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Regulations of Connecticut State Agencies (Last Updated: June 14,2023) |
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Title38a Insurance Department |
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SubTitle38a-495a-1_38a-495a-21. Medicare Supplement Insurance |
AppendixA.
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MEDICARE SUPPLEMENT REFUND CALCULATION FORM
FOR CALENDAR YEAR ___________________
TYPE1 ___________________________ SMSBP2 ___________________________
For the State of _______________________________________________________
Company Name ______________________________________________________
NAIC Group Code _________________ NAIC Company Code ________________
Address _____________________________________________________________
Person Completing This Exhibit __________________________________________
Title _____________________________ Telephone Number ___________________
line
(a)
Earned
Premium3
(b)
Incurred
Claims4
1
Current Year's Experience
a. Total (all policy years)
b. Current year's issues5
c. Net (for reporting purposes = 1a-1b)
2
Past Years' Experience (All Policy Years)
3
Total Experience
(Net Current Year + Past Years' Experience)
4
Refunds Last year (Excluding Interest)
5
Previous Since Inception (Excluding Interest)
6
Refunds Since Inception (Excluding Interest)
7
Benchmark Ratio Since Inception (SEE WORKSHEET FOR RATIO 1)
8
Experienced Ratio Since Inception
Total Actual Incurred Claims (line 3, col b) = Ratio 2
---------------------------------------------
Tot. Earned Prem. (line 3, col a)-Refunds Since Inception (line 6)
9
Life Years Exposed Since Inception
If the Experienced Ratio is less than the Benchmark Ratio, and there are more than 500 life years exposure, then proceed to calculation of refund.
10
Tolerance Permitted (obtained from credibility table)
Medicare Supplement Credibility Table
Life Years Exposed
Since Inception
Tolerance
10,000 +
0.0%
5,000 -9,999
5.0%
2,500 -4,999
7.5%
1,000 -2,499
10.0%
500 - 999
15.0%
If less than 500, no credibility.
1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.
2 "SMSBP" = Standardized Medicare Supplement Benefit Plan. Use "P" for pre-standardized plans.
3 Includes modal loadings and fees charges.
4 Excludes Active Life Reserves.
5 This is to be used as "Issue Year Earned Premium" for Year 1 of next year's "Worksheet for Calculation of Benchmark Ratios"
MEDICARE SUPPLEMENT REFUND CALCULATION FORM
FOR CALENDAR YEAR ____________
TYPE1 ___________________________ SMSBP2 _________________________
For the State of _____________________________________________________
Company Name _____________________________________________________
NAIC Group Code _________________ NAIC Company Code _______________
Address ___________________________________________________________
Person Completing This Exhibit ________________________________________
Title _____________________________ Telephone Number _________________
11
Adjustment to Incurred Claims for Credibility
Ratio 3 = Ratio 2 + Tolerance
If ratio 3 is more than benchmark ratio (ratio 1), a refund or credit to premium is not required.
If ratio 3 is less than the benchmark ratio, then proceed.
12
Adjusted Incurred Claims =
(Tot. Earned Premiums (line 3, col a)-Refunds Since Inception (line 6)) x Ratio 3 (line 11)
13
Refund = Total Earned Premiums (line 3, col a)-
Refunds Since Inception (line 6)-
Adjusted Incurred Claims (line 12)
--------------------------
Benchmark Ratio (Ratio 1)
If the amount on line 13 is less than .005 times the annualized premium in force as of the December 31 of the reporting year, then no refund is made. Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund and/or credit against premiums to be used must be attached to this form.
I certify that the above information and calculations are true and accurate to the best of my knowledge and belief.
_______________________________
Signature
_______________________________
Name - Please Type
_______________________________
Title - Please Type
_______________________________
Date
REPORTING FORM FOR THE CALCULATION OF BENCHMARK
RATIO SINCE INCEPTION FOR GROUP POLICIES
FOR CALENDAR YEAR __________
TYPE1 ____________________________ SMSBP2 _____________________________
FOR THE STATE OF_________________ Company Name_______________________
NAIC Group Code ___________________ NAIC Company Code __________________
Address____________________________ Person Completing This Exhibit __________
Title ______________________________ Telephone Number _____________________
(a)3
(b)4
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(o)5
Year
Earned Premium
Factor
(b)x(c)
Cumulative Loss Ratio
(d)x(e)
Factor
(b)x(g)
Cumulative Loss Ratio
(h)x(i)
Policy Year Loss Ratio
1
2.770
0.507
0.000
0.000
0.46
2
4.175
0.567
0.000
0.000
0.63
3
4.175
0.567
1.194
0.759
0.75
4
4.175
0.567
2.245
0.771
0.77
5
4.175
0.567
3.170
0.782
0.8
6
4.175
0.567
3.998
0.792
0.82
7
4.175
0.567
4.754
0.802
0.84
8
4.175
0.567
5.445
0.811
0.87
9
4.175
0.567
6.075
0.818
0.88
10
4.175
0.567
6.650
0.824
0.88
11
4.175
0.567
7.176
0.828
0.88
12
4.175
0.567
7.655
0.831
0.88
13
4.175
0.567
8.093
0.834
0.89
14
4.175
0.567
8.493
0.837
0.89
15+6
4.175
0.567
8.684
0.838
0.89
Total:
(k):
(l):
(m):
(n):
Benchmark Ratio Since Inception: (l + n)/(k + m):__________
1Individual, Group, Individual Medicare Select, or Group Medicare Select Only.
2"SMSBP" = Standardized Medicare Supplement Benefit Plan. Use "P" for pre-standardized plans.
3Year 1 is the current calendar year -1
Year 2 is the current calendar year - 2
(etc.)
(Example: If the current year is 1991, then:
Year 1 is 1990. Year 2 is 1989; etc.)
4For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.
5These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.
6To include the earned premium for all years prior to as well as the 15th year prior to the current year.
REPORTING FORM FOR THE CALCULATION OF BENCHMARK
RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIES
FOR CALENDAR YEAR __________
TYPE1 ____________________________ SMSBP2 _____________________________
FOR THE STATE OF_________________ Company Name_______________________
NAIC Group Code ___________________ NAIC Company Code __________________
Address____________________________ Person Completing This Exhibit __________
Title ______________________________ Telephone Number _____________________
(a)3
(b)4
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(o)5
Year
Earned Premium
Factor
(b)x(c)
Cumulative Loss Ratio
(d)x(e)
Factor
(b)x(g)
Cumulative Loss Ratio
(h)x(i)
Policy Year Loss Ratio
1
2.770
0.442
0.000
0.000
0.4
2
4.175
0.493
0.000
0.000
0.55
3
4.175
0.493
1.194
0.659
0.65
4
4.175
0.493
2.245
0.669
0.67
5
4.175
0.493
3.170
0.678
0.69
6
4.175
0.493
3.998
0.686
0.71
7
4.175
0.493
4.754
0.695
0.73
8
4.175
0.493
5.445
0.702
0.75
9
4.175
0.493
6.075
0.708
0.76
10
4.175
0.493
6.650
0.713
0.76
11
4.175
0.493
7.176
0.717
0.76
12
4.175
0.493
7.655
0.720
0.77
13
4.175
0.493
8.093
0.723
0.77
14
4.175
0.493
8.493
0.725
0.77
15+6
4.175
0.493
8.684
0.725
0.77
Total:
(k):
(l):
(m):
(n):
Benchmark Ratio Since Inception: (l + n)/(k + m):__________
1Individual, Group, Individual Medicare Select, or Group Medicare Select Only.
2"SMSBP" = Standardized Medicare Supplement Benefit Plan. Use "P" for pre-standardized plans.
3Year 1 is the current calendar year -1
Year 2 is the current calendar year - 2
(etc.)
(Example: If the current year is 1991, then:
Year 1 is 1990. Year 2 is 1989; etc.)
4For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.
5These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.
6To include the earned premium for all years prior to as well as the 15th year prior to the current year.
(Effective July 30, 1992; Amended December 1, 2005; Amended November 30, 2009; Amended April 4, 2019)
Notation
Notes: Section republished to update table formatting. (October 21, 2016)
Notes: Typographical content and placement errors in and under the 'REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIOS SINCE INCEPTION FOR GROUP POLICIES' were corrected as follows: the typographical error '4.493' printed in column G, row 14 was corrected to '8.493;' the typographical error '(b)x(i)' printed in column J, row 1 was corrected to '(h)x(i);' the phrase 'for pre-standardized plans' printed by mistake in note five (5) was moved to note two (2); note two (2) was placed in correct numerical sequence; the block of text beginning with the words 'Year 2' and ending with the words 'Year 2 is 1989; etc.),' printed by mistake in note four (4) was moved to note three (3); and the sentence, 'They are shown here for informational purposes only.' printed by mistake immediately preceding note (6) was moved to note five (5). (August 17, 2018)
Notes: Typographical content and placement errors in and under the 'REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIOS SINCE INCEPTION FOR INDIVIDUAL POLICIES' were corrected as follows: the typographical error '4.493' printed in column G, row 14 was corrected to '8.493;' the typographical error '(b)x(i)' printed in column J, row 1 was corrected to '(h)x(i);' the phrase 'for pre-standardized plans' printed by mistake in note five (5) was moved to note two (2); note two (2) was placed in correct numerical sequence; the block of text beginning with the words 'Year 2' and ending with the words 'Year 2 is 1989; etc.),' printed by mistake in note four (4) was moved to note three (3); and the sentence, 'They are shown here for informational purposes only.' printed by mistake immediately preceding note (6) was moved to note five (5). (August 17, 2018)