Mo. Code Regs. Ann. tit. 20, § 600-1.010
PURPOSE: This regulation facilitates the collecting of relevant Medicare supplement premium loss data in order to ensure that mandated loss ratios are being met by insurers who sell Medicare supplement insurance.
(1) Medicare supplement loss data must be reported annually on or before April 1 of each year for the twelve (12) months ending December 31 next preceding on the forms which follow as appendices.
AUTHORITY: sections 374.045, 374.190 and 376.870, RSMo 1986 and 376.874.2., RSMo Supp. 1989.* This rule was previously filed as 4 CSR 190-14.117. Original rule filed Feb. 4, 1987, effective July 1, 1987. Amended: Filed Sept. 14, 1989, effective Jan. 1, 1990. *Original authority: 374.045, RSMo 1967; 374.190, RSMo 1939, amended 1949, 1967; and 376.874.2, RSMo. APPENDIX A Reporting Instructions Medicare Supplement Insurance Experience Report 1. Policy Form Number: A report form should be filled out for each Medicare supplement policy. Asterisk any policy that is mass marketed. 2. Year First Issued in Missouri: Self-explanatory. 3. Group or Individual Policy: Use the Roman Numeral “I” if the policy is a group policy or “II” if an individual policy or a mass-marketed form. 4. Renewability Type: Enter a two-digit alphabetic code from the following table: OR—Optionally Renewable CR—Conditionally Renewable or Quasi-Guaranteed GO—Guaranteed Renewable NC—Non-Cancellable 5. Missouri Inforce Policy Counts: Average count for reporting year, calculated by summing monthly inforce count for year and dividing by 12 or using the inforce count of mid-reporting period. The count for group business is the number of certificate holders residing in this state; the count for individual business is the number of policyholders in the state. Number insured under this policy for: 1 year, etc. This number should be the number that have been insured for 1 (1 . . . 5 years+) or less, for example, if an individual has been insured for less than two years, report him/her as part of the count for “1 year.” 6. Nationalwide Inforce Policy Counts: Average nationwide count for reporting year, calculated the same for Missouri Inforce Policy counts. Number insured under this policy for: (Calculate same as Missouri Inforce Counts.) 7. Premium Data: Net Premium Written: Premium written less any refund of premium. Net Premium Earned: Current year premium earned plus premium from prior year earned in current year. 8. Losses Incurred Data: Note: Losses Paid and Losses Incurred exclude administrative expense and all loss adjustment expense. a. Losses Incurred and Paid Current Year: Calculate the losses incurred and paid during the current year being reported. b. Incurred Prior Year and Paid Current Year: Calculate losses which were incurred in the prior year and paid in the current year being reported. c. Paid Current Year: Self-explanatory. d. Due and Unpaid Current Year: Calculate losses due and outstanding at the end of the current reporting year, excluding those incurred but not reported. e. Due and Unpaid Current Year: Calculate losses due and outstanding at the end of the prior reporting year, excluding incurred but not reported. f. Change in Reserve: Self-explanatory. g. IBNR Losses Due and Unpaid Current Year: Calculate losses due and incurred but not reported at end of current reporting year. h. IBNR Losses Due and Unpaid Prior Year: Calculate losses due and incurred but not reported at the end of the prior reporting year. i. Change in IBNR Reserve: Self-explanatory. j. Total Losses Incurred Current Year: Self-explanatory. State of Missouri Medicare Supplement of Insurance Experience Report For Calendar Year________________ 1. Policy Form No. ________________________________ 3. This is a Group (I)/Individual or Mass-Marketed (II) Policy ________________________________________________________________ 4. Renewability Type (Use two-digit alphabetic code from instructions): _________________________________________________________ 5. Current Missouri Inforce Policy Counts __________________________________ Number insured under this policy for: 1 Year 2 Years ____________ _____________ _____________ 6. Current National Inforce Policy Counts __________________________________________ Number insured under this policy for: 1 Year 2 Years ____________ _____________ _____________ 7. Net Premium Written ________________________________________ Net Premium Earned ___________________________________ 8. Losses Incurred: a. Losses incurred and paid current year b. Losses incurred prior year, paid current year c. Total losses paid current year d. Outstanding losses due and unpaid current year e. Outstanding losses due and unpaid prior year f. Change in reserve (d … e) g. IBNR losses due and unpaid current year h. IBNR losses due and unpaid prior year i. Change in IBNR reserve (g … h) j. TOTAL LOSSES INCURRED CURRENT YEAR (c+f+i) NOTE: Missouri experience only except as indicated. 20 CSR 600-1 2. Year First Issued in Missouri _______________________________ 3 Years 4 Years ___________ 3 Years 4 Years ___________ $____________________ $____________________ $____________________ $____________________ $____________________ $____________________ _______________________________________________________ Signature of Person Preparing Report/Title _______________________________________________________ Print Name _______________________________________________________ Company Name NAIC Number _______________________________________________________ Address _______________________________________________________ Phone Number 5 Years+ ____________ 5 Years+ ____________ $____________________ $____________________ $____________________ $____________________ Appendix B Reporting Instructions Medicare Supplement Insurance Experience Report 1. Policy Form Number: A report form should be filled out for each Medicare Supplement policy form. Policy forms are not to be grouped unless they are nearly identical in Coverage & Premium. Do not include any experience for optional riders that may be attached to the policy form being reported. 2. Year First Issued in Missouri: Self-explanatory. 3. Is the same rate charged Countrywide for this policy form? Enter “Y” for Yes or “N” for No. 4. Is this a Group Policy or an Individual Policy? Enter the appropriate code as follows: I=Group II=Individual Policy III=Mass Marketed or Direct Response 5. Is the policy form Mass Marketed? Enter “Y” for Yes and “N” for No. Direct Response policies are to be considered Mass Marketed. 6. Renewability Type: Enter a two-digit alphabetic code from the following table: OR=Optionally Renewable CR=Conditionally Renewable or Quasi-Guaranteed GR=Guaranteed Renewable NC=Non-Cancellable 7. Missouri Experience: Enter experience in the following categories by policy duration as displayed in the report form for Missouri only: Duration—The number of years a policy has been in force. Round down to the nearest year when reporting experience. Number of Policies in Force Written Premium Earned Premium Paid Claim Count—Enter number of claims paid Paid Losses—Enter dollars paid for claims excluding loss adjustment expense Total Loss Reserves—Enter all reserves used to adjust paid losses to incurred losses Incurred Claim Counts—Enter the number of incurred claims Incurred Losses—Enter the dollars incurred Exclude all Administrative and Loss Adjustment Expenses. (Paid ± Loss Reserve) Loss Ratio—Incurred Losses divided by Earned Premium 8. Missouri Loss Reserves—Use Missouri data only. a. Unpaid Claim Reserves 1) Claim Reserves, current year: Enter the current year ending amount set aside to pay all claims outstanding no matter what year the loss was incurred. 2) Claim Reserves, prior year: Enter the prior year ending amount that was set aside to pay all claims outstanding no matter what year the loss was incurred. 3) Change in Unpaid Claim Reserves: Current Year Reserve—Prior Year Reserve b. Incurred but no Reported Reserves 1) IBNR Reserves, current year: Enter the current year ending amount set aside as IBNR reserve. 2) IBNR Reserves, prior year: Enter the prior year ending amount set aside as IBNR reserve. 3) Change in IBNR Reserves: Current Year Reserve—Prior Year Reserve c. Total Reserves added for Missouri this Calendar Year: Change in Unpaid Claim Reserves + Change in IBNR Reserves. This number must equal the total for all loss reserves by duration (line 6). 9. List all Riders Attached to this Policy Form and Included in the Experience Above—Provide the rider number and a brief description of all riders included in the experience reported. Do not include optional riders in the experience reported. (10) Countrywide Experience: Please enter total countrywide experience for this policy form by duration for the following: Duration—The number of years a policy has been in force. Round down to the nearest year when reporting experience. Number of Policies in Force Written Premium Earned Premium Paid Claim Count—Enter number of claims paid Paid Losses—Enter dollars paid for claims excluding loss adjustment expense Total Loss Reserves—Enter all reserves used to adjust paid losses to incurred losses Incurred Claim Counts—Enter the number of incurred claims Incurred Losses—Enter the dollars incurred. Exclude all Administrative and Loss Adjustment Expenses. (Paid + Loss Reserve) Loss Ratio—Incurred Losses divided by Earned Premium State of Missouri Medicare Supplement Insurance Experience Report For Calendar Year:_________ 1. Policy Form No. ___________________________________ 2. Year First Issued in Missouri ______________________________ 3. Is the same rate charged countrywide for this policy form?__________________________________________________________________ 4. Group (I) or Individual (II) Policy?_____________________________________________________________________________________ 5. Is this policy Mass-Marketed? (“Y” or “N”)?____________________________________________________________________________ 6. Renewability Type (Use two-digit alphabetic code from instructions):_________________________________________________________ 7. Missouri Experience: Number Paid Total Duration of Policies Written Earned Claim Paid Loss (Policy Year) in Force Premium Premium Count Losses Reserves 5± Total 8. Missouri Loss Reserves: A. Unpaid Claim Reserves 1) Claim Reserves, current year: 2) Claim Reserves, prior year 3) Change in Unpaid Claim Reserves (1 ! 2) B. IBNR Reserves 1) IBNR Reserves, current year: 2) IBNR Reserves, prior year 3) Change in IBNR Reserves (1 ! 2) C. Total Loss Reserves Added for Missouri This Calendar Year ((A.3) + B.3) Incurred Claim Incurred Loss Counts Losses Ratio ________ ________ ________ ________ ________ ________ ________ ________ 9. List All Riders Attached to This Policy Form and Included in the Experience Above: Rider Form Number Description A. B. C. D. E. F. 10. Countrywide Experience: Number Paid Duration of Policies Written Earned Claim Paid (Policy Year) in Force Premium Premium Count Losses 5+ Total Total Loss Reserves ___________________________________________________________ Signature of an Officer of the Company/Title ___________________________________________________________ Signature of Person Preparing Report/Title ___________________________________________________________ Print Name of Person Preparing Report ___________________________________________________________ Company Name ___________________________________________________________ NAIC Group and Company Code ___________________________________________________________ Address ___________________________________________________________ Phone Number 20 CSR 600-1 Incurred Claim Incurred Loss Counts Losses Ratio