Md. Code Regs. 31.10.06.20
The following form is to be used in making reports of multiple policies in accordance with the requirements of Regulation .17 of this chapter: The purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate. The information is to be grouped by individual policyholder.
| (a)3 | (b)4 | (c) | (d) | (e) | (f) | (g) | (h) | (i) | (j) | (o)5 |
|---|---|---|---|---|---|---|---|---|---|---|
| Year | Earned Premium | Factor | (b) × (c) | Cumulative Loss Ratio | (d) × (e) | Factor | (b) × (g) | Cumulative Loss Ratio | (h) × (i) | Policy Year Loss Ratio |
| 1 | 2.770 | 0.442 | 0.000 | 0.000 | 0.4 | |||||
| 2 | 4.175 | 0.493 | 0.000 | 0.000 | 0.55 | |||||
| 3 | 4.175 | 0.493 | 1.194 | 0.659 | 0.65 | |||||
| 4 | 4.175 | 0.493 | 2.245 | 0.669 | 0.67 | |||||
| 5 | 4.175 | 0.493 | 3.170 | 0.678 | 0.69 | |||||
| 6 | 4.175 | 0.493 | 3.998 | 0.686 | 0.71 | |||||
| 7 | 4.175 | 0.493 | 4.754 | 0.695 | 0.73 | |||||
| 8 | 4.175 | 0.493 | 5.445 | 0.702 | 0.75 | |||||
| 9 | 4.175 | 0.493 | 6.075 | 0.708 | 0.76 | |||||
| 10 | 4.175 | 0.493 | 6.650 | 0.713 | 0.76 | |||||
| 11 | 4.175 | 0.493 | 7.176 | 0.717 | 0.76 | |||||
| 12 | 4.175 | 0.493 | 7.655 | 0.720 | 0.77 | |||||
| 13 | 4.175 | 0.493 | 8.093 | 0.723 | 0.77 | |||||
| 14 | 4.175 | 0.493 | 8.493 | 0.725 | 0.77 | |||||
| 15+6 | 4.175 | 0.493 | 8.684 | 0.725 | 0.77 | |||||
| ________ | ________ | ________ | ________ | |||||||
| Total: | (k): | (l): | (m): | (n): |
| FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES | |
|---|---|
| Company name: | ________________________________________ |
| Address: | ________________________________________ |
| ________________________________________ | |
| Phone Number: | ________________________________________ |
| Due: March 1, annually | |
| Policy and Certificate # | Date of Issuance |
|---|---|
Authority: Health-General Article, §§19-705 and 19-706; Insurance Article, §§2-109 and 8-403(b), Title 15, Subtitle 9, and Title 27; Annotated Code of Maryland
Effective date:
Regulations .01—.21 adopted as an emergency provision effective July 14, 1992 (19:16 Md. R. 1466); adopted permanently effective August 3, 1992 (19:15 Md. R. 1389)
Chapter revised effective April 1, 1996 (23:6 Md. R. 475)
Regulation .14A amended, and Regulation .21 repealed, and Regulations .22 and .23 recodified to Regulations .21 and .22, respectively, as an emergency provision effective April 25, 1996 (23:10 Md. R. 728); amended permanently effective September 10, 1996 (23:18 Md. R. 1317)
Chapter recodified from COMAR 09.30.90 to COMAR 31.10.06 effective September 7, 1998 (25:18 Md. R. 1439)
Regulation .02 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .02 amended as an emergency provision effective July 25, 2000 (27:16 Md. R. 1520); amended permanently effective November 13, 2000 (27:22 Md. R. 2061)
Regulation .02 amended as an emergency provision effective October 1, 2001 (28:23 Md. R. 2053); emergency status expired March 29, 2002; amended permanently effective April 1, 2002 (29:6 Md. R. 570)
Regulation .03 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .04B amended as an emergency provision effective January 1, 2000 (27:4 Md. R. 452); emergency status expired June 28, 2000
Regulation .04B amended effective August 21, 2000 (27:16 Md. R. 1526)
Regulation .06 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .08 amended as an emergency provision effective July 25, 2000 (27:16 Md. R. 1520); amended permanently effective November 13, 2000 (27:22 Md. R. 2061)
Regulation .08 amended as an emergency provision effective October 1, 2001 (28:23 Md. R. 2053); emergency status expired March 29, 2002; amended permanently effective April 1, 2002 (29:6 Md. R. 570)
Regulation .09 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .09-1 adopted as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); adopted permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .09-1 amended as an emergency provision effective July 25, 2000 (27:16 Md. R. 1520); amended permanently effective November 13, 2000 (27:22 Md. R. 2061)
Regulation .09-1 amended as an emergency provision effective October 1, 2001 (28:23 Md. R. 2053); emergency status expired March 29, 2002; amended permanently effective April 1, 2002 (29:6 Md. R. 570)
Regulation .13 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .13 amended as an emergency provision effective July 25, 2000 (27:16 Md. R. 1520); amended permanently effective November 13, 2000 (27:22 Md. R. 2061)
Regulation .22 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .23 adopted as an emergency provision effective October 1, 2001 (28:23 Md. R. 2053); emergency status expired March 29, 2002; adopted permanently effective April 1, 2002 (29:6 Md. R. 570)
Regulation .24 adopted as an emergency provision effective October 1, 2001 (28:23 Md. R. 2053); emergency status expired March 29, 2002; adopted permanently effective April 1, 2002 (29:6 Md. R. 570)
Chapter revised effective January 1, 2006 (32:18 Md. R. 1522)
Regulation .02B amended effective September 21, 2009 (36:19 Md. R. 1439); January 14, 2019 (46:1 Md. R. 13)
Regulation .06A amended effective August 21, 2023 (50:16 Md. R. 729)
Regulation .07A amended effective September 21, 2009 (36:19 Md. R. 1439)
Regulation .08 amended effective September 21, 2009 (36:19 Md. R. 1439)
Regulation .09 amended effective September 21, 2009 (36:19 Md. R. 1439)
Regulation .13 amended effective September 21, 2009 (36:19 Md. R. 1439)
Regulation .13E amended effective November 29, 2010 (37:24 Md. R. 1660)
Regulation .26 adopted effective June 29, 2009 (36:13 Md. R. 901)
Regulations .27—.30 adopted effective September 21, 2009 (36:19 Md. R. 1439)
Regulation .28H amended effective November 29, 2010 (37:24 Md. R. 1660); January 14, 2019 (46:1 Md. R. 13)
Regulation .29 repealed effective November 29, 2010 (37:24 Md. R. 1660)
Regulation .30 amended effective January 14, 2019 (46:1 Md. R. 13)
Regulation .30I, J amended effective November 29, 2010 (37:24 Md. R. 1660)
Regulation .31 adopted effective January 14, 2019 (46:1 Md. R. 13)