PURPOSE: This rule provides requirements for use and record keeping for insurance companies or reciprocal interinsurance exchanges using rate variations (consent to rate). This rule was adopted pursuant to the provisions of section 374.045, RSMo and implements sections 375.031, 375.136, 379.318.2., 379.321.3. and 379.470.6., RSMo.

1. (1) Standards for the Use of Consent to Rate.

   1. (A) No insurance company or reciprocal interinsurance exchange using rates subject to section 379.318 or 379.470, RSMo shall effect a policy of insurance or a renewal at a rate varying from the rate properly filed for its use on that specific risk unless the form contained as Exhibit A or one (1) substantially similar is completed by the insured.

   2. (B) Reasons for any individual modifications in rate for private passenger automobile or homeowners or occupied residential dwelling fire policies must be entered in Exhibit A and must—

      1. 1. Be highly unusual and have a docu-

mentably probable effect upon losses, stating specifically why the proposed insured is not within a reasonable class or classification system;

1. 2. Be clearly and specifically stated as

to each specific risk factor (such general statements as “Risk does not meet normal rates” are not acceptable);

1. 3. Not be based solely upon the actions

of another insurer toward that insured or that person’s age, residence, race, sex, color, creed, national origin, ancestry or lawful occupation; and

1. 4. The following statement must be a

part of each form 20 CSR 500-4.300 Exhibit A and signed by the insured: “I,_________________, declare that I have been unable to obtain this insurance from other companies and hereby consent to pay the higher rates which I am being charged for this insurance. I understand that any deductible amount stated in my policy will be deducted from each claim I may make under the policy issued me.”

1. (C) Schedule experience rated policies, or both, approved and filed by the Missouri Department of Insurance (MDI) are exempt from this rule.
2. (D) Policies rated on any substandard dwelling schedule or rating plan filed with the MDI are considered special rating policies for the purposes of the record requirements of section (2) of this rule. 20 CSR 500-4

1. (2) Record Keeping Requirements.

   1. (A) All insurance companies subject to this rule shall—

      1. 1. Complete and execute monthly, with

the signature of a person authorized by the company to do so, Exhibit B;

1. 2. File and preserve the original com-

pleted Exhibits A and B in the company’s policy file and a duplicate copy of each in the company’s Missouri records file; and

1. 3. Transmit to the Department of

Insurance a completed signed copy of Exhibit B before the end of the next monthly period.

1. (B) Exhibits A and B, included herein, or forms substantially similar may be prepared by each company concerned. EXHIBIT A State of Missouri Department of Insurance (Complete in duplicate)

NAME OF COMPANY_____________________________________________

INDICATE LINE OF BUSINESS For Audit & Examination Use Only

Audit Information:

Automobile____________________________________

Fire__________________________________________

Liability______________________________________

1. 1. Name of Insured__________________________________________________________________________________________________

   Mailing Address________________________________________________________________________________________________

2. 2. Property or other risk insured___________________________________________________________________________________

   Location (if fixed)_____________________________________________________________________________________________

3. 3. Coverage involved and Code or Classification________________________________________________________________________________________________ ____________________________________________________________________________________________________________________
4. 4. Specific Reasons for Special Rating (Use reverse, if necessary) ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________
5. 5. Proposed New Rates Standard Filed Rates (or filed if substandard)

6. 6. Policy Effective Date____________________________________________________________________________________________

   Policy Expiration Date___________________________________________________________________________________________

7. 7. Policy Number__________________________________________________________________________________________________

8. 8. (I understand that rates charged are not standard and accept this cost).

   Insured’s Signature____________________________________________________________________________________________

   Date________________________________________________________________________________________________________

9. 9. Insurance Producer’s Signature______________________________________________________________________________________

   Date________________________________________________________________________________________________________

10. 10. Company Officer’s Signature____________________________________________________________________________________

    Date________________________________________________________________________________________________________ (Company officer certifies that company and insurance producer are licensed for business written)

NAME OF COMPANY____________________________________________________________________________________________

Total Special Rating Policies___________________________,

Total Special Rating Policies (By line of business) in___________________________________________________, ______________:

Individual Listing of Policy Number by Line of Business: (Attach extra page if necessary)

MATT BLUNT 20 CSR 500-4

EXHIBIT B

State of Missouri Department of Insurance (Complete in duplicate)

_________ ________________________________________

Month Year Total

Month Year

Automobile_____________________________________________________________________________________________

Fire ______________________________________________________________________________________________

Liability ______________________________________________________________________________________________

________________________________________ ________________________________________________

________________________________________ ________________________________________________

________________________________________ ________________________________________________

AUTHORITY: sections 374.045, 379.318(2) and 379.470(6), RSMo 2000; 375.031 and 375.136, RSMo Supp 2001; and 379.321(3) RSMo 2002.* This rule was previously filed as 4 CSR 190-16.080. Original rule filed Dec. 20, 1974, effective Dec. 30, 1974. Amended: Filed April 23, 1999, effective Nov. 30, 1999. Amended: Filed July 12, 2002, effective Jan. 30, 2003.

*Original authority: 374.045, RSMo 1967, amended 1993, 1995; 375.031, RSMo 1979, amended 1985, 1986, 2001; 375.136, RSMo 1967, amended 1977, 2001; 379.318, RSMo 1972; and 379.321, RSMo 1972, 2002; and 379.470, RSMo 1947.