(a) The following rules shall apply with
respect to experience data for individual insurance.
(1) Maintaining experience. Premium and loss
data shall be recorded for each policy form and, where more than one coverage
may be provided at the option of the insured under a single policy form, for
each major combination of coverage and each age group (i.e., under age 65 and
age 65 and over) on the following basis for each calendar year:
(i) premiums written or paid;
(ii) each reserve component (i.e., the
increase in premium reserves, policy reserves, and claim reserves and
liability);
(iii) earned premiums
by duration, in durations corresponding to the expected loss ratios in section
52.40(d)(1)(x) of
this Part. Approximations by duration may be used when included as part of the
filing under section
52.40(d)(1) of
this Part, or by separate prior approval;
(iv) paid losses;
(v) incurred losses;
(vi) the interest assumptions used in the
applicable expected future loss ratio calculations; and
(vii) dividends incurred, as used in the
policy experience exhibit.
Other than subparagraphs (vi) and (vii), the above terms
are as defined in the current New York Instructions for Completion of the Life
and Accident and Health Annual Statement. For policies issued on an attained
age rating basis, or where benefits or premiums are changed at attained age 65,
experience must be separately maintained for those under age 65 and age 65 and
over. Experience, by age, need not be maintained for certain coverages, such as
travel accident, with the prior consent of the superintendent.
(2) Combining
experience. Experience under different policies where the coverage is
substantially the same, and the premium rates are on a consistent basis, may be
combined, but only with the prior consent of the superintendent.
(b) Standards for maintaining
experience data for benefits under the Disability Benefits Law. Premium and
loss data shall be maintained yearly:
(1)
separately for each of the following categories:
(i) male vs. female; and
(ii) each premium basis the insurer has on
file, including experience-rated vs. nonexperience-rated;
(2) for each of the following items:
(i) premium earned;
(ii) claims paid, by number, duration and
amounts; and
(iii) claims
incurred.
(c)
Additional standards for maintaining data concerning those insured by and the
benefits paid by long term care insurance, nursing home insurance only, home
care insurance only, or nursing home and home care insurance should be as
follows:
(1) for each insured:
(i) insured's identification number, such as
policy or certificate number;
(ii)
policy form number;
(iii) brief
summary of the insured's benefits (including types of coverage provided,
benefit amounts, elimination period, maximum benefit, inflation protection and
nonforfeiture option);
(iv) whether
this policy provides individual or family coverage;
(v) relationship of insured to policyholder
or certificateholder;
(vi) date of
issue;
(vii) sex;
(viii) date of birth;
(ix) risk classification (standard or
substandard);
(x) current state of
residence and zip code;
(2) for each claim:
(i) insured's identification number, such as
policy or certificate number;
(ii)
claim identification number;
(iii)
claim incurral date;
(iv) claim
termination date;
(v) paid claims
by coverage type;
(vi) benefit
days/visits by coverage type.