Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
304.4-010,
304.13-053,
304.14-120,
304.50-010,
304.50-115,
304.50-055,
304.50-065
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.50-010(2), requires the
Commissioner of the Department of Insurance to promulgate administrative
regulations as necessary to govern admission certification and regulation of
workers' compensation self-insured groups.
KRS
304.50-115, requires workers' compensation
self-insured groups to file rates, supplementary rating information, and
coverage form filings with the commissioner. This administrative regulation
establishes workers' compensation self-insured group rate, rule and form filing
procedures.
Section 1. Definitions.
(1) "Coverage form" is defined by
KRS
304.50-015(10).
(2) "Commissioner" is defined by
KRS
304.1-050(1).
(3) "Department" is defined by
KRS
304.1-050(2).
(4) "Self-insured group" is defined by
KRS
304.50-015(29).
Section 2. General Filing
Requirements.
(1) Every self-insured group
shall file with the commissioner its coverage forms, rates, loss costs, rating
plans, rating rules, underwriting rules or guidelines, statistical plans,
supporting information, supplementary information, and premium payment plans
accompanied by a completed and signed Form WC SIG: F-1A P & C, "Face Sheet
and Verification Form for Workers Compensation Self-Insured Groups".
(2) All filings shall include two (2) full
document sets on 8 1/2 in. x 11 in. white paper with three (3) cover letters
and a self-addressed stamped envelope.
(3) A filing may include any number of
documents, filed together on a particular date. Rates, loss costs, and rules
shall be filed separately from coverage forms.
(4) Pursuant to
KRS
304.4-010(2), all fees and
charges payable under the insurance code shall be collected in advance. The
period of time that the commissioner may affirmatively approve or disapprove
the filing shall not begin until a complete filing and the appropriate fee, as
set forth in
806 KAR
4:010, Section 1(22), is received.
Section 3. Rate and Rule Filings.
(1) Form WC SIG: S-1 P & C, "Filing
Synopsis for Rates and or Rules" shall be filed with all rate or rule
filings.
(2)
(a) Form WC SIG: LC-1 P & C, "Calculation
of Loss Cost Multiplier" shall be filed with all rate filings referencing loss
costs formulated by any advisory organization.
(b) Form WC SIG: LC-2 P & C, "Expense
Constant Supplement" shall be filed with all rate filings referencing loss
costs formulated by an advisory organization in which an expense constant is
used.
(3) Form WC SIG:
EMA P & C, "E-Mod Affidavit" shall be filed with all rate or rule filings
containing experience modification factors.
(4)
(a) All
rate or rule filings containing schedule rating plans shall identify the
characteristics of the risk not reflected in an experience modification
factor.
(b) Any application of the
schedule rating plan shall be based on evidence contained in the self-insured
group's file at the time it is applied. The schedule rating plan debit or
credit factor(s) applied shall be made available to the member upon
request.
(c) If the reason for
application of any schedule debit is corrected by the member to the
satisfaction of the self-insured group, the debit may be removed when evidence
of the correction is received by the group.
Section 4. Coverage Form Filings.
(1) Form WC SIG: S-2 P & C, "Filing
Synopsis Form" and Form WC SIG: F-2 P & C, "Forms Index" shall be filed
with all coverage form filings.
(2)
A coverage form shall not be used until it has been approved by the
commissioner. If the rates pertaining to a coverage form are required by law to
be filed with or approved by the commissioner, the coverage form shall not be
used until the appropriate rates have been filed or approved as
required.
(3) A filing which
amends, replaces, or supplements a coverage form previously filed and approved
shall include an explanation setting forth all changes contained in the newly
filed coverage form, the effect, if any, the changes have upon the hazards
purported to be assumed by the policy, and an explanation as to the effect on
the rates applicable thereto.
(4) A
change of signature of the executing officer on a coverage form shall not,
because of this change alone, require a new filing.
Section 5. Advisory Organization Filings.
(1) A self-insured group that is a member,
subscriber, or service purchaser of an advisory organization, statistical
agent, or forms provider may choose to adopt coverage forms, rating plans,
rating rules, rating schedules, other supplementary rating information,
underwriting rules or guidelines, or statistical plans of that advisory
organization or statistical agent by doing so in accordance with the procedures
established in this administrative regulation and shall clearly identify each
filing of the advisory organization or statistical agent it is
adopting.
(2) If a self-insured
group chooses to adopt only a specific filing of an advisory organization,
statistical agent, or form provider it shall do so in accordance with the
procedures established in this administrative regulation, and shall clearly
identify which filing of the advisory organization or statistical agent it is
adopting. Loss cost filings shall be specifically adopted.
(3)
(a) If
a self-insured group chooses to adopt all of the current and future coverage
forms, rating plans, rating rules, rating schedules, other supplementary rating
information, underwriting rules or guidelines, and statistical plans, excluding
loss costs, of an advisory organization, statistical agent, or forms provider,
it may file written notice with the commissioner that it is adopting by blanket
reference all of the current and future coverage forms, rating plans, rating
rules, rating schedules, other supplementary rating information, underwriting
rules or guide-lines, and statistical plans, excluding loss costs, as filed by
the advisory organization, statistical agent, or forms provider. Loss cost
filings shall not be adopted on this blanket reference basis.
(b) If a self-insured group previously
notified the commissioner of its adoption of all current and future filings,
excluding loss cost filings, by the advisory organization, statistical agent,
or forms provider and chooses not to adopt certain coverage forms, rating
plans, rating rules, rating schedules, other supplementary rating information,
underwriting rules or guidelines, or statistical plans, the group shall file
notice of the nonadoption with the commissioner and shall pay the appropriate
filing fee, as set forth in
806 KAR
4:010, Section 1(22).
1. If a self-insured group previously
notified the commissioner of its adoption of all current and future filings,
excluding loss cost filings, by the advisory organization, statistical agent,
or forms provider and chooses to delay the effective date of its adoption, it
shall submit a letter to the commissioner requesting the revised date upon
which it will adopt the filing.
2.
The delayed adoption date shall be within six (6) months of the original
effective date.
3. If additional
time is needed, a second letter shall be submitted to the commissioner
requesting a revised delayed adoption date.
4. All revised delayed adoption dates shall
be within one (1) year of the original effective date as filed by the advisory
organization, statistical agent, or forms provider.
5. If a self-insured group fails to adopt the
advisory organization, statistical agent, or forms provider filing within one
(1) year of the original effective date as filed by the advisory organization,
statistical agent, or forms provider, the insurer shall submit a filing to the
commissioner indicating it is nonadopting.
Section 6. Incorporation by
Reference.
(1) The following material is
incorporated by reference:
(a) Form WC SIG:
F-1A P & C, "Face Sheet and Verification Form for Workers Compensation Self
Insurance Groups," March 2005, Department of Insurance;
(b) Form WC SIG: F-2 P & C, "Forms
Index," March 2005, Department of Insurance;
(c) Form WC SIG: S-1 P & C, "Filing
Synopsis for Rates and or Rules," March 2005, Department of
Insurance;
(d) Form WC SIG: S-2 P
& C, "Filing Synopsis Form," March 2005, Department of Insurance;
(e) Form WC SIG: LC-1 P & C, "Calculation
of Loss Cost Multiplier," March 2005, Department of Insurance;
(f) Form WC SIG: LC-2 P & C, "Expense
Constant Supplement," March 2005, Department of Insurance; and
(g) Form WC SIG: EMA P & C, "E-mod
Affidavit," March 2005, Department of Insurance.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, from the Department of
Insurance, The Mayo-Underwood Building, 500 Mero Street, Frankfort, Kentucky
40601, Monday through Friday, 8 a.m. to 4:30 p.m. This material is also
available on the Department's Web site at
http://www.insurance.ky.gov.
STATUTORY AUTHORITY:
KRS
304.4-010,
304.50-010(2),
304.50-115