Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.06 - Standards for Medicare Supplement Policies
Section 31.10.06.19 - Report Form for Calculation of Loss Ratios

Universal Citation: MD Code Reg 31.10.06.19

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

The following forms are to be used for reporting loss ratios and calculating refunds for credits required under Regulation .11B of this chapter:

A. Medicare Supplement Refund Calculation Form.

MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR _____

TYPE1___________________________________ SMSBP2_______________________________________
For the State of____________________________ Company Name ________________________________
NAIC Group Code _________________________ NAIC Company Code ___________________________
Address ________________________________ Person Completing This Exhibit ____________________
Title ___________________________________ Telephone Number _____________________________

line (a) Earned Premium3 (b) Incurred Claims4
1 Current Year's Experience
a. Total (all policy years)
b. Current year's issues5
c. Net (for reporting purposes = 1a - 1b) ____________ ____________
2 Past Years' Experience
(All Policy Years) ____________ ____________
3 Total Experience (Net Current Year + Past Years' Experience) ____________ ____________
4 Refunds last year (Excluding Interest)
5 Previous Since Inception (Excluding Interest)
6 Refunds Since Inception (Excluding Interest)
7 Benchmark Ratio Since Inception (SEE WORKSHEET FOR RATIO 1)
8 Experienced Ratio Since Inception (Ratio 2)
Total Actual Incurred Claims (line 3, col b) Tot. Earned Prem. (line 3, col a) -
Refunds Since Inception (line 6)		 ____________
9 Life years Exposed Since Inception ____________
If the Experienced Ratio is less than the Benchmark Ratio, and there are more than 500 life years exposure, then proceed to calculation of refund.
10 Tolerance Permitted (obtained from credibility table) ____________

MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR _____

TYPE1___________________________________ SMSBP2_______________________________________
For the State of____________________________ Company Name ________________________________
NAIC Group Code _________________________ NAIC Company Code ___________________________
Address ________________________________ Person Completing This Exhibit ____________________
Title ___________________________________ Telephone Number _____________________________

line
11 Adjustments to Incurred Claims for Credibility
Ratio 3 = Ratio 2 + Tolerance ____________
If Ratio 3 is more than benchmark ratio (ratio 1), a refund or credit to premium is not required.
If Ratio 3 is less than the benchmark ratio, then proceed.
12 Adjusted Incurred Claims
{Tot. Earned Premiums (line 3, col. a) - Refunds
Since Inception (line 6)} x Ratio 3 (line 11)		 ____________
13 Refund = Total Earned Premiums (line 3, col a) -
Refunds Since Inception (line 6) -
{Adjusted Incurred Claims (line 12)/
Benchmark Ratio (Ratio 1) }		 ____________
If the amount on line 13 is less than .005 times the annualized premium in force as of December 31 of the reporting year, then no refund is made. Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund or credit against premiums to be used must be attached to this form.
Medicare Supplement Credibility Table
Life Years Exposed Since Inception Tolerance
10,000 + 0.0%
5,000-9,999 5.0%
2,500-4,999 7.5%
1,000-2,499 10.0%
500-999 15.0%
If less than 500, no credibility.

MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR _____

TYPE1___________________________________ SMSBP2_______________________________________
For the State of____________________________ Company Name ________________________________
NAIC Group Code _________________________ NAIC Company Code ___________________________
Address ________________________________ Person Completing This Exhibit ____________________
Title ___________________________________ Telephone Number _____________________________

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only

2 "SMSBP" = Standardized Medicare Supplement Benefit Plan-Use "P" for prestandarized plans

3 Includes modal loadings and fees charged.

4 Excludes Active Life Reserves

5 This is to be used as "Issue Year Earned Premium" for Year 1 of next year's "Worksheet for Calculation of Benchmark Ratios"

I certify that the above information and calculations are true and accurate to the best of my knowledge and belief.

________________________________ Signature

________________________________ Name"Please Type

________________________________ Title"Please Type

________________________________ Date

B. Reporting Form for Benchmark Ratio for Group Policies.

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIES FOR CALENDAR YEAR ________

TYPE1___________________________________ SMSBP2_______________________________________
For the State of____________________________ Company Name ________________________________
NAIC Group Code _________________________ NAIC Company Code ___________________________
Address ________________________________ Person Completing This Exhibit ____________________
Title ___________________________________ Telephone Number _____________________________

(a)3 (b)4 (c) (d) (e) (f) (g) (h) (i) (j) (o)5
Year Earned
Premium		 Factor (b) x (c) Cumulative
Loss Ratio		 (d) x (e) Factor (b) x (g) Cumulative
Loss Ratio		 (h) x (i) Policy Year
Loss Ratio
1 2.770 0.507 0.000 0.000 0.46
2 4.175 0.567 0.000 0.000 0.63
3 4.175 0.567 1.194 0.759 0.75
4 4.175 0.567 2.245 0.771 0.77
5 4.175 0.567 3.170 0.782 0.8
6 4.175 0.567 3.998 0.792 0.82
7 4.175 0.567 4.754 0.802 0.84
8 4.175 0.567 5.445 0.811 0.87
9 4.175 0.567 6.075 0.818 0.88
10 4.175 0.567 6.650 0.824 0.88
11 4.175 0.567 7.176 0.828 0.88
12 4.175 0.567 7.655 0.831 0.88
13 4.175 0.567 8.093 0.834 0.89
14 4.175 0.567 8.493 0.837 0.89
15+6 4.175 0.567 8.684 0.838 0.89
________ ________ ________ ________
Total: (k): (l): (m): (n):

Benchmark Ratio Since Inception: (l + n)/(k + m):

1Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2"SMSBP" = Standardized Medicare Supplement Benefit Plan-Use "P" for pre-standardized plans

3Year 1 is the current year -

1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then Year 1 is 1990; Year 2 is 1989, etc.)

4For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6To include the earned premium for all years prior to as well as the 15th year prior to the current year.

C. Reporting Form for Benchmark Ratio for Individual Policies.

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIES FOR CALENDAR YEAR ________

TYPE1___________________________________ SMSBP2_______________________________________
For the State of____________________________ Company Name ________________________________
NAIC Group Code _________________________ NAIC Company Code ___________________________
Address ________________________________ Person Completing This Exhibit ____________________
Title ___________________________________ Telephone Number _____________________________

(a)3 (b)4 (c) (d) (e) (f) (g) (h) (i) (j) (o)5
Year Earned
Premium		 Factor (b) x (c) Cumulative
Loss Ratio		 (d) x (e) Factor (b) x (g) Cumulative
Loss Ratio		 (h) x (i) Policy Year
Loss Ratio
1 2.770 0.442 0.000 0.000 0.4
2 4.175 0.493 0.000 0.000 0.55
3 4.175 0.493 1.194 0.659 0.65
4 4.175 0.493 2.245 0.669 0.67
5 4.175 0.493 3.170 0.678 0.69
6 4.175 0.493 3.998 0.686 0.71
7 4.175 0.493 4.754 0.695 0.73
8 4.175 0.493 5.445 0.702 0.75
9 4.175 0.493 6.075 0.708 0.76
10 4.175 0.493 6.650 0.713 0.76
11 4.175 0.493 7.176 0.717 0.76
12 4.175 0.493 7.655 0.720 0.77
13 4.175 0.493 8.093 0.723 0.77
14 4.175 0.493 8.493 0.725 0.77
15+6 4.175 0.493 8.684 0.725 0.77
________ ________ ________ ________
Total: (k): (l): (m): (n):

Benchmark Ratio Since Inception: (l + n)/(k + m):

1Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2"SMSBP" = Standardized Medicare Supplement Benefit Plan-Use "P" for prestandardized plans

3Year 1 is the current year -

1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then Year 1 is 1990; Year 2 is 1989, etc.)

4For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

5These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

6To include the earned premium for all years prior to as well as the 15th year prior to the current year.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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