REPORTING FORM FOR THE CALCULATION OF BENCHMARK

RATIO SINCE INCEPTION FOR GROUP POLICIES

FOR CALENDAR YEAR____________________

Benchmark Ratio Since Inception: (l + n)/(k + m): __________

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2“SMSBP” = Standardized Medicare Supplement Benefit Plan ‑ Use “P” for pre‑standardized plans

3 Year 1 is the current calendar year ‑ 1. Year 2 is the current calendar year ‑ 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6 To include the earned premium for all years prior to as well as the 15^th year prior to the current year

REPORTING FORM FOR THE CALCULATION OF BENCHMARK

RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIES

FOR CALENDAR YEAR____________________

Benchmark Ratio Since Inception: (l + n)/(k + m): __________

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2 “SMSBP” = Standardized Medicare Supplement Benefit Plan ‑ Use “P” for pre‑standardized plans

3 Year 1 is the current calendar year ‑ 1. Year 2 is the current calendar year ‑ 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6 To include the earned premium for all years prior to as well as the 15^th year prior to the current year.

Author: Commissioner of Insurance

Statutory Authority: Code of Ala. 1975, §§27-2-17, 27-19-50 et seq.

History: Filed with LRS July 11, 2003. Rule is not subject to the Alabama Administrative Procedure Act. Revised: July 14, 2005; effective August 1, 2005. Rule is not subject to the Alabama Administrative Procedure Act. Revised: June 11, 2009; effective June 30, 2009. Filed with LRS June 12, 2009. Rule is not subject to the Alabama Administrative Procedure Act.