Wyo. Code R. agency 044, Subagency 0002, ch. 49, app A - ACTUARIAL CERTIFICATION

TO: SMALL EMPLOYER HEALTH INSURANCE COMPLIANCE DIVISION

FROM: (Please type or print)

NAME OF COMPANY: ___________________

NAIC NUMBER: _________________

NAME OF CONTACT PERSON: ______________________

TITLE: __________________

TELEPHONE NUMBER: ____________________________

DATE: __________________

ADDRESS: _______________________________

_______________________________

_______________________________

_______________________________

I. Actuarial Certification:

I hereby certify that the rates charged small groups in the state of Wyoming are:

1. Based on rating methods that are actuarially sound;

2. Such that the index rate for any class of business does not exceed the index rate for another class of business by more than twenty percent (20%);

3. Such that rates for small employers with similar characteristics within a class of business do not vary from the index rate by more than thirty-five percent (35%);

4. Such that the percentage increase in the premium rate for a renewal rating period does not exceed the sum of the following:

(a) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period, or the percentage change in the base premium rate in the case of a class of business for which the insurer is not issuing new policies,

(b) An adjustment of not more than fifteen (15%) annually, adjusted pro rata for shorter rating periods, for such rating factors as claim experience, health status, and duration of coverage, determined in accordance with the [name of small employer carrier] rate manual or renewal rating guidelines, and

(c) An adjustment for a change in case characteristics or in benefit design characteristics, determined in accordance with the [name of small employer carrier] rate manual and rating procedure.

5. Such that the rate factor associated with any industry classification does not vary from the arithmetic average of the rate factors associated with all industry classifications by greater than fifteen percent (15%) of such coverage; and

6. In compliance with all other facets of W.S. 26-19-301 through 310, based upon the examination of premium rates for applicable health benefit plans and the review of their underlying actuarial assumptions and methods.

I certify that sufficient documentation of compliance is on file with the [name of small employer carrier] and available upon request by the Commissioner of Insurance.

_________________

Signature

Name ( Typed or printed) ________________

Title (Typed or Printed) _______________

Notes

Wyo. Code R. agency 044, Subagency 0002, ch. 49, app A