New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Appendix A

Current through Register Vol. 56, No. 14, July 15, 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
..........%