New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES
Appendix A
Universal Citation: NJ Admin Code A
Current through Register Vol. 56, No.
6, March 18, 2024
| ................................... | Date of filling out Form:.......... | |
| ................................... | ||
| Space Reserved for Insurance | NEW JERSEY INSURER RATE FILING | |
| Department Use | ADOPTION OF ADVISORY ORGANIZATION | |
| PROSPECTIVE LOSS COSTS | ||
| FILING ADOPTION FORM | ||
| ................................... | ||
| 1. | INSURER NAME ........................................................... | |
| ADDRESS ........................................................... | ||
| ............................................................ | ||
| ............................................................ | ||
| ............................................................ | ||
| ............................................................ | ||
| PERSON RESPONSIBLE FOR FILING ......................................... | ||
| TITLE .................................TELEPHONE #..................... | ||
| 2. | INSURER GROUP NAIC # .................................................. | |
| 2A. | INSURER COMPANY NAIC # ................................................ | |
| 3. | LINE OF INSURANCE ..................................................... | |
| 4. | ADVISORY ORGANIZATION ................................................. | |
| 5. | ADVISORY ORGANIZATION REFERENCE FILING # .............................. | |
| 6. | The above insurer hereby declares that it is a member, subscriber or | |
| service purchaser of the named advisory 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. | ||
| 7. | PROPOSED RATE LEVEL CHANGE ........% | EFFECTIVE DATE ......... |
| 8. | PRIOR RATE LEVEL CHANGE ........% | EFFECTIVE DATE ......... |
| 9. | ATTACH "FILING ADOPTION FORM" FOR EACH INSURER | |
| IF SELECTED LOSS COST MULTIPLER IS DIFFERENT. | ||
| ** | The Field Loss Cost Level Change Factor for the initial filing is the | |
| Ratio of Revised Loss Costs to Current Rates divided by the Deviation | ||
| which the insurer applied to the Current Rates (expressed as a decimal); | ||
| and for the subsequent filings, the Ratio Loss Cost Level | ||
| to Current Loss Cost Levels. | ||
| Insurer Name: ..................... | Date of filling out Form: ......... | |
| NAIC #: Group: -......Company:- .... | ||
| NEW JERSEY INSURER RATE FILING | ||
| ADOPTION OF ADVISORY ORGANIZATION PROSPECTIVE LOSS COSTS | ||
| PROSPECTIVE LOSS COSTS | ||
| FILING ADOPTION FORM | ||
| CALCULATION OF LOSS COST MULTIPLIER | ||
| 10. | Line, Subline, Coverage, Territory, Class, etc. combination to which this | |
| page applies: .......................................................... | ||
| 11. | 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" OR OTHER SUPPORTING INFORMATION, AND DO NOT COMPLETE ITEMS 12-16 BELOW. | |||
| 12. Development of Expected Loss Ratio. (Attach exhibit detailing insurer expense data and/or other supportinginformation.) | |||
| Selected Provisions | |||
| A. | Total Production Expense | .................% | |
| B. | General Expense | .................% | |
| C. | Taxes, Licenses & Fees | .................% | |
| D. | Profit & Contingencies * | .................% | |
| E. | Other (explain) | .................% | |
| F. | TOTAL | .................% | |
| 13A. | Expected Loss Ratio: ELR = 100% - 12F = | .................% |
| 13B. | ELR in decimal form = | .................% |
| 14A. | Company Loss Cost Multiplier: (11B/13B) = | ................ |
| 14B. | Company Selected Loss Cost Multiplier = | ................ |
| 15. | Company Current Loss Cost Multiplier (Only on subsequent Loss Cost | |
| Filings): ................................ | ||
| 16. | Rate level change for the coverages to which this page applies:...% | |
| i.e. [(14B/15) x Filed Loss Cost Level Change Factor - 1.00]. | ||
| Note that for the initial Loss Cost Filing, Item 15 = 1.000). | ||
| Example 1: Loss Cost modification factor: If your company's loss cost | ||
| modification is - 10%, a factor of 0.9 (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. | ||
| *This should reflect investment income. | ||
| Insurer Name: ....................... Date of filling out Form: ..... | |
| NAIC #: GROUP:- ..... Company:-..... |
| NEW JERSEY EXPENSE CONSTANT SUPPLEMENT | |
| CALCULATION OF COMPANY LOSS COST MULTIPLIER | |
| 17. | Development of Expect Loss Ratio. |
| (Attach exhibit detailing insurer expense data and/or other supporting | |
| information). |
| Selected Provisions | ||||
| Overall | Variable | Fixed | ||
| A. | Total Production Expense | ..............% | .............% | .........% |
| B. | General Expense | ..............% | .............% | .........% |
| C. | Taxes, Licenses & Fees | ..............% | .............% | .........% |
| D. | Underwriting Profit & | |||
| Contingencies | ..............% | .............% | .........% | |
| E. | Other (explain) | ..............% | .............% | .........% |
| F. | TOTAL | ..............% | .............% | .........% |
| 18A. | Expected Loss Ratio: ELR = 100% - Overall 17F= | .............% |
| B. | ELR expressed in decimal form = | ............. |
| C. | Variable Expected Loss Ratio VELR = 100% - | |
| Variable 17F = | .............% | |
| D. | VELR in decimal form = | ............. |
| 19. | Formula Expense Constant: | |
| [(1.00 / 18B) - (1.00 / 18D)]* Average Prospective Loss | ||
| Cost = | .......... | |
| Formula Variable Loss Cost Multiplier: (11B / 18D) = | .......... | |
| 20. | Selected Expense Constant = | .......... |
| Selected Variable Loss Cost Multiplier = | .......... | |
| 21. | Rate level change for the coverages to which this page | |
| applies | ..........% |
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