Wash. Admin. Code § 284-55-210

Current through Register Vol. 24-23, December 1, 2024

Section 284-55-210 - Form of medicare supplement loss ratio experience

The following form of medicare supplement loss ratio experience shall be used by all insurers:

MEDICARE SUPPLEMENT LOSS RATIO EXPERIENCE

(SUMMARIZED BY POLICY YEAR)

Experience reported for January 1 to December 31 of 19

To be filed on or before June 30

of the

Address (City, State, and Zip Code)

NAIC Group Code

NAIC Company Code

CIC Code

National Experience

Form No.

No. of Contracts in Force

Policy Duration

Incurred Losses

Earned Premiums

Loss Ratio

Unearned Premium Reserve

Policy Reserves

Claim Reserves

Washington Experience

Form No.

No. of Contracts in Force

Policy Duration

Incurred Losses

Earned Premiums

Loss Ratio

Unearned Premium Reserve

Policy Reserves

Claim Reserves

I hereby certify that I have supervised the preparation of this experience exhibit, that it is complete and accurate to the best of my knowledge, and it is in compliance with RCW 48-66-150, and WAC 284-55-115, and WAC 284-55-150.

Signature of Officer

Date

Name and Title of Officer

Prepared by

Phone Number

Wash. Admin. Code § 284-55-210

Statutory Authority: RCW 48.02.060(3)(a) and 48.66.050. 89-11-096 (Order R 89-7), § 284-55-210, filed 5/24/89.