Date _________________ | |
Space Reserved for Insurance Department Use | Insurer Rate Filing Adoption of Rating Organization Prospective Loss Costs Reference Filing Adoption Form State of Maryland |
1. Insurer Name | ____________________________ |
Address | ____________________________ |
____________________________ | |
____________________________ | |
____________________________ | |
Person Responsible for Filing | ____________________________ |
Title ___________________________ | Telephone # __________________ |
2. Insurer NAIC # | ____________________________ |
3. Line of Insurance | ____________________________ |
4. Rating Organization | ____________________________ |
5. Rating Organization Reference Filing # | ____________________________ |
6. The above insurer hereby declares that it is a member, subscriber or service purchaser of the named rating organization for this line of insurance. The insurer hereby files to be deemed to have independently submitted as its own filing the prospective loss costs in the captioned Reference Filing. The insurer's rates will be the combination of the prospective loss costs and the loss cost multipliers and, if utilized, the expense constants specified in the attachments. | |
7. Proposed Rate Level | |
Change ____________ % | Effective Date _________________ |
8. Prior Rate Level | |
Change ____________ % | Effective Date _________________ |
9. Attach "Summary of Supporting Information Form" (Use a separate Summary for each insurer-selected loss cost multiplier.) | |
10. Check one of the following: | |
() The insurer hereby files to have its loss cost multipliers and, if utilized, expense constants be applicable to future revisions of the rating organization's prospective loss costs for this line of insurance. The insurer's rates will be the combination of the rating organization's prospective loss costs and the insurer's loss cost multipliers and, if utilized, expense constants specified in the attachments. The rates will apply to policies effective on or after the effective date of the rating organization's prospective loss costs. This authorization is effective until disapproved by the Commissioner, or amended or withdrawn by the insurer. | |
() The insurer hereby files to have its loss cost multipliers and, if utilized, expense constants be applicable only to the above Rating Organization Reference Filing. | |
B. Summary of Supporting Information Form. | |
Insurer Name: ____________________ | Date: _______________________ |
NAIC Number: ___________________ |
________________________________________________________
() Without modification. (factor = 1.000)
() With the following modification(s). (Cite the nature and percent modification, and attach supporting data and/or rationale for the modification.)
________________________________________________________ ________________________________________________________
NOTE: If expense constants are utilized, attach "Expense Constant Supplement", §C, below, or other supporting information. Do not complete items 3-7, below.
Selected Provisions | |
A. Total Production Expense | ________________ % |
B. General Expense | ________________ % |
C. Taxes, Licenses, and Fees | ________________ % |
D. Underwriting Profit and Contingencies | ________________ % |
E. Other (explain) | ________________ % |
F. TOTAL | ________________ % |
4A. Expected Loss Ratio: ELR = | |
100% - 3F = | ________________ % |
4B. ELR in decimal form = | ________________ |
5. Company Formula Loss Cost | |
Multiplier: (2B/4B)= | ________________ |
6. Company Selected Loss Cost | |
Multiplier = | ________________ |
Explain any differences between 5 and 6: | |
________________________________________________ ________________________________________________ | |
7. Rate level change for the coverages to | |
which this page applies: | ________________ % |
________________________________________________ ________________________________________________ | |
Example 1: Loss cost modification factor: If your company's loss cost modification is -10%, a factor of .90 (1.000 - .100) should be used. | |
Example 2: Loss cost modification factor: If your company's loss cost modification is +15%, a factor of 1.15 (1.000 + .150) should be used. | |
C. Expense Constant Supplement Form. | |
Insurer Name: _____________________ | Date: ____________ |
NAIC Number: __________________________________________ |
Overall | Selected Provisions Variable | Fixed | |
A. Total Production Expense | _______ | ________ | ________ |
B. General Expense | _______ | ________ | ________ |
C. Taxes, Licenses, and Fees | _______ | ________ | ________ |
D. Underwriting Profit and Contingencies | _______ | ________ | ________ |
E. Other (explain) | _______ | ________ | ________ |
F. TOTAL | _______ | ________ | ________ |
2.A. Expected Loss Ratio: ELR = 100% - Overall 1F = | _______ | ||
B. ELR expressed in decimal form = | _______ | ||
C. Variable Expected Loss Ratio VELR = 100% - Variable 1F = | ________ | ||
D. VELR in decimal form = | ________ |
3. Formula Expense Constant: ((1.00+2B) - (1.00+2D)) x Average Underlying Loss Cost = ________ Formula Variable Loss Cost Multiplier: (2B+2D) = ________ |
4. Selected Expense Constant = ________ Selected Variable Loss Cost Multiplier ________ |
5. Explain any differences between 3 and 4: |
_____________________________________________ _____________________________________________ |
6. Rate level change for the coverages to which this page applies: _______% |
Md. Code Regs. 31.07.01.08
Regulation .08 amended effective March 25, 1996 (23:6 Md. R. 475)