Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE
Appendix 031-220-A

Current through 2024-38, September 18, 2024

Forms L1, L2, L3, and L4 must be completed for each case involving credit life insurance. Forms D1, D2, D3 and D4 must be completed for each case involving credit disability insurance. Copies of all forms are attached. Experience reports shall be submitted in electronic format. Electronic versions of the forms are available on the Bureau of insurance web site at www.maineinsurancereg.org. All reports must be submitted on or before June 1 each year.

CREDIT LIFE INSURANCE SUMMARY REPORT - STATE OF MAINE

FORM L1

COMPANY ________________ NAIC # ____________

CASE ___________________________________________YEAR ENDING_________________

Classes of Business (Check all that apply):

[ ] (a) credit unions [ ] (e) other sales finance

[ ] (b) commercial & savings banks [ ] (f) production credit associations; bank

[ ] (c) finance companies agricultural loans

[ ] (d) motor vehicle dealers [ ] (g) all others

Mode of Premium Payment:

[ ] Outstanding Balance(Monthly Premium) [ ] Revolving Account

[ ] Single Premium [ ] Fixed Monthly Premium

Plan of Benefits (Check one or both): [ ] Decreasing [ ] Non-Decreasing

MONTHLY PREMIUM PER $1,000

__Single Life __ ___ Joint Life____

Present Case Rate __________________ __________________

Calculated Case Rate (from

Form L2, Line J) __________________ __________________

Case Rate to be Used __________________ __________________

Effective Date of Last Rate Revision* __________________ __________________

Effective Date of New Rates or Renewal

Date of Present Rates __________________ __________________

The information above and on Forms L2, L3 and L4 attached is true to the best of my knowledge and belief.

Signature (not required if filed electronically) ______________________________________

Name _________________________________

(Type or Print)

Position ____________________________Telephone _____________________________

Email ____________________________________

* Enter the date the rates were initially implemented if there have not been any rate revisions.

CREDIT LIFE INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM L2

COMPANY _____________________________________NAIC # ____________

CASE______________________________________________________________

MAINE EXPERIENCE LAST THREE YEARS

SINGLE ____JOINT_______ TOTAL

(from Form L3)

A. Earned Premium at Prima Facie Rate __________ ___________ ____________

B. Incurred Losses _____________ ______________ _________________

C.

*

1. Number of Life

Years Covered _______________ _____________ _____________

2. Number of Claims Incurred ___________ ____________ ______________

D. Credibility Factor (from table)

(Use TOTAL factor for both SINGLE and JOINT)__________________

E. Prima Facie Rate .50 .84 XXX

F. Prima Facie Claim Cost .315 .63 XXX

G. Expected Losses [A x F/E] _______________ ________________ _________________

H. Actual/Expected Ratio [B/G]

(Use TOTAL ratio for both SINGLE and JOINT)_________________

I. Deviation [D x (H - 1) x F] ___________ _______________ XXX

J. Deviated Rate [E + I] ___________ ______________ XXX

* Complete either C.1. or C.2., as elected in writing pursuant to Section 13 of Rule Chapter 220.

CREDIT LIFE INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM L3

COMPANY __________________________NAIC # _____________________

CASE____________________________________________________________

A. Earned Premium at

Prima Facie Rate _____________ ________________ _____________ ________________

B. Incurred Losses ____________ ____________ ____________ _____________

C.

*

1. Number of Life

Years Covered __________________ ________________ ______________ ________________

2. Number of Claims

Incurred _______________ ______________ _____________ _____________________

A. Earned Premium at

Prima Facie Rate ________________ ____________ ________________ ______________

B. Incurred Losses ______________ ______________ ____________ __________________

C.

*

1. Number of Life

Years Covered ______________ _______________ ________________ _________________

2. Number of Claims

Incurred ________________ ________________ ______________ _____________________

* Complete either C.1. or C.2., as elected in writing pursuant to Section 13 of Rule Chapter 220.

CREDIT LIFE INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM L4

COMPANY _________________________________NAIC # ____________

CASE ____________________________________________YEAR ENDING________________

1. Actual Earned Premiums Single Joint

a. Gross premium written (before deduction for

Dividends and Experience Rating Credits) _________________ __________________

b. Refunds on Termination ____________________ ____________________

c. Net [a - b] ________________________ ________________________________

d. Premium reserve, beginning of period ___________________ _______________

e. Premium reserve, end of period ______________________ ___________________

f. Actual Earned Premiums [c+d-e] ________________ _______________________

2. Prima Facie Earned Premiums

a. Insured Balance [See Section 9.D(3) of Rule] ___________________ ________________

b. Earned Premium at prima facie rate

[Single: (a x .00050); Joint: (a x .00084)] _________________ __________________

3. Incurred Claims

a. Claims paid __________________ _______________________

b. Unreported claims, beginning of period _________________ _______________________

c. Unreported claims, end of period ____________________ ____________________

d. Claim reserve, beginning of period ___________________ ________________________

e. Claim reserve, end of period ______________________ __________________________

f. Incurred claims (a - b + c - d + e) _______________________ _____________________

4. Loss Ratio

a. Actual loss ratio (3f / 1f) _______________________ ________________________

b. Loss ratio at prima facie rate (3f / 2b) _______________________ _____________________

5. State basis for incurred but unreported claims:_________________________________

_____________________________________________________________________

_____________________________________________________________________

CREDIT DISABILITY INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM D1

COMPANY ___________________________NAIC # ____________

CASE _______________________YEAR ENDING_________________________

Classes of Business (Check all that apply):

[ ] (a) credit unions [ ] (e) other sales finance

[ ] (b) commercial & savings banks [ ] (f) production credit associations; bank

[ ] (c) finance companies agricultural loans

[ ] (d) motor vehicle dealers [ ] (g) all others

Mode of Premium Payment:

[ ] Single Premium [ ] Revolving Account

[ ] Outstanding Balance (Monthly Premium) [ ] Fixed Monthly Premium

DEVIATION RATIO

Present Deviation Ratio for Case ______________________________

Calculated Deviation Ratio (from Form D2, Line O) ______________________________

Deviation Ratio to be Used ______________________________

Effective Date of Last Rate Revision* ______________________________

Effective Date of New Rates or Renewal Date of

Present Rates ______________________________

The information above and on Forms D2, D3 and D4 attached is true to the best of my knowledge and belief.

Signature (not required if filed electronically)

Name ______________________________

(Type or Print)

Position _________________________________Telephone_____________________________

Email ______________________________

* Enter the date the rates were initially implemented if there have not been any rate revisions.

CREDIT DISABILITY INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM D2

COMPANY ______________________________________NAIC # ____________

CASE____________________________________________________________

MAINE EXPERIENCE LAST THREE YEARS

A. Earned Premium at Prima Facie Rate_________________________________________________________________________

B. Incurred Losses ________________________________________________________________________

C. Imputed Investment Income ______________________________________________________________________

D. Incurred Loss Ratio at Prima Facie [B/(A+C)] ______________________________________________________________

E.

*

1. Number of Life Years Covered_____________________________________________________________________

2. Number of Claims Incurred________________________________________________________________________

DEVIATION

F. Credibility Factor (from table) XXX XXX_________

G Average Term of Indebtedness __________ ____________XXX

H. Prima Facie Rate ____________________ _________________XXX

I. Benchmark Loss Ratio _________________ _______________XXX

J. Prima Facie Claim Cost [HxI] ___________ ________________XXX

K Expense Loading [H-J] _______________ ______________XXX

L. Plan Ratio [D/I] _____________________ _________________XXX

M. Adjusted Plan Ratio [ {(L - 1) X F } + 1 ________________ ________________XXX

N. [(MxJ)+K] _________________ ____________________XXX

O. [N/H] ___________________ ______________________XXX

P. [OxA] ____________________ + _____________________=

Q. Calculated Deviation Ratio [ P / A ] XXX XXX

* Complete either E.1. or E.2., as elected in writing pursuant to Section 13 of Rule Chapter 220.

CREDIT DISABILITY INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM D3

COMPANY _____________________________NAIC # ____________

CASE _____________________________YEAR ENDING_______________

1. Actual Earned Premiums RETRO NON-RETRO

a. Gross premium written (before deduction for

dividends and experience rating credits) _________________ ______________________

b. Refunds on termination ___________________________ _______________________

c. Net [a - b] _____________________________ ______________________________

d. Premium reserve, beginning of period ______________ _________________________

e. Premium reserve, end of period _______________________ ____________________

f. Actual earned premiums [c +d - e] ____________________ _____________________

2. Prima Facie Earned Premiums (from D4) _________________ ____________________

3. Imputed Investment Income [(1d + 1e) x .03] ________________ __________________

4. Incurred claims ___________________ __________________________

a. Claims paid _____________________ __________________________

b. Unreported claims, beginning of period _____________________ ___________________

c. Unreported claims, end of period ___________________ _______________________

d. Claim reserve, beginning of period ___________________ ______________________

e. Claim reserve, end of period _________________ ______________________

f. Incurred claims (a - b + c - d + e) __________________ ___________________

5. Loss Ratio

a. Actual loss ratio (4f / 1f) _____________________ ______________________

b. Loss ratio at prima facie rate (4f / line 2) ___________________ __________________

CREDIT DISABILITY INSURANCE EXPERIENCE REPORT - STATE OF MAINE

FORM D4

COMPANY ________________________NAIC # ____________

CASE ___________________________YEAR ENDING