ETC. |
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Requirement for
duplicate copies and return envelope with adequate postage. |
Insurers that desire a
stamped returned copy of the filing or submission letter must submit a
duplicate copy of the filing/letter, along with a return envelope large
enough and containing enough postage to accommodate the return filing. |
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COVER
LETTER & EXPLANATORY MEMORANDUM |
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Two copies of a
submission letter are required, and the submission letter must contain the
information specified. "Me too" filings are not allowed. Use of NAIC Uniform Transmittal form is acceptable as long as
all required information is included. |
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All filings must be
accompanied by a submission letter which includes all of the following
information: 1) Exact
name of the company making the filing. 2)
Federal Employer Identification Number (FEIN) of the company making the filing. 3) Unique filing identification number –
may be alpha, numeric, or both. Each
filing number must be unique within a company and may not be repeated on
subsequent filings. If filing subsequent
revisions to a pending filing, use the same filing number as the pending
filing or the revision(s) will be considered a new filing. 4) Identification of the classes of medical
liability insurance to which the filing applies (for identifying classes,
refer to Lines of Insurance shown on Page 1 of this checklist, in compliance
with the NAIC Product Coding Matrix). 5) Notification of whether the filing is new
or supersedes a present filing. If
filing supersedes a present filing, insurer must identify all changes in
superseding filings, and all superseded filings, including the
following information: ·
Copy of the
complete rate/rule manual section(s) being changed by the filing with all
changes clearly highlighted or otherwise identified. ·
Written statement
that all changes made to the superseded filing have been disclosed. ·
List of all pages
that are being completely superseded or replaced with new pages. ·
List of pages
that are being withdrawn and not being replaced. ·
List of new pages
that are being added to the superseded filing. ·
Copies of all
manual pages that are affected by the new filing, including but not limited
to subsequent pages that are amended solely by receiving new page numbers. 6) Effective
date of use. 7) Actuarial
certification (see Actuarial Certification section below). Insurers may use their own form or may use
the sample form developed by the Department. 8) Statement that the insurer, in offering,
administering, or applying the filed rate/rule manual and/or any amended
provisions, does not unfairly discriminate. Companies
under the same ownership or general management are required to make separate,
individual company filings. Company Group ("Me too") filings
are unacceptable. If insurers wish to use the NAIC Uniform Transmittal form in
lieu of a cover letter/explanatory memorandum, the Department will accept such
form, as long as all information required in this section is properly
included. |
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FORM
RF-3 Summary Sheet |
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For any rate change, duplicate
copies of Form RF-3 must be filed, no later than the effective date. |
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For any
rate level change, insurers must file two copies of Form RF-3 (Summary Sheet)
which provides information on changes in rate level based on the
company’s premium volume, rating system, and distribution of business
with respect to the classes of medical liability insurance to which the rate
revision applies. Such forms must be
received by the Department’s Property & Casualty Compliance Section
no later than the stated effective date of use. Insurers
must report the rate change level and premium volume amounts on the
“Other” Line and insert the words “Medical Liability”
on the “Other” descriptive line.
Do not list the information on the "Other Liability" line. If
the Medical Liability premium is combined with any other Lines of Business (e.g.
CGL, commercial property, etc.), the insurer must report the effect of rate
changes to each line separately on the RF-3, indicating the premium written
and percent of rate change for each line of business. The RF-3 form must
indicate whether the information is "exact" or
"estimated." |
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PAYMENT PLANS |
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Quarterly premium
payment installment plan required as prescribed by the Director. |
A company writing
medical liability insurance in ·
May not require
more than 40% of the estimated total premium to be paid as the initial
payment; ·
Must spread the
remaining premium equally among the 2nd, 3rd, and 4th
installments, with the maximum set at 30% of the estimated total premium, and
due 3, 6, and 9 months from policy inception, respectively; ·
May not apply
interest charges; ·
May include an
installment charge or fee of no more than the lesser of 1% of the total
premium or $25; ·
Must spread any
additional premium resulting from changes to the policy equally over the
remaining installments, if any. If
there are no remaining installments, the additional premium may be billed
immediately as a separate transaction; and ·
May, but is not
required to offer payment plan for extensions of a reporting period, or to
insureds whose annual premiums are less than $500. However, if offered to either, the plan
must be made available to all within that group. |
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DEDUCTIBLES |
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Deductible plans should
be filed if offered. |
A company writing
medical liability insurance in |
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DISCOUNTS |
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Premium discount for
risk management activities should be filed if offered. |
A company writing
medical liability insurance in |
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CLAIMS MADE REQUIREMENTS |
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Extended reporting
period (tail coverage) requirements. |
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When issuing
claims-made medical liability insurance policies, insurers must include the
following specific information in their rate/rule manuals: ·
Offer of an extended
reporting period (tail coverage) of at least 12 months. The rate/rule manual must specify whether
the extended reporting period is unlimited or indicate its term (i.e. number
of years).*** ·
Cost of the
extended reporting period, which must be priced as a factor of one of
the following:*** o
the last 12
months' premium. o
the premium in
effect at policy issuance. o
the expiring
annual premium. ·
List of any
credits, discounts, etc. that will be added or removed when determining the
final extended reporting period premium. ·
Insurer will inform
the insured of the extended reporting period premium at the time the last
policy is purchased. The insurer may not wait until the insured requests to
purchase the extended reporting period coverage to tell the insured what the
premium will be or how the premium would be calculated. ·
Insurer will offer
the extended reporting period when the policy is terminated for any reason,
including non-payment of premium, and whether the policy is terminated at the
company's or insured's request. ·
Insurer will allow
the insured 30 days after the policy is terminated to purchase the extended
reporting period coverage.***
***If
the medical liability coverage is combined with other professional or general
liability coverages, the medical liability insurer must meet all of the above
requirements, except those indicated with ***, in which case, the insurer
must: ·
Offer free 5-year
extended reporting period (tail coverage) or ·
Offer an
unlimited extended reporting period with the limits reinstated (100% of
aggregate expiring limits for the duration) ·
Cap the premium
at 200% of the annual premium of the expiring policy; and ·
Give the insured
a free-60 day period after the end of the policy to request the coverage. |
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GROUP MEDICAL LIABILITY |
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Group medical liability
insurance is not specifically allowed under the Illinois Insurance Code. |
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Part 906 of the Illinois Administrative Code prohibits writing
of group casualty (liability) insurance unless specifically authorized by
statute. The Illinois Insurance Code
does not specifically authorize the writing of group medical liability
insurance. |
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CANCELLATION & NONRENEWAL PROVISION REQUIREMENTS |
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If rate/rule manuals
contain language pertaining to cancellation or nonrenewal, must comply with
all cancellation/nonrenewal laws. |
See Medical Liability
Forms Checklist for Specific Information about |
If a rate or rule
manual contains language pertaining to cancellation or nonrenewal of any
medical liability insurance coverage, such provisions must comply with all
cancellation and nonrenewal provisions of the Illinois Insurance Code,
including but not limited to the following:
143.10, 143.16, 143.16a, 143.17a.
See Medical Liability Forms Checklist for Specific Information about |
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ACTUARIAL
REVIEW REQUIREMENTS |
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Rates shall not be
excessive, inadequate, or unfairly discriminatory. |
In the making or use of
rates pertaining to all classes of medical liability insurance, rates shall
not be excessive, or inadequate, nor shall they be unfairly discriminatory. Rate and rule manual
provisions should be defined and explained in a manner that allows the
Department to ascertain whether the provision could be applied in an unfairly
discriminatory manner. For example, if
a rate/rule manual contains ranges of premiums or discounts, the provision
must specify the criteria to determine the specific premium/discount an
insured or applicant would receive. The Director may, by
order, adjust a rate or take any other appropriate action at the conclusion
of a public hearing. |
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PRICING |
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Insurers shall consider
certain information when developing medical liability rates. |
Consideration shall be
given, to the extent applicable, to past and prospective loss experience
within and outside this State, to a reasonable margin for underwriting profit
and contingencies, to past and prospective expenses both countrywide and
those especially applicable to Consideration may also be given in the making and use of rates to dividends, savings or unabsorbed premium deposits allowed or returned by companies to their policyholders, members or subscribers. The systems of expense provisions included in the rates for use by any company or group of companies may differ from those of other companies or groups of companies to reflect the operating methods of any such company or group with respect to any kind of insurance, or with respect to any subDepartment or combination thereof. |
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Minimum
Premium Rules |
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Insurers may group or
classify risks for establishing rates and minimum premiums. |
Risks may be grouped by
classifications for the establishment of rates and minimum premiums. |
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“A”
RATED RISKS |
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Individual Risk Rating |
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Risks may be rated on
an individual basis as long as all provisions required in Section 155.18 are
met. |
Classification rates
may be modified to produce rates for individual risks in accordance with
rating plans which establish standards for measuring variations in hazards or
expense provisions, or both. Such standards may measure any difference among
risks that have a probable effect upon losses or expenses. Such classifications
or modifications of classifications of risks may be established based upon
size, expense, management, individual experience, location or dispersion of
hazard, or any other reasonable considerations, and shall apply to all risks
under the same or substantially the same circumstances or conditions. The
rate for an established classification should be related generally to the
anticipated loss and expense factors or the class. |
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RISK CLASSIFICATION |
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Risks may be grouped by
classifications. |
Risks may be grouped by
classifications for the establishment of rates and minimum premiums. |
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Rating decisions based
solely on domestic violence. |
No insurer may that
issues a property and casualty policy may use the fact that an applicant or
insured incurred bodily injury as a result of a battery committed against
him/her by a spouse or person in the same household as a sole reason for a
rating decision. |
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Unfair methods of
competition or unfair or deceptive acts or practices defined. |
It is an unfair method
of competition or unfair and deceptive act or practice if a company makes or
permits any unfair discrimination between individuals or risks of the same
class or of essentially the same hazard and expense element because of the
race, color, religion, or national origin of such insurance risks or
applicants. |
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Procedure as to unfair
methods of competition or unfair or deceptive acts or practices not defined. |
Outlines the procedures
the Director follows when he has reason to believe that a company is engaging
in unfair methods of competition or unfair or deceptive acts or practices. |
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Territorial Definitions |
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Rate/rule manuals must
contain correct and adequate definitions of |
When an insurer’s
rate/rule program includes differing territories within the State of |
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ACTUARIAL
SUPPORT INFORMATION REQUIRED |
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ACTUARIAL CERTIFICATION |
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Actuarial certification
must accompany all rate filings and all rule filings that affect rates. |
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Every rate and/or rating rule filing must include a
certification by an officer of the company and a qualified actuary
that the company’s rates and/or rules are based on sound actuarial
principles and are not inconsistent with the company’s experience. Insurers may use their own form or may use the sample form
created by the Department. |
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ACTUARIAL OR STATISTICAL INFORMATION |
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Director may request
actuarial and statistical information. |
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The Director may
require the filing of statistical data and any other pertinent information
necessary to determine the manner of promulgation and the acceptability or
unacceptability of a filing for rules, minimum premiums, rates, forms or any
combination thereof. If the Director
requests information or statistical data to determine the manner the insurer
used to set the filed rates and/or to determine the reasonableness of those
rates, as well as the manner of promulgation and the acceptability or
unacceptability of a filing for rules, minimum premiums, or any combination
thereof, the insurer shall provide such data or information within 14
calendar days of the Director’s request. |
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Explanatory Memorandum |
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Insurers shall include
actuarial explanatory memorandum with any rate filing, as well as any rule
filing that affects the ultimate premium. |
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Insurers shall include
actuarial explanatory memorandum with any rate filing, as well as any rule
filing that affects the ultimate premium.
The explanatory memorandum shall contain, at minimum, the following
information: ·
Explanation of
ratemaking methodologies. ·
Explanations of
specific changes included in the filing. ·
Narrative that
will assist in understanding the filing. |
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Summary of Effects Exhibit |
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Insurers shall include
an exhibit illustrating the effect of each change and calculation indicating
how the final effect was derived. |
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Insurers shall include
an exhibit illustrating the effect of each individual change being made in
the filing (e.g. territorial base rates, classification factor changes,
number of exposures affected by each change being made, etc.), and include a
supporting calculation indicating how the final effect was derived. |
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Actuarial Indication |
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Insurers shall include
actuarial support justifying the overall changes being made. |
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Insurers shall include
actuarial support justifying the overall changes being made, including but
not limited to: ·
Pure premiums (if
used). ·
Earned premiums. ·
Incurred losses. ·
Loss development
factors. ·
Trend factors. ·
On-Level factors. ·
Permissible loss
ratios, etc. |
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Loss Development Factors and Analysis |
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Insurers shall include
support for loss development factors and analysis. |
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Insurers shall include
actuarial support for loss development factors and analysis, including but
not limited to loss triangles and selected factors, as well as support for
the selected factors. |
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Ultimate Loss Selections |
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Insurers shall include
support for ultimate loss selections. |
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Insurers shall include
support for ultimate loss selections, including an explanation of selected
losses if results from various methods differ significantly. |
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Trend Factors and Analysis |
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Insurers shall include
support for trend factors and analysis. |
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Insurers shall include
support for trend factors and analysis, including loss and premium trend
exhibits demonstrating the basis for the selections used. |
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On-Level Factors and Analysis |
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Insurers shall include
support for on-level factors and analysis. |
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Insurers shall include
support for on-level factors and analysis, including exhibits providing
on-level factors and past rate changes included in calculations. |
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Loss Adjustment Expenses |
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Insurers shall include
support for loss adjustment expenses. |
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Insurers shall include
support for loss adjustment expenses, including exhibits providing
documentation to support factors used for ALAE and ULAE. If ALAE is included in loss development
analysis, no additional ALAE exhibit is required. |
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Expense Exhibit |
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Insurers shall include
an expense exhibit. Insurers may use
expense provisions that differ from those of other companies or groups of
companies. |
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Insurers shall include
an exhibit indicating all expenses used in the calculation of the permissible
loss ratio, including explanations and support for selections. The systems of expense
provisions included in the rates for use by any company or group of companies
may differ from those of other companies or groups of companies to reflect
the operating methods of any such company or group with respect to any kind
of insurance, or with respect to any subDepartment or combination thereof. |
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Investment Income Calculation |
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Insurers shall include
an exhibit for investment income calculation. |
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Insurers shall include
an exhibit demonstrating the calculation for the investment income factor
used in the indication. |
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Profit and Contingencies Calculation |
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Insurers shall include
an exhibit for profit and contingencies load. |
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Insurers shall include
an exhibit illustrating the derivation of any profit and contingencies
load. |
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Credibility Standard Used |
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Insurers shall include
the number of claims being used to calculate the credibility factor. |
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Insurers should include
the number of claims being used to calculate the credibility factor. If
another method of calculating credibility is utilized, insurers should
include a description of the method used. |
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Other Actuarial Information Required |
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Insurers must include the information described in this section.
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Insurers shall also
include the following information: ·
All actuarial
support/justification for all rates being changed, including but not limited
to changes in: o
Base rates; o
Territory definitions; o
Territory factor
changes; o
Classification
factor changes; o
Classification
definition changes; o
Changes to
schedule credits/debits, etc. ·
Exhibits
containing current and proposed rates/factors for all rates and
classification factors, etc. being changed.
·
Any exhibits
necessary to support the filing that are not mentioned elsewhere in this
checklist. |
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Schedule Rating |
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Insurers must include
the described information described at right. |
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Insurers should include
appropriate actuarial justification when filing schedule rating plans and/or
changes to schedule rating plans. |
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