N.J. Admin. Code § Tit. 11, ch. 3, subch. 16, APPENDIX, exh. D

Current through Register Vol. 56, No. 23, December 2, 2024

Exhibit D

Date of filling out form: ____________________________________

NEW JERSEY INSURER RATE FILING

ADOPTION OF RATING ORGANIZATION

PROSPECTIVE LOSS COSTS

REFERENCE FILING ADOPTION FORM

PRIVATE PASSENGER AUTOMOBILE

1. INSURER NAME ____________________________________

ADDRESS ____________________________________

____________________________________

PERSON RESPONSIBLE FOR FILING ____________________________________

TITLE ______________________________________________ TELEPHONE _______________________________

2. INSURER GROUP NAIC # __________________________________________________________________________

2A. INSURER COMPANY 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.

7. PROPOSED RATE LEVEL CHANGE _______________% EFFECTIVE DATE _____________________________

8. PRIOR RATE LEVEL CHANGE____________________% EFFECTIVE DATE _____________________________

9. ATTACH "FILING ADOPTION FORM" FOR EACH INSURER IF SELECTED LOSS COST MULTIPLIER IS DIFFERENT.

** The filed Loss Cost Level Change Factor for the initial filing is the Ratio of the Revised Loss Costs to Current Rates divided by the Deviation which the insurer applied to the Current Rates (expressed as a decimal); and for subsequent filings, the Ratio Loss Cost Level to Current Loss Cost Levels.

Insurer Name: ________________________________ Date of filling out form: ____________

NAIC #Group: _____________ Company: _______________

NEW JERSEY EXPENSE CONSTANT SUPPLEMENT

CALCULATION OF COMPANY LOSS COST MULTIPLIER

10. Coverage to which this page applies: ___________________________________________________________________

11. Lost Cost Modification

A. The Insurer hereby files to adopt the prospective loss costs in the captioned reference filing:

(CHECK ONE)

Without Modification (Factor = 1.000) ______________________________________________________________

With the following modification(s): ________________________________________________________________

B. Loss Cost Modification Expressed as a Factor: ________________________________________________________

(See examples below.)

12. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supporting information.)

		Overall	Variable	Fixed
A. Commissions Expense		__________%	__________%	__________%
B. Other Acquisition Expense		__________%	__________%	__________%
C. General Expense		__________%	__________%	__________%
D. Expenses Subject to Cap		__________%	__________%	__________%
E. Expense Cap		__________%	__________%	__________%
F. Capped Expenses		__________%	__________%	__________%
G. Taxes, Licenses & Fees		__________%	__________%	__________%
H. Assessments		__________%	__________%	__________%
I. AIRE Impact		__________%	__________%	__________%
J. Profit and Contingency Provision		__________%	__________%	__________%
K. Other		__________%	__________%	__________%
L. Total (F + G + H + I + J + K)		__________%	__________%	__________%
M. Fixed Expense Trend Factor		__________
N. Trended Fixed Expense Ratio		__________%
13.	A. Expected Loss Ratio: ELR = 100% Overall	__________%
12L
B. ELR expressed in decimal form:		__________
C. Variable Expected Loss Ratio: VELR = 13A +		__________
12N
D. VELR in decimal form:		__________
14.	Formula Expense Constant:		__________
Average Prospective Loss Cost =		__________
Formula Variable Loss Cost Multiplier:		__________
(11B/13D)
15.	Selected Expense Constant =		__________
Selected Variable Loss Cost Multiplier =		__________
16.	Rate level change for the coverage to which this page applies		__________%

N.J. Admin. Code Tit. 11, ch. 3, subch. 16, APPENDIX, exh. D

New Rule, R.1998 d.128, effective 3/2/1998.
See: 29 N.J.R. 5240(a), 30 N.J.R. 828(a).
Amended by R.2005 d.176, effective 6/6/2005.
See: 36 N.J.R. 5640(a), 37 N.J.R. 2026(a).
Rewrote the section.