2019 MEDICARE SUPPLEMENT DATA CALL
Reporting Due Date: May 31, 2020
transacted individual or group Medicare Supplement business in the
Commonwealth of Pennsylvania in 2019
and Health Insurance Actuary
Supplement Refund Calculation
Tracie Gray, Director
Bureau of Life, Accident and Health Insurance
Office of Insurance Product Regulation and Administration
31 s 89.780(b) of the Pennsylvania Insurance Regulations, the Pennsylvania
Insurance Department has prescribed the Excel worksheets contained in the
workbook linked below as the applicable Medicare Supplement Refund Calculation
forms to be used by insurers to submit the required annual refund calculation
data to the Department for each individual and group standardized Medicare
Supplement benefit plan.
must submit the refund calculation data in the prescribed Excel format to the
Commissioner by May 31 of each year. The
shaded areas on the worksheet are to be completed by the company; all other
information will be calculated from the entered data.
Separate blank worksheets
for individual and group business are contained in the linked workbook, which
incorporate specific loss ratios to calculate the benchmark ratio for the
applicable market; otherwise the two worksheets are identical. These worksheets should be completed for each
standardized Medicare Supplement benefit plan (SMSBP): A, B, C, D, E, F, G, H,
I, J, K, L, M, and N.
- Submit all of the insurer's worksheets in one Excel workbook.
- Do not convert the information to a pdf file.
- Do not modify the formatting of the workbook (other than to hide, rather than delete, rows or columns if the company considers it necessary), and leave all formulas intact.
- Note that in the determination of the Benchmark Loss Ratio, all data for calendar years prior to 2004 will be automatially included in the Calendar Year 2004 row for calculation purposes.
- Standard and Select plan experience must be reported on separate worksheets.
- 1990 and 2010 form series experience must be combined in one exhibit for each SMSPB.
- High deductible Plan F and Plan J experience must be included in the exhibits for Plan F and Plan J, respectively.
- Earned Premiums are to include all modal loads and fees charged.
- Incurred claims are to exclude active life reserves.
worksheets must also be completed for any pre-standardized individual or group
plans (SMSBP: P) for which business remained inforce in 2019. Again, individual and group plan experience
must be submitted separately, with the combined experience for all applicable policies
included on the appropriate worksheet (individual or group).
purposes of calculating the refunds for pre-standardized plans, 1996 is
considered the year of issue for all business. So, in the Calendar Year Experience
section of the worksheet, data will be entered only in Year of Issue 1996, for
calendar years 1996 and subsequent.
of the experience submitted in the previous year’s filing differs from the
experience for the same period submitted in the current year’s filing, provide an
explanation of the reason(s) that the data has changed. This explanation must
be included in a cover letter that accompanies the current year’s filing.
Medicare Supplement Refund Calculation
filings must be submitted via SERFF, using:
Type of Insurance (TOI) code MS-09
Medicare Supplement - Other 2010
Sub-Type of Insurance (Sub-TOI) code MS09.000
Medicare Supplement Other 2010
Filing Type Rate - Medicare
Supplement Refund Calculation
If you have any questions, please contact Michael Gurgiolo
at (717) 783-2115 or email email@example.com
prescribed workbook with individual and group pages can be found here:
Medicare Supplement Refund Workbook