Appendix A - ACTUARIAL CERTIFICATION
TO: SMALL EMPLOYER HEALTH INSURANCE COMPLIANCE DIVISION
FROM: (Please type or print)
NAME OF COMPANY: ___________________
NAIC NUMBER: _________________
NAME OF CONTACT PERSON: ______________________
TITLE: __________________
TELEPHONE NUMBER: ____________________________
DATE: __________________
ADDRESS: _______________________________
_______________________________
_______________________________
_______________________________
I. Actuarial Certification:
I hereby certify that the rates charged small groups in the state of Wyoming are:
1. Based on rating methods that are actuarially sound;
2. Such that the index rate for any class of business does not exceed the index rate for another class of business by more than twenty percent (20%);
3. Such that rates for small employers with similar characteristics within a class of business do not vary from the index rate by more than thirty-five percent (35%);
4. Such that the percentage increase in the premium rate for a renewal rating period does not exceed the sum of the following:
(a) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period, or the percentage change in the base premium rate in the case of a class of business for which the insurer is not issuing new policies,
(b) An adjustment of not more than fifteen (15%) annually, adjusted pro rata for shorter rating periods, for such rating factors as claim experience, health status, and duration of coverage, determined in accordance with the [name of small employer carrier] rate manual or renewal rating guidelines, and
(c) An adjustment for a change in case characteristics or in benefit design characteristics, determined in accordance with the [name of small employer carrier] rate manual and rating procedure.
5. Such that the rate factor associated with any industry classification does not vary from the arithmetic average of the rate factors associated with all industry classifications by greater than fifteen percent (15%) of such coverage; and
6. In compliance with all other facets of W.S. 26-19-301 through 310, based upon the examination of premium rates for applicable health benefit plans and the review of their underlying actuarial assumptions and methods.
I certify that sufficient documentation of compliance is on file with the [name of small employer carrier] and available upon request by the Commissioner of Insurance.
_________________
Signature
Name ( Typed or printed) ________________
Title (Typed or Printed) _______________