Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 07 - INSURANCE RATING LAW
Chapter 31.07.01 - Property, Casualty, Surety, and Marine Rating, and Supplementary Information Filings
Section 31.07.01.08 - Forms

Universal Citation: MD Code Reg 31.07.01.08

Current through Register Vol. 51, No. 19, September 20, 2024

A. Reference Filing Adoption Form.

Date _________________
Space Reserved for Insurance Department Use Insurer Rate Filing Adoption
of Rating Organization Prospective Loss Costs Reference
Filing Adoption Form State of Maryland
1. Insurer Name ____________________________
Address ____________________________
____________________________
____________________________
____________________________
Person Responsible for Filing ____________________________
Title ___________________________ Telephone # __________________
2. Insurer NAIC # ____________________________
3. Line of Insurance ____________________________
4. Rating Organization ____________________________
5. Rating Organization Reference Filing # ____________________________
6. The above insurer hereby declares that it is a member, subscriber or service purchaser of the named rating organization for this line of insurance. The insurer hereby files to be deemed to have independently submitted as its own filing the prospective loss costs in the captioned Reference Filing. The insurer's rates will be the combination of the prospective loss costs and the loss cost multipliers and, if utilized, the expense constants specified in the attachments.
7. Proposed Rate Level
Change ____________ % Effective Date _________________
8. Prior Rate Level
Change ____________ % Effective Date _________________
9. Attach "Summary of Supporting Information Form"
(Use a separate Summary for each insurer-selected loss cost multiplier.)
10. Check one of the following:
() The insurer hereby files to have its loss cost multipliers and, if utilized, expense constants be applicable to future revisions of the rating organization's prospective loss costs for this line of insurance. The insurer's rates will be the combination of the rating organization's prospective loss costs and the insurer's loss cost multipliers and, if utilized, expense constants specified in the attachments. The rates will apply to policies effective on or after the effective date of the rating organization's prospective loss costs. This authorization is effective until disapproved by the Commissioner, or amended or withdrawn by the insurer.
() The insurer hereby files to have its loss cost multipliers and, if utilized, expense constants be applicable only to the above Rating Organization Reference Filing.
B. Summary of Supporting Information Form.
Insurer Name: ____________________ Date: _______________________
NAIC Number: ___________________
1. Line, Subline, Coverage, Territory, Class, etc. combination to which this page applies:

________________________________________________________

2. Loss Cost Modification:
A. The insurer hereby files to adopt the prospective loss costs in the captioned reference filing: (CHECK ONE)

() Without modification. (factor = 1.000)

() With the following modification(s). (Cite the nature and percent modification, and attach supporting data and/or rationale for the modification.)

________________________________________________________ ________________________________________________________

B. LOSS COST MODIFICATION Expressed as a Factor: _______ (See examples below.)

NOTE: If expense constants are utilized, attach "Expense Constant Supplement", §C, below, or other supporting information. Do not complete items 3-7, below.

3. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supporting information.)

Selected Provisions
A. Total Production Expense ________________ %
B. General Expense ________________ %
C. Taxes, Licenses, and Fees ________________ %
D. Underwriting Profit and Contingencies ________________ %
E. Other (explain) ________________ %
F. TOTAL ________________ %
4A. Expected Loss Ratio: ELR =
100% - 3F = ________________ %
4B. ELR in decimal form = ________________
5. Company Formula Loss Cost
Multiplier: (2B/4B)= ________________
6. Company Selected Loss Cost
Multiplier = ________________
Explain any differences between 5 and 6:
________________________________________________ ________________________________________________
7. Rate level change for the coverages to
which this page applies: ________________ %
________________________________________________ ________________________________________________
Example 1: Loss cost modification factor: If your company's loss cost modification is -10%, a factor of .90 (1.000 - .100) should be used.
Example 2: Loss cost modification factor: If your company's loss cost modification is +15%, a factor of 1.15 (1.000 + .150) should be used.
C. Expense Constant Supplement Form.
Insurer Name: _____________________ Date: ____________
NAIC Number: __________________________________________
1. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supporting information.

Overall Selected
Provisions
Variable 		Fixed
A. Total Production Expense _______ ________ ________
B. General Expense _______ ________ ________
C. Taxes, Licenses, and Fees _______ ________ ________
D. Underwriting Profit and Contingencies _______ ________ ________
E. Other (explain) _______ ________ ________
F. TOTAL _______ ________ ________
2.A. Expected Loss Ratio: ELR = 100% - Overall 1F = _______
B. ELR expressed in decimal form = _______
C. Variable Expected Loss Ratio VELR = 100% - Variable 1F = ________
D. VELR in decimal form = ________

3. Formula Expense Constant: ((1.00+2B) - (1.00+2D)) x
Average Underlying Loss Cost = ________
Formula Variable Loss Cost Multiplier: (2B+2D) = ________
4. Selected Expense Constant = ________ Selected Variable Loss Cost Multiplier ________
5. Explain any differences between 3 and 4:
_____________________________________________ _____________________________________________
6. Rate level change for the coverages
to which this page applies: _______%

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