S.D. Admin. R. 20:06:06:08 - Filing of experience information

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Insurers doing credit life or credit health insurance business, or both, in this state shall annually file with the division a report of its credit life insurance experience and credit health insurance experience on the following form prescribed by the director:

CREDIT LIFE INSURANCE EXPERIENCE EXHIBIT

All Credit Life Insurance Written Under the N.A.I.C.

Model Credit Insurance Bill in the State of South Dakota

Experience of Calendar year 19__ or of

Policy Years Ending in 19__ (Indicate Which)

To be filed on or before June 30

I. Single Premium Paid in Advance, Reducing Term

A. Other than Commercial and Savings Banks

a. Cash Loans (Small Loans, Industrial Bank Loans, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves,

including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force

(100 X Item 4 -:- Item 1) _____

6. Losses per $100.00 initial amount on basis of 12 months policy (13/24 X Item 5) _____

7. Premium rate per $100.00 initial amount on basis of 12 months policy:

(a) minimum ____

(b) maximum ____

in force _____

8. Eligibility requirements (explain) (Footnote a) _____ _____

9. Underwriting limitations (explain) (Footnote b) _____ _____

10. Other limits on coverage (explain) _____ _____

11. Loss ratio (Item 6 -:- Item 7(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force after appropriate deduction for reducing term provision and terminations.

b. Sales Finance (Discount Transactions, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves,

including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force

(100 X Item 4 -:- Item 1) _____

6. Losses per $100.00 initial amount on basis of 12 months policy (13/24 X Item 5) _____

7. Premium rate per $100.00 initial amount on basis of 12 months policy:

(a) minimum ____

(b) maximum ____

in force _____

8. Eligibility requirements (explain) (Footnote a) _____ _____

9. Underwriting limitations (explain) (Footnote b) _____ _____

10. Other limits on coverage (explain) _____ _____

11. Loss ratio (Item 6 - Item 7(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force after appropriate deduction for reducing term provision and terminations.

B. Commercial and Savings Banks

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves,

including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force

(100 X Item 4 -:- Item 1) _____

6. Losses per $100.00 initial amount on basis of 12 months policy (13/24 X Item 5) _____

7. Premium rate per $100.00 initial amount on basis of 12 months policy:

(a) minimum ____

(b) maximum ____

in force _____

8. Eligibility requirements (explain) (Footnote a) _____ _____

9. Underwriting limitations (explain) (Footnote b) _____ _____

10. Other limits on coverage (explain) _____ _____

11. Loss ratio (Item 6 - Item 7(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force after appropriate deduction for reducing term provision and terminations.

C. Credit Unions

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves,

including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force

(100 X Item 4 -:- Item 1) _____

6. Losses per $100.00 initial amount on basis of 12 months policy (13/24 X Item 5) _____

7. Premium rate per $100.00 initial amount on basis of 12 months policy:

(a) minimum ____

(b) maximum ____

insurance in force _____

8. Eligibility requirements (explain) (Footnote a) _____ _____

9. Underwriting limitations (explain) (Footnote b) _____ _____

10. Other limits on coverage (explain) _____ _____

11. Loss ratio (Item 6 - Item 7(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force after appropriate deduction for reducing term provision and terminations.

II. Single Premium Paid in Advance, Level Term

A. Other than Commercial and Savings Banks

a. Cash Loans (Small Loans, Industrial Bank Loans, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum _____

(b) maximum _____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

b. Sales Finance (Discount Transactions, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

B. Commercial and Savings Banks

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

C. Credit Unions

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

III. Outstanding Balance Premium Method

A. Other than Commercial and Savings Banks

a. Cash Loans (Small Loans, Industrial Bank Loans, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

b. Sales Finance (Discount Transactions, etc.)

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

of mean insurance in force _____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

B.Commercial and Savings Banks

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5.Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

C. Credit Unions

1. Mean insurance in force* $_____

2. Losses paid _____

3. Increase (+) or decrease (-) in loss reserves, including incurred but unreported _____

4. Losses incurred (Item 2 + Item 3) _____

5. Losses per $100.00 mean insurance in force (100 X Item 4 -:- Item 1) _____

6. Annual premium rate per $100.00:

(a) minimum ____

(b) maximum ____

7. Eligibility requirements (explain) (Footnote a) _____ _____

8. Underwriting limitations (explain) (Footnote b) _____ _____

9. Other limits on coverage (explain) _____ _____

10. Loss ratio (Item 5 -:- Item 6(c)) _____

______________________________

Name

______________________________

Company (Please Print)

_____

*Mean insurance in force reflecting terminations during the year.

(a)Show eligibility requirements such as age, good health, employment, etc.

(b)Show such limitations as statement of good health, use of application, any limitations on amount because of age or underwriting restrictions, etc.

_____All States

_____All Model Act States

_____State of South Dakota

_____Other (Explain Fully) _____ _____ _____ _____

(Check one of the above, this being at Insurer's Option)

To Be Filed on or Before June 30 of Each Year

1. Gross Premium Written (A) _____ _____ _____ _____

2. Refunds on Termination _____ _____ _____ _____

3. Net Premium Written (1-2) _____ _____ _____ _____

4. Premium Reserve at Start of Period (B) _____ _____ _____ _____

5. Premium Reserve at End of Period (B) _____ _____ _____ _____

6. Earned Premium (3+4-5) _____ _____ _____ _____

7. Claims Paid _____ _____ _____ _____

8. Reserve for Claims at End of Period _____ _____ _____ _____

9. Reserve for Claims at Beginning of Period _____ _____ _____ _____

10. Incurred Losses (7+8-9) _____ _____ _____ _____

11. Loss Ratio - Ratio of Line 10 to Line 6 _____ _____ _____ _____

(A)Include membership fees or policy fees and all other insurance fees (excluding reinsurance assumed and without deduction of reinsurance ceded), without any reduction or deduction for any purpose or to any extent.

(B)For purposes of this form, premium reserves shall be reported on a monthly pro rata basis.

(C)Experience under forms providing substantially the same benefits at the same premium rates with substantially the same eligibility and underwriting requirements shall be reported on a combination basis if the difference in the number of the form is primarily due to difference in required uniform provisions or required differences in wording of other policy provisions. Where substantially different benefits are provided under the same form, the experience shall be reported separately.

(D)Indicate, also, waiting period and whether coverage is retroactive or nonretroactive as well as any approved limits on preexisting conditions.

(E)Show eligibility requirements such as age, good health, employment, etc.

(F)Show such limitations as statement of good health, use of application, etc.

(G)Show cash loans (small loans, industrial bank loans, etc.); Sales Finance (discount transactions, etc.); Credit Unions, Banks (Commercial and Savings).

______________________________

Name

______________________________

Company (Please Print)

_____ Calendar Year or

_____ Policy Year

(Check one of the above, this being at Insurer's Option)

To be Filed on or Before June 30 of Each Year

1. Form No. (C) _____ _____ _____ _____

2. Indicate Group or Individual _____ _____ _____ _____

3. Brief Description of Type of Coverage (D) _____ _____ _____ _____

4. Premium Rates (A) _____ _____ _____ _____

5. Eligibility Requirements (E) _____ _____ _____ _____

6. Underwriting Limitations (F) _____ _____ _____ _____

7. Other Limitations on Coverage _____ _____ _____ _____

8. Class of Business (G) _____ _____ _____ _____

9. Other Remarks _____ _____ _____ _____

(B)For purposes of this form, premium reserves shall be reported on a monthly pro rata basis.

(C)Experience under forms providing substantially the same benefits at the same premium rates with substantially the same eligibility and underwriting requirements shall be reported on a combination basis if the difference in the number of the form is primarily due to differences in required uniform provisions or required differences in wording of other policy provisions. Where substantially different benefits are provided under the same form, the experience shall be reported separately.

(D)Indicate, also, waiting period and whether coverage is retroactive or nonretroactive as well as any approved limits on preexisting conditions.

(E)Show eligibility requirements such as age, good health, employment, etc.

(F)Show such limitations as statement of good health, use of application, etc.

(G)Show cash loans (small loans, industrial bank loans, etc.); Sales Finance (discount transactions, etc.); Credit Unions, Banks (Commercial and Savings).

______________________________

Name

______________________________

Company (Please Print)

Notes

S.D. Admin. R. 20:06:06:08

4 SDR 6, effective August 9, 1977; 5 SDR 91, effective April 25, 1979; 12 SDR 151, 12 SDR 155, effective July 1, 1986.

General Authority: SDCL 58-19-34.

Law Implemented: SDCL 58-19-26.

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