Illinois Administrative Code › Title 50 - INSURANCE › Part 3801 - SMALL EMPLOYER CARRIER ACTUARIAL CERTIFICATION AND DOCUMENTATION REQUIREMENTS › ILLUSTRATION A - Actuarial Certification

Current through Register Vol. 48, No. 28, July 12, 2024
The following illustrates an acceptable actuarial
				certification:
I, ____________ (name) am an officer/employee of
				___________(carrier name)___ OR am associated with the firm of ______________
				(employer name) and am a member of the American Academy of Actuaries and meet
				the Qualification Standards appropriate for this certification.
(or)
I, ____________ (name) am an officer/employee of ___________
				(carrier name) OR am associated with the firm of ________________ (employer
				name) and am not a member of the American Academy of Actuaries. I meet the
				definitional standards of the "Other Individual Acceptable to the Director" and
				have received the Director's prior
approval on _________ (date) pursuant to Section
				5101.30
				(50 Ill. Adm. Code 5001.30 )
I am completing the small employer carrier actuarial
				certification for _____________ (carrier name). I am familiar with the
				applicable statutory provisions of
				215 ILCS 93/1 through
				99 and requirements of 50 Ill. Adm. Code 5101 and the Company Bulletins issued
				by the Director of Insurance.
This certification is for the period from __________ through
				_______.
I relied on listings (summaries, rate manuals, etc.) of
				relevant data prepared by __________ (name and title of company officer
				responsible for preparing the underlying records). Attached is a (are)
				statement(s) by the indicated company officer(s) on whom I relied.
The Carrier had ________ separate class(es) of business at the
				end of the certification period. (If more than one, list the classes and the
				substantial differences which qualified each as a separate class. For each
				class, list the criteria by which groups are assigned to the class.)
The Carrier had small employer group annual premium volume of $
				________ in force at the end of the certification period. I tested the rates of
				small employer groups whose annual premium volume totaled $ ________ to verify
				that the rates actually charged were in accordance with the rating
				manual(s).
Based upon my review, I find that the small employer carrier
				____________ (was or was not) in compliance with Section 25 of the Small
				Employer Health Insurance Rating Act [
				215 ILCS 93/25 ].
				(If not in compliance, include required additional paragraph, detail of
				instances of noncompliance and a description of the small employer carrier's
				plan to correct the areas of noncompliance.)
In other respects, my examination included a review
				of the actuarial methods in order to assure that the rating methods of the
				small employer carrier were actuarially sound.
Actuarial methods, considerations and analysis used
				in forming my opinion to conform the appropriate Actuarial Standards Board's
				Standards of Practice (ASOP), which form the basis of the statement of
				opinion.
________________________________
Actuary name or the pre-approved
individual's name (typewritten)
________________________________
Signature
________________________________
Date