Section 2312.5 - Contract Reserves(a) General Rules(1) Contract reserves are required, unless otherwise specified in paragraph (a)(2) for: (A) All individual and group contracts with which level premiums are used; or(B) All individual and group contracts with respect to which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time. This evaluation may be applied on a rating block basis if the total premiums for the block were developed to support the total risk assumed and expected expenses for the block each year, and a qualified actuary certifies the premium development. The actuary should state in the certification that premiums for the rating block were developed such that each year's premium was intended to cover that year's costs without any prefunding. If the premium is also intended to recover costs for any prior years, the actuary should also disclose the reasons for and magnitude of such recovery. The values specified in this paragraph shall be calculated based on subsection § 2312.5(b).(2) Contracts not requiring a contract reserve are:(A) Contracts which cannot be continued after one year from issue; or(B) Contracts already in force on the effective date of this article for which no contract reserve is required under Section 997 of the Insurance Code.(3) The contract reserve shall be in addition to claim reserves and premium reserves.(4) The methods and procedures for the calculation of contract reserves shall be consistent with those for claim reserves for any contract, or else appropriate adjustment shall be made when necessary to assure provision for the aggregate liability. The definition of the date of incurral must be the same in both determinations.(5) The total contract reserve established shall incorporate provisions for moderately adverse deviations.(b) Minimum Standards for Contract Reserves(1) Basis. (A) Morbidity or other Contingency. Minimum standards with respect to morbidity are those set forth in § 2315. Valuation net premiums used under each contract shall have a structure consistent with the gross premium structure at issue of the contract as this relates to advancing age of insured, contract duration and period for which gross premiums have been calculated. Contracts for which tabular morbidity standards are not specified in § 2315 shall be valued using tables established for reserve purposes by a qualified actuary with the approval of the Commissioner. The morbidity tables shall contain a pattern of incurred claims cost that reflects the underlying morbidity and shall not be constructed for the primary purpose of minimizing reserves. 1. In determining the morbidity assumptions, the actuary shall use assumptions that represent the best estimate of anticipated future experience, but shall not incorporate any expectation of future morbidity improvement. Morbidity improvement is a change, in the combined effect of claim frequency and the present value of future expected claim payments given that a claim has occurred, from the current morbidity tables or experience that will result in a reduction to reserves. It is not the intent of this provision to restrict the ability of the actuary to reflect the morbidity impact for a specific known event that has occurred and that is able to be evaluated and quantified.2. Business in force as of the effective date of § 2312.5(b)(1)(C)2. may be permitted to retain the original reserve basis which may not meet the provisions of Item 1. above, subject to the acceptability to the Commissioner.(B) Interest. The maximum interest rate is specified in § 2315.(C) Termination Rates. Termination rates used to compute reserves shall be on the basis of a mortality table as specified in § 2315 except as noted in the following paragraphs: 1. Under contracts for which premiums rates are not guaranteed, and where the effects of insurer underwriting are specifically used by policy duration in the valuation morbidity standard or for return of premium or other deferred cash benefits, total termination rates may be used at ages and durations where these exceed specified mortality table rates, but not in excess of the lesser of: (i) Eighty percent of the total termination rate used in the calculation of the gross premiums, or2. For long-term care individual policies or group certificates issued on or after January 1, 2005, the contract reserve shall be established on the basis of: (i) Mortality (as specified in § 2315); and(ii) Terminations other than mortality, where the terminations are not to exceed: I. For policy year one, the lesser of eighty percent (80%) of the voluntary lapse rate used in the calculation of gross premiums and six percent (6%);II. For policy years two (2) through four (4), the lesser of eighty percent (80%) of the voluntary lapse rate used in the calculation of gross premiums and four percent (4%); andIII. For policy years five (5) and later, the lesser of one hundred percent (100%) of the voluntary lapse rate used in the calculation of gross premiums and two percent (2%), except for group insurance as defined in Section 10231.6 of the Insurance Code, where the 2% shall be three percent (3%)3. Where a morbidity standard specified in § 2315 is on an aggregate basis, such morbidity standard may be adjusted to reflect the effect of insurer underwriting by policy duration. The adjustments shall be appropriate to the underwriting and must be approved by the Commissioner.(2) Reserve Method. (A) For all disability insurance as defined in § 2310(a) except for contracts issued on or after January 1, 1995, which provide long-term care and return of premium or other deferred cash benefits, the minimum reserve shall be the reserve calculated on the two-year full preliminary term method; that is, under which the terminal reserve is zero at the first and also the second contract anniversary.(B) For long-term care insurance issued on or after January 1, 1995, the minimum reserve shall be the reserve calculated on the one-year full preliminary term method.(C) For return of premium or other deferred cash benefits issued on or after January 1, 1995, the minimum reserve shall be the reserve calculated as follows: 1. On the one year preliminary term method if such benefits are provided at any time before the twentieth anniversary;2. On the two year preliminary term method if such benefits are only provided on or after the twentieth anniversary.(D) The preliminary term method may be applied only in relation to the date of issue of a contractual obligation. Reserve adjustments introduced later, as a result of rate increases, revisions in assumptions (e.g., projected inflation rates) or for other reasons, shall be applied immediately as of the effective date of adoption of the adjusted basis.(3) Negative Reserves. Negative reserves on any benefit may be offset against positive reserves for other benefits in the same contract, but the total contract reserve with respect to all benefits combined shall not be less than zero.(4) Nonforfeiture Benefits for Long-Term Care Insurance. The contract reserve on a policy basis shall not be less than the net single premium for the nonforfeiture benefits at the appropriate policy duration, where the net single premium is computed according to the above specifications.
(c) Alternative Valuation Methods and Assumptions Generally Provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified above, an insurer may use any reasonable assumptions as to interest rates, termination and/or mortality rates, and rates of morbidity or other contingency. Also subject to the preceding condition, an insurer may employ methods other than the methods stated above in determining a sound value of its liabilities under such contracts, including, but not limited to the following: the net level premium method; the one-year full preliminary term method; prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses; the use of approximations such as those involving age groupings, groupings of several years of issue, average amounts of indemnity, grouping of similar contract forms; the computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregate contract reserves exclusive of the benefit or benefits so valued; and the use of a composite annual claim for all or any combination of the benefits included in the contracts valued.
(d) Tests For Adequacy and Reasonableness of Contract Reserves Annually, an appropriate review shall be made of the insurer's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves, giving consideration to future gross premiums. The insurer shall make appropriate increases to such tabular reserves if such tests indicate that the basis of such reserves is no longer adequate subject to the minimum standards in subsection (b).
If an insurer has a contract or a group of related similar contracts, for which future gross premiums will be restricted by contract, insurance department regulations, or for other reasons, such that the future gross premiums reduced by expenses for administration, commissions and taxes will be insufficient to cover future claims, the insurer shall establish contract reserves for such shortfall in the aggregate.
Cal. Code Regs. Tit. 10, § 2312.5
1. New section filed 11-4-94; operative 12-5-94 (Register 94, No. 44).
2. Amendment filed 12-13-2005; operative 12-13-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 50). Note: Authority cited: Sections 997(a) and 10489.95, Insurance Code. Reference: Sections 985, 997 and 10489.15(a), Insurance Code.
1. New section filed 11-4-94; operative 12-5-94 (Register 94, No. 44).
2. Amendment filed 12-13-2005; operative 12-13-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 50).