reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 13 - AGENT SERVICES DIVISION - NON-INSURANCE ENTITIES › Section .0500 - BAIL BONDSMEN AND RUNNERS › Section 13 .0542 - BAIL BOND PRELICENSING AND BCEC INSTRUCTORS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				person desiring approval as a bail bond prelicensing or BCEC instructor shall
				make written application to the Commissioner.
(b) Instructor applicants must be sponsored
				by a provider seeking to employ the applicant as an instructor. If the
				employing provider is not currently approved by the Commissioner, an
				application for prelicensing or BCEC provider approval shall be submitted along
				with the application for instructor approval.
(c) The Commissioner shall approve an
				applicant for a bail bond prelicensing instructor upon finding that the
				applicant has met the following qualifications:
(1) Has not been disqualified in any manner
				under Chapter 58 of the North Carolina General Statutes; and
(2) Has 10 years or more experience in the NC
				bail bond industry;
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0100 - GENERAL PROVISIONS › Section 14 .0101-.0103

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-4;
				  58-7.3;
				  58-9;
Eff. February 1,
				  1976;
Readopted Eff. January 22, 1980;
Repealed Eff.
				  July 1, 1988.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0200 - FORMATION OF DOMESTIC INSURANCE COMPANY › Section 14 .0201-.0203 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-2-165;
				  58-5-30;
				  58-7-35;
				  58-7-37;
				  58-7-40;
				  58-7-75;
				  58-7-80;
				  58-16-30;
Eff.
				  February 1, 1976;
Readopted with Change Eff. January 22, 1980
				  (.0201, .0202);
Readopted Eff. January 22, 1980
				  (.0203);
Amended Eff. July 1, 2004; February 1, 1996; April 1,
				  1990;
Pursuant to
				  G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0200 - FORMATION OF DOMESTIC INSURANCE COMPANY › Section 14 .0204-.0209

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-150;
				  58-150(1);
				  58-151(2);
				  58-151.1;
Eff.
				  February 1, 1976;
Readopted Eff. January 22, 1980;
Repealed Eff. April 1, 1990.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0300 - HEALTH MAINTENANCE ORGANIZATIONS › Section 14 .0301-0307

Current through Register Vol. 39, No. 2, July 15, 2024
Legislative Objection
				  Lodged Eff. June 16, 1980;
Statutory Authority
				  G.S.
				  57A-3;
				  57A-3(c)(9);
				  57A-3(c)(10);
				  57A-4;
				  57A-4(b)(3);
				  57A-8(b)(2);
57B-4; 57B-6; 57B-17; 57B-18; 58-150(2);
Eff. January 22,
				  1980;
Amended Eff. August 25, 1980;
Repealed Eff. April
				  1, 1993.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0300 - HEALTH MAINTENANCE ORGANIZATIONS › Section 14 .0308 - REPEALED - ADMITTED ASSETS: HMO

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Adoption Eff. December 18, 1990, For a Period of 180 Days to Expire
on June 15, 1991;
Statutory Authority
				  G.S.
				  58-2-40(1);
				  58-67-20;
				  58-67-110(b);
Eff. May 1, 1991;
Repealed Eff. April 1,
				  1993.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0401-.0408

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57A-3;
				  57A-4;
				  57A-18;
				  58-63;
				  58-63(1);
				  58-66;
				  58-72;
				  58-150;
58-150(3);
				  58-153; 58-182.5; 105-228.4(a);
Eff. January 22, 1980;
Repealed Eff. July 1, 1988.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0409 - EXPIRED - BIOGRAPHICAL AFFIDAVIT

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-7-35;
				  58-7-40;
				  58-16-5;
Eff. January
				  22, 1980;
Amended Eff. April 1, 1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0410 - REPEALED - INSURANCE COMPANY LICENSE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-72;
				  105-228.4;
Eff.
				  January 22, 1980;
Repealed Eff. July 1,
				  1988.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0411-.0412

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57A-3;
				  57A-4;
				  58-73;
				  58-77;
Eff. January
				  22, 1980;
Repealed Eff. April 1,
				  1990.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0413-.0414

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-6-5;
				  58-7-45;
				  58-7-75;
				  58-7-80;
				  58-16-5;
Eff. January
				  22, 1980;
Amended Eff. April 1, 1990;
Repealed Eff.
				  July 1, 2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0415 - REPEALED - PETITION FOR ADMISSION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-16-5(2);
Eff.
				  April 1, 1990;
Repealed Eff. March 1,
				  2004.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0416-.0417 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-5-30;
				  58-16-5(10);
				  58-16-30;
Eff. April
				  1, 1990;
Amended Eff. July 1, 2004;
Pursuant to
				  G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0418-.0426

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-16-5;
				  58-21-20;
				  58-22-45(a);
				  58-40-30;
				  58-41-50;
Eff. April
				  1, 1990;
Repealed Eff. July 1,
				  2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0427-.0429 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-22-20(1)a.;
				  58-22-20(1)b.; 58-22-40;
Eff. April 1, 1990;
Pursuant
				  to G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0430-.0431

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-22-20(3);
				  58-22-35(b);
Eff. April 1, 1990;
Repealed Eff. February 1,
				  1996.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0400 - DESCRIPTION OF FORMS › Section 14 .0432 - REPEALED - APPLICATION FOR LICENSE: INSURANCE COMPANY

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-7-40;
				  58-16-5;
Eff. February
				  1, 1996;
Repealed Eff. July 1,
				  2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0500 - ADMISSION OF A FOREIGN OR ALIEN INSURANCE COMPANY › Section 14 .0501 - REPEALED - APPLICATION FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-16-5;
Eff. April 1,
				  1990;
Amended Eff. July 1, 2004;
Repealed Eff. July 1,
				  2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0500 - ADMISSION OF A FOREIGN OR ALIEN INSURANCE COMPANY › Section 14 .0502-.0503 - EXPIRED - ANNUAL STATEMENTS, REPORTS ON EXAMINATION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-2-165;
				  58-16-5(1);
				  58-16-5(2);
Eff. April 1, 1990;
Amended Eff. July 1, 2004; April 1,
				  1993;
Pursuant to
				  G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0500 - ADMISSION OF A FOREIGN OR ALIEN INSURANCE COMPANY › Section 14 .0504-.0505

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-16-5(2);
Eff. April 1, 1990;
Amended Eff. July 1, 2004; April 1,
				  1993;
Repealed Eff. February 1,
				  2010.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0500 - ADMISSION OF A FOREIGN OR ALIEN INSURANCE COMPANY › Section 14 .0506 - EXPIRED - EXCEPTION TO IN FORCE POLICY REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-16-15;
Eff. April 1,
				  1990;
Pursuant to
				  G.S.
				  150B-21.3A, rule Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0600 - SURPLUS LINES › Section 14 .0601-.0605 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-2-165;
				  58-21-5;
				  58-21-20;
				  58-21-20(a);
				  58-21-20(b);
				  58-21-30;
Eff. April
				  1, 1990;
Amended Eff. July 1, 2004; February 1, 1996; April 1,
				  1993;
Pursuant to
				  G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0700 - FEDERAL RISK RETENTION ACT ENTITIES › Section 14 .0701-.0704 - EXPIRED

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-22-20;
				  58-22-20(1)d;
				  58-22-40;
				  58-22-40(c);
				  58-22-45;
				  58-22-70;
Eff. April
				  1, 1990;
Amended Eff. July 1, 2004;
Pursuant to
				  G.S.
				  150B-21.3A, rules Expired January 1,
				  2015.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 14 - ADMISSION REQUIREMENTS › Section .0700 - FEDERAL RISK RETENTION ACT ENTITIES › Section 14 .0705 - REPEALED - FILING AND PAYMENT OF PREMIUM TAXES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-22-20;
				  58-22-35;
Eff. April
				  1, 1990;
Repealed Eff. March 1,
				  2004.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 15 - MEDICAL DATABASE COMMISSION › Section 15 .0101-.0110

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				G.S.
				131E-212(b);
Eff. May 1, 1987;
Amended Eff. December 1, 1994; November 1, 1994;
				February 1, 1993; April 1, 1991;
Repealed Eff. September 1,
				2002.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 15 - MEDICAL DATABASE COMMISSION › Section 15 .0111 - REPEALED - FEES AND CHARGES FOR DATA

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				G.S.
				131E-211(k);
				131E-212(b)(7);
Eff. November 1, 1993;
Repealed Eff. September 1,
				2002.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 15 - MEDICAL DATABASE COMMISSION › Section 15 .0112 - REPEALED - SUCCESSOR FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				G.S.
				131E-212(b);
Temporary Adoption Eff. January 1, 1994 For a Period of 180 Days or Until the
				Permanent Rule Becomes Effective, Whichever is Sooner;
Eff. April
				1, 1994;
Amended Eff. November 1, 1994;
Repealed Eff.
				September 1, 2002.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0101 - APPLICABILITY

Current through Register Vol. 39, No. 2, July 15, 2024
The following Rules describe statistical data that shall be
				  submitted to the Actuarial Services Division.
(1)
									11 NCAC
				16 .0103 shall apply to all companies that
				write North Carolina nonfleet private passenger automobile insurance and to all
				statistical organizations that collect data relating to that line of
				insurance.
(2)
									11 NCAC
				16 .0105 shall apply to all companies that
				provide professional liability insurance to more than two percent of the
				insured physicians and surgeons in North Carolina.
(3)
									11 NCAC
				16 .0106 shall apply to all companies that
				write North Carolina credit property insurance.
(4)
									11 NCAC
				16 .0107 shall apply to all companies that
				write North Carolina nonfiling insurance.
Authority
				  G.S.
				  58-2-40(1);
				  58-2-190;
Eff.
				  December 1, 1990;
Amended Eff. July 1, 2011;
Readopted
				  Eff. October 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0102 - REPEALED - LOSS RESERVES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-2-190;
Eff.
				  December 1, 1990;
Amended Eff. August 1, 1991;
Repealed
				  Eff. July 1, 2011.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0103 - NONFLEET PRIVATE PASSENGER AUTOMOBILE INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
All companies writing North Carolina nonfleet private
				  passenger automobile insurance shall collect the statistical data described in
				  this Rule and shall report such data to their statistical agent. The
				  statistical agents shall thereupon provide the data on a combined basis to the
				  Actuarial Services Division.
(1)
				Premium, Exposure, Loss, and Claim Experience. Provide written and earned
				exposures, written and earned premiums, number of paid and incurred claims, and
				paid and incurred total limit losses biannually for each of the latest six
				accident or calendar half-years in the following detail:
(a) by coverage as follows: bodily injury,
				property damage, medical payments, uninsured motorist, underinsured motorist,
				comprehensive, or collision;
(b) by
				type of exposure as follows: voluntary, or involuntary;
(c) by territory;
(d) by class;
(e) by basic or increased limit or
				deductible; and
(f) by cause or
				type of loss for comprehensive coverage.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0104 - REPEALED - PROFESSIONAL LIABILITY INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-170;
				  58-2-190;
Eff.
				  December 1, 1990;
Repealed Eff. July 1,
				  2011.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0105 - PHYSICIANS AND SURGEONS PROFESSIONAL LIABILITY INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Companies that insure more than two percent of the insured
				  physicians and surgeons in North Carolina shall submit the following data upon
				  request, evaluated as of December 31 to the Actuarial Services Division:
(1) number of insured doctors by
				speciality;
(2) basic limits losses
				and ultimate claims for the most recent ten accident or report years;
(3) class one frequency, basic limits
				severity, and basic limits pure premium for the most recent ten accident or
				report years;
(4) exposure
				distributions separately by class, by maturity, and by increased limits factor
				for the most recent ten calendar years; and
(5) percentage of claims closed with neither
				a loss payment nor an allocated loss adjustment payment and the percentage of
				claims closed with only an allocated loss adjustment payment for the most
				recent ten calendar and for the most recent ten accident or report
				years.
Authority
				  G.S.
				  58-2-40(1);
				  58-2-190;
				  58-41-50(e)(14);
Eff. December 1, 1990;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0106 - CREDIT PROPERTY INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Each writer of North Carolina credit property insurance shall
				  submit the data described in this Rule upon request to the Actuarial Services
				  Division.
(1) North Carolina premium,
				loss, and expense:
(a) written
				premium;
(b) earned
				premium;
(c) paid losses and
				claims;
(d) incurred losses and
				claims;
(e) paid loss adjustment
				expense;
(f) incurred loss
				adjustment expense;
(g) incurred
				commissions and brokerage expenses;
(h) incurred other acquisition
				costs;
(i) incurred premium
				taxes;
(j) other incurred
				expenses;
(k) incurred loss and
				loss adjustment expense ratio;
(l)
				incurred loss, loss adjustment expense, and other underwriting expense
				ratio;
(m) dividends
				paid;
(n) retrospective rate
				credits paid; and
(o) commissions
				paid.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0107 - NONFILING INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Writers of North Carolina nonfiling insurance shall submit
				  the following information upon request to the Actuarial Services
				  Division:
(1) written
				premium;
(2) earned
				premium;
(3) earned
				exposures;
(4) incurred
				losses;
(5) number of incurred
				claims; and
(6) incurred
				expenses.
Authority
				  G.S.
				  53-177;
				  58-2-40(1);
Eff. December 1, 1990;
Readopted Eff. March 21,
				  2019.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0100 - FIRE AND CASUALTY STATISTICAL DATA › Section 16 .0108 - SINGLE OR DUAL INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Writers of North Carolina Single or Dual Interest Automobile
				  Physical Damage Insurance shall submit the following data described in this
				  Rule upon request to the Actuarial Services Division.
(1) North Carolina premium, loss, and
				expense:
(a) written premium and car year
				exposures;
(b) earned premium and
				car year exposures;
(c) paid losses
				and claims;
(d) incurred losses and
				claims;
(e) paid loss adjustment
				expense;
(f) incurred loss
				adjustment expense;
(g) incurred
				commissions and brokerage expenses;
(h) incurred other acquisition
				costs;
(i) incurred premium
				taxes;
(j) other incurred
				expenses;
(k) incurred loss and
				loss adjustment expense ratio;
(l)
				incurred loss, loss adjustment expense and other underwriting expense ratio;
				and
(m) policyholder dividends
				paid.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0201 - MINIMUM LOSS RATIO STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For
				individual accident and health insurance policies and riders delivered in this
				State, the standard minimum guideline loss ratio for conditionally renewable,
				guaranteed renewable, and non-cancelable medical expense, loss of income, and
				other type coverages, but not including long-term care insurance policies
				issued in this State on or after February 1, 2003, shall be as promulgated by
				the National Association of Insurance Commissioners (NAIC) for such coverages
				as of the issue date of such policies and riders.
(b) If a company fails to satisfy NAIC
				minimum future or lifetime loss ratio standards for a particular type of
				coverage, then to comply with the loss ratio standards in Paragraph (a) of this
				Rule, the company shall:
(1) combine the
				experience of such policy forms with other forms with similar type of coverage
				for which the pooling of experience is actuarially justified;
(2) provide premium credits or
				refunds;
(3) decrease premium rates
				for one or more subsequent rating periods; or
(4) implement an actuarially justified
				alternative proposal.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0202 - ACCIDENT AND HEALTH INSURANCE RENEWABILITY DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
With respect to all individual accident and health insurance
				  in this State, the following renewability definitions or substantively similar
				  wording as the Commissioner approves shall be used:
(1) Conditionally Renewable - Renewal may be
				declined for stated reasons, except for the deterioration of health of an
				individual insured, provided that the declination applies to all insureds in
				this state insured under the same policy or rider.
(2) Guaranteed Renewable - Renewal may not be
				declined by an insurance company for any reason, but the insurance company may
				revise rates on a class basis.
(3)
				Non-cancelable - Renewal may not be declined nor may rates be revised by an
				insurance company.
Authority
				  G.S.
				  58-2-40;
				  58-51-95;
				  58-63-15(7)b.;
Eff. March 1, 1992;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0203 - CONDITIONALLY RENEWABLE STATED REASON PROHIBITED

Current through Register Vol. 39, No. 2, July 15, 2024
For policies or riders permitting the adjustment of premiums
				  for which the insurer retains the right to nonrenew, no insurer shall exercise
				  a right not to renew for the following reason or any synonymous reason:
"The insurer is prevented by any law, or any regulation, or
				  any ruling of a government agency from using a table of premium rates that the
				  insurer has certified as being reasonable in relation to the benefits provided
				  under the policy."
Authority
				  G.S.
				  58-2-40;
				  58-51-20;
Eff. March
				  1, 1992;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0204 - OPTIONALLY RENEWABLE PROHIBITED

Current through Register Vol. 39, No. 2, July 15, 2024
No policy of accident, health, or accident and health
				  insurance shall contain a provision that permits the insurer to refuse to renew
				  the coverage of an individual insured based upon the deterioration of health of
				  an individual insured or based upon the claim experience of an individual
				  insured. As used in this Rule, "policy" shall include an endorsement, rider, or
				  any amendment to a policy.
Authority
				  G.S.
				  58-2-40;
				  58-51-95;
				  58-63-15(7)b;
Eff. March 1, 1992;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0206 - CLASS DEFINITION RESTRICTION

Current through Register Vol. 39, No. 2, July 15, 2024
With respect to individual accident and health insurance
				  policies for which the adjustment of premium rates is allowed by law, the
				  insurer shall not establish, for rate revision purposes, a class within a
				  policy form or group of policy forms so as to eliminate the possibility of new
				  entrants into the class. This Rule shall not preclude actuarially justified
				  apportionments of aggregate rate revisions on either open or closed blocks of
				  business between classes established at the time the policy form or group of
				  policy forms were approved by the Commissioner.
Authority
				  G.S.
				  58-2-40(1);
				  58-51-95;
				  58-63-15(7)b;
Eff. June 1, 1992;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0207 - COMMON BLOCK

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As used in this
				Rule, "Common Block" means a grouping of similar policy form types for which
				the pooling of experience is actuarially justified and for which the rate
				revisions are based upon the common experience. A Common Block may include both
				open and closed policy form types.
(b) If a company establishes a Common Block
				for compliance with
				G.S.
				58-51-95(h), with respect to
				all future rate revision filings, the company shall request a common uniform
				rate revision to apply to all policy forms in the Common Block and shall not
				request an apportionment by form. If policy forms are grouped into a Common
				Block, they shall remain grouped for future rate filings. Actuarially justified
				apportionments of the common rate increase, due to differences in benefits
				between forms, shall be allowed.
(c) If a company establishes a Common Block
				for compliance with
				G.S.
				58-51-95(h), the Closed
				Block portion of policy forms that make up the Common Block shall comply with
				G.S.
				58-3-275.
Authority
				  G.S.
				  58-2-40;
				  58-3-275;
				  58-51-95;
				  58-63-15(7)b;
Eff. July 1, 2006;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE › Section 16 .0208 - ANNUAL ACTUARIAL CERTIFICATIONS FOR LONG-TERM CARE FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
For actuarial certifications required by
				  G.S.
				  58-51-95(i):
(1) The actuarial certification shall be made
				by an individual who is either a Fellow or an Associate of the Society of
				Actuaries, a Fellow or an Associate of the Casualty Actuarial Society, or a
				member of the American Academy of Actuaries.
(2) For a policy form which becomes closed,
				but for that no corrective action is currently required, or for other
				situations for which no corrective action is currently required, the actuary
				shall, in lieu of the plan of corrective action required by
				G.S.
				58-51-95(i)(2), provide a
				certification that the actuary has reviewed the historical experience for the
				policy form and that, in the actuary's opinion, a rate revision is not
				currently justified.
Authority
				  G.S.
				  58-2-40;
				  58-2-171;
				  58-3-275;
				  58-51-95;
				  58-63-15(7)b;
Eff. July 1, 2006;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0300 - SMALL EMPLOYER GROUP HEALTH INSURANCE; FOR CALENDAR YEAR 1994 ACTUARIAL CERTIFICATION › Section 16 .0301-.0303

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Adoption Eff. January 25, 1993 for a Period of 180 Days or Until the Permanent
				  Rule Becomes Effective, Whichever is Sooner;
Authority
				  G.S.
				  58-2-40;
				  58-50-130(b);
Eff. May 3, 1993;
Amended Eff. January 1, 1994; October 1,
				  1993;
Repealed Eff. April 1,
				  2001.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0400 - CREDIT LIFE ACCIDENT AND HEALTH RATE DEVIATION › Section 16 .0401 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Section:
(1) "Class of Business" means one of the
				following determined by the source of the business:
(a) Credit Unions;
(b) Commercial Banks and Savings and Loan
				Associations;
(c) Finance
				Companies;
(d) Motor Vehicle
				Dealers;
(e) Other Sales Finance;
				or
(f) All Others.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0400 - CREDIT LIFE ACCIDENT AND HEALTH RATE DEVIATION › Section 16 .0402 - GENERAL SUBMISSION REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All
				rate deviation requests, including the data required by Rule .0403 of this
				Section, shall be submitted to the Life and Health Division. All rate deviation
				requests shall be submitted no later than March 31, of each calendar year to
				become effective during the calendar year of submission.
(b) All experience used in the calculation of
				the rate deviation shall only be North Carolina experience.
(c) All rate deviations shall be submitted,
				in accordance with this Rule, to the Life and Health Division each succeeding
				year for reevaluation.
(d) All rate
				deviation calculations shall be performed by or under the supervision of a
				qualified actuary.
(e) The
				following information shall be submitted in regards to the qualified actuary:
(1) the name of the qualified
				actuary;
(2) the professional
				designations of the qualified actuary, e.g. A.S.A., F.S.A., ACAS, FCAS, or
				M.A.A.A.;
(3) the name and address
				of the company or actuarial consulting firm employing the qualified actuary;
				and
(4) the telephone number,
				including extension, of the qualified actuary.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0400 - CREDIT LIFE ACCIDENT AND HEALTH RATE DEVIATION › Section 16 .0403 - CALCULATION PROCEDURE AND DATA REQUIREMENTS FOR RATE DEVIATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
An insurer requesting a rate deviation shall submit to the
				  Department of Insurance the following information, the results of each
				  calculation as follows, and the corresponding data required to perform each
				  calculation in accordance with this Rule, identified for each case for which
				  the insurer is requesting a rate deviation:
(1) identification of the class of business
				and plan of insurance associated with the case;
(2) identification of the single or multiple
				account case and, for a multiple account case, identification of each
				case;
(3) for the case, calculate
				the incurred loss ratio at the current North Carolina approved rate as defined
				in Rule .0401(15) of this Section;
(4) for the case, calculate the credibility
				factor using the credibility formula as defined in
				11 NCAC
				16 .0401(6);
(5) multiply Item (3) of this Rule by Item
				(4) of this Rule;
(6) for the class
				of business, calculate the class of business incurred loss ratio at current
				North Carolina approved rate as defined in
				11 NCAC
				16. 0401(16);
(7) for the class of business, calculate the
				credibility factor using the credibility formula as defined in
				11 NCAC
				16.0401(6);
(8) multiply Item (7) of this Rule by the
				quantity one minus Item (4) of this Rule, as in the following formula: Item (7)
				of this Rule x [1 - Item (4) of this Rule];
(9) multiply Item (6) of this Rule by Item
				(8) of this Rule;
(10) multiply the
				quantity one minus Item (4) of this Rule by the quantity one minus Item (7) of
				this Rule, as in the following formula: [1 - Item (4) of this Rule] x [1 - Item
				(7) of this Rule];
(11) multiply
				.60 by Item (10) of this Rule;
(12)
				add Items (5), (9) and (11) of this Rule;
(13) calculate the expense ratio as defined
				in 11
				NCAC 16. 0401(9);
(14) calculate the benchmark loss ratio as
				defined in
				11 NCAC
				16. 0401(11);
(15) the rate adjustment factor is equal to
				Item (12) of this Rule divided by Item (14) of this Rule; however, if the rate
				adjustment factor is greater than or equal to 0.95 and less than or equal to
				1.05, then the rate adjustment factor shall be set equal to the number one;
				and
(16) the maximum approved rate
				in effect for a period of 12 months is equal to the current North Carolina
				approved rate for the case multiplied by Item (15) of this Rule.
Authority
				  G.S.
				  58-2-40;
				  58-57-35(a);
				  58-57-70;
Eff. January
				  1, 1994;
Amended Eff. October 1, 2008;
Readopted Eff.
				  October 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0500 - CREDIT UNEMPLOYMENT MINIMUM LOSS RATIO STANDARD › Section 16 .0501 - MINIMUM INCURRED LOSS RATIO

Current through Register Vol. 39, No. 2, July 15, 2024
The premium rates charged for credit unemployment insurance
				  shall be reasonable in relation to the benefits provided as indicated by a
				  minimum annual incurred loss ratio of 60%.
Authority
				  G.S.
				  58-2-40;
				  58-57-110(a);
Eff. January 1, 1994;
Amended Eff. November 11, 2011;
Readopted Eff. October 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0500 - CREDIT UNEMPLOYMENT MINIMUM LOSS RATIO STANDARD › Section 16 .0502 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Section:
(1) "Earned Premium" means North Carolina
				credit unemployment earned premium, during the experience period, restated as
				though the current North Carolina credit unemployment rate had been
				charged.
(2) "Incurred Claims"
				means North Carolina credit unemployment incurred losses during the experience
				period.
(3) "Experience Period"
				means the period of time for which experience is reported, but not for a period
				longer than the most recent three years.
(4) "Incurred Claim Count" means the number
				of North Carolina credit unemployment claims incurred during the experience
				period. This means the total number of claims reported during the experience
				period, whether paid or in the process of payment, plus any claims incurred but
				not reported at the end of the experience period less the number of claims
				incurred but not reported at the beginning of the experience period. Only the
				initial claim payment for that period of unemployment shall be
				counted.
(5) "Credibility Factor"
				means the degree to which the past experience is expected to occur in the
				future.
(6) "Credibility Formula"
				means the following process used to calculate the credibility factor:
(a) determine the incurred claim count during
				the experience period;
(b) divide
				Sub-item (6)(a) of this Rule by 1082;
(c) take the square root of Sub-item (6)(b)
				of this Rule; and
(d) the
				credibility factor is the lesser of the number one and the results of Sub-item
				(6)(c) of this Rule.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0500 - CREDIT UNEMPLOYMENT MINIMUM LOSS RATIO STANDARD › Section 16 .0503 - GENERAL SUBMISSION REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All
				credit unemployment minimum incurred loss ratio compliance demonstrations shall
				be submitted to the Life and Health Division upon request.
(b) All experience used in the demonstration
				of compliance shall be only North Carolina experience.
(c) All compliance demonstrations shall be
				submitted, in accordance with this Rule, to the Life and Health Division each
				succeeding year for reevaluation.
(d) The following information shall be
				submitted in regards to the qualified actuary:
(1) the name of the qualified
				actuary;
(2) the professional
				designations of the qualified actuary;
(3) the name and address of the company or
				actuarial consulting firm employing the qualified actuary; and
(4) the telephone number, including
				extension, of the qualified actuary.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0500 - CREDIT UNEMPLOYMENT MINIMUM LOSS RATIO STANDARD › Section 16 .0504 - CALCULATION PROCEDURE AND DEMONSTRATION OF COMPLIANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Each credit unemployment insurer shall submit to the
				  Department of Insurance the results of each calculation as follows and the
				  corresponding data required to perform each calculation in accordance with this
				  Rule:
(1) calculate the incurred loss
				ratio at current credit unemployment rate as defined in
				11 NCAC
				16 .0502(8);
(2) calculate the credibility factor using
				the credibility formula as defined in
				11 NCAC
				16 .0502(6);
(3) multiply Item (1) of this Rule by Item
				(2) of this Rule;
(4) multiply .60
				by the quantity one minus Item (2) of this Rule;
(5) add Items (3) and (4) of this Rule;
				and
(6) divide Item (5) of this
				Rule by .60. Compliance with
				11 NCAC
				16 .0501 shall be satisfied if this quotient
				is equal to or greater than one. If this quotient is less than one, then in
				order to satisfy
				11 NCAC
				16 .0501 the insurer shall decrease the
				current credit unemployment rate until the quotient is equal to or greater than
				one.
Authority
				  G.S.
				  58-2-40;
				  58-57-70;
				  58-57-110(a);
Eff. January 1, 1994;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0602 - HMO GENERAL FILING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All
				schedules of premiums for enrollee coverage for health care services and all
				amendments to schedules of premiums that are filed with the Department shall be
				submitted to and stamped received by the Life and Health Division and shall
				indicate whether the filing is an original or amended filing. All data
				requirements prescribed by this Section shall be submitted within 30 days after
				the date that the filing is stamped received, or the filing will be deemed to
				be disapproved. Subsequent data submissions for rate filings deemed to be in
				non-compliance with this Section shall be made directly to the Department's
				Actuarial Services Division within the 30 day period.
(b) All filings shall be accompanied by:
(1) A certification by a qualified actuary
				that the premiums applicable to an enrollee are not individually determined
				based on the status of their health and that such premiums are established in
				accordance with actuarial principles for various categories of enrollees and
				are not excessive, inadequate, or unfairly discriminatory.
(2) Actuarial data supporting the schedule of
				premiums as prescribed by
				11 NCAC
				16 .0603,
				11 NCAC
				16 .0604,
				11 NCAC
				16 .0605,
				11 NCAC
				16 .0206 and
				11 NCAC
				16 .0207.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0603 - HMO RATE FILING DATA REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
All HMO rate filings shall include the following data:
(1) identification and a brief description of
				the HMO model type;
(2)
				identification of the enrollee issue basis, whether individual or
				group;
(3) identification and a
				brief description of the type of rating methodology, such as community rating,
				community rating by class, adjusted community rating, credibility rating, or
				other;
(4) identification and
				listing of all rate classification factors, such as age, gender, geographic
				area, industry, group size, or effective date;
(5) a brief, summary description and
				numerical demonstration of the development of the capitated rate, including a
				listing of sources used;
(6) a
				brief, summary description and numerical demonstration of the development of
				any portion of the premium rate developed for fee-for-service claims, including
				a listing of sources used;
(7) a
				brief, summary description of the claim reserving methodology and the
				incorporation of claim reserves into the premium rate;
(8) a brief, summary description of the
				procedure and assumptions used to convert the total per member per month cost
				to the proposed premium rates, including assumptions for the distribution of
				community rated contracts by contract type, the ratios by tier to the single
				rate, and the average number of members in each contract type;
(9) the projected monthly incurred loss
				ratios for the period of time equal to the number of months for which the rates
				will be in effect, plus the number of months the rates will be guaranteed;
				and
(10) the percentage of the per
				member per month premium for administrative expenses and for surplus.
Authority
				  G.S.
				  58-67-50(b);
				  58-67-150;
Eff. April
				  1, 1995;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0604 - INITIAL HMO RATE FILING DATA REQUIREMENTS AND STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All initial HMO rate filings shall
				include, in addition to the data required by
				11 NCAC
				16 .0603, the following data:
(1) a comparison of the rates to other HMO
				rates with the same effective date in North Carolina for similar benefit plans;
				and
(2) a three-year financial
				projection, provided by the Department's Actuarial Services Division, that
				details total membership, revenues, and expenses, and that includes a statement
				of cash flow, a balance sheet, and a statement of working capital and net
				worth.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0605 - HMO EXPANSION REQUEST DATA REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
All HMO expansion requests shall include, in addition to the
				  data required by 11 NCAC .0603, the following data:
(1) a comparison of the actual financial
				results, including total membership, revenues, and expenses, to the projected
				financial results for at least the most recent 12-month period; and
(2) a three-year financial projection,
				provided by the Department's Actuarial Services Division, that details total
				membership, revenues, and expenses, and that includes a statement of cash flow,
				a balance sheet, and a statement of working capital and net worth for both the
				existing service area and the proposed area of expansion.
Authority
				  G.S.
				  58-67-10(d)(1);
				  58-67-50(b);
				  58-67-150;
Eff. April
				  1, 1995;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0606 - HMO RATE REVISION FILING DATA REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
All HMO rate revision filings shall include, in addition to
				  the data required by
				  11 NCAC
				  16 .0603, the following data:
(1) a brief, summary description of the scope
				and reason for any rate revision, including the methodology employed to
				determine the revised rates;
(2)
				the number of months the rates will be in effect and the number of months the
				rates will be guaranteed;
(3) the
				dates and average percentage amounts of:
(a)
				all prior rate revisions in North Carolina during the preceding three years;
				and
(b) the current rate revision
				request;
and quarterly rate increases shall be shown in comparison to
				  both the immediately preceding quarter and the corresponding quarter of the
				  previous 12-month period;
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS › Section 16 .0607 - HMO INCURRED LOSS RATIO STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				following shall apply to all HMO rate revision filings:
(1) The application of a requested rate
				increase or decrease shall result in an average incurred loss ratio projected
				for North Carolina over the period required in
				11 NCAC
				16 .0606(8) of this Section
				that is not less than:
(A) 75.0% for
				full-service HMO products issued on a group basis;
(B) 65.0% for single-service HMO products
				issued on a group basis;
(C) 65.0%
				for full-service HMO products issued on an individual basis; or
(D) 55.0% for single-service HMO products
				issued on an individual basis.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0700 - HEALTH MAINTENANCE ORGANIZATION CLAIM RESERVE DATA REQUIREMENTS › Section 16 .0701 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Section:
(1) "Claim reserves" means reserves or
				liabilities held for claims incurred on or before the valuation date, but
				unpaid as of the valuation date. Claim reserves include both reported and
				unreported claims. Claim reserves are established for both accrued and
				unaccrued benefits.
(2) "Valuation
				date" means the date at which reserves are estimated.
Authority
				  G.S.
				  58-2-40;
				  58-67-135(b);
Eff. February 1, 1995;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0700 - HEALTH MAINTENANCE ORGANIZATION CLAIM RESERVE DATA REQUIREMENTS › Section 16 .0702 - CLAIMS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) When an HMO has been informed that a
				claim has been incurred, if the date reported is on or before the valuation
				date, the claim shall be considered as a reported claim.
(b) When an HMO has not been informed, on or
				before the valuation date, concerning a claim that has been incurred on or
				before the valuation date, the claim shall be considered as an unreported
				claim.
(c) The date on which a
				claim is determined to be a liability of an HMO is the incurred date. For
				example: The incurred date for charges for inpatient hospital and physician
				visits in hospital shall be the date of admission, for outpatient hospital
				charges shall be the date of service, and for surgical expenses shall be the
				date of the surgery.
Authority
				  G.S.
				  58-2-40;
				  58-67-135(b);
Eff. February 1, 1995;
Readopted Eff. October 1,
				  2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 16 - ACTUARIAL SERVICES DIVISION › Section .0700 - HEALTH MAINTENANCE ORGANIZATION CLAIM RESERVE DATA REQUIREMENTS › Section 16 .0703 - CLAIM RESERVE FILING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				quarterly claim reserve data filing shall be made by any HMO that has been in
				operation for more than one full calendar year but less than three full
				calendar years.
(b) An annual claim
				reserve data filing shall be made by any HMO that satisfies either of the
				following conditions:
(1) for the most recent
				quarterly valuation the net worth less the contingency reserve is less than the
				statutory minimum stated in
				G.S.
				58-67-110(c) or
				G.S.
				58-67-110(d); or
(2) for the most recent annual valuation the
				sum of the following exceeds 110 percent of the estimated liability of unpaid
				claims on December 31 of the previous year:
(A) total of claims paid during the year and
				incurred in previous years; and
(B)
				claims unpaid at December 31 of the current year on claims incurred in previous
				years.