806 KAR 52:030. Workers’ compensation

self-insured group rate, rule and form filings.

 

      RELATES TO: KRS 304.4-010, 304.13-053,

304.14-120, 304.50-010, 304.50-115

      STATUTORY AUTHORITY: KRS 304.4-010,

304.50-010(2), 304.50-115

      NECESSITY, FUNCTION, AND CONFORMITY: KRS

304.50-010(2), authorizes the Executive Director of the Office of Insurance to

promulgate administrative regulations as necessary to govern admission

certification and regulation of workers’ compensation self-insured groups. KRS

304.50-115, requires workers’ compensation self-insured groups to file rates,

supplementary rating information and coverage form filings with the executive

director. This administrative regulation establishes workers’ compensation

self-insured group rate, rule and form filing procedures.

 

      Section 1. Definitions. (1)

"Coverage form" is defined in KRS 304.50-015(10).

      (2) "Executive director" means

the Executive Director of the Office of Insurance.

      (3) "Office" means the Office

of Insurance.

      (4) "Self-insured group" is defined

in KRS 304.50-015(29).

 

      Section 2. General Filing Requirements.

(1) Every self-insured group shall file with the executive director its

coverage forms, rates, loss costs, rating plans, rating rules, underwriting

rules or guidelines, statistical plans, supporting information, supplementary

information and premium payment plans accompanied by a completed and signed

Form WC SIG F-1A P&C, "Face Sheet and Verification Form for Workers

Compensation Self-Insured Groups".

      (2) All filings shall include two (2)

full document sets on 8 1/2 in. x 11 in. white paper with three (3) cover

letters and a self-addressed stamped envelope.

      (3) A filing may include any number of

documents, filed together on a particular date. Rates, loss costs, and rules

shall be filed separately from coverage forms.

      (4) KRS 304.4-010(2) requires all fees

and charges payable under the insurance code to be collected in advance. The

period of time in which the executive director may affirmatively approve or

disapprove the filing shall not begin until a complete filing and the

appropriate fee, as set forth in 806 KAR 4:010, Section 1(21), is received.

 

      Section 3. Rate and Rule Filings. (1)

Form WC SIG: S-1 P & C, "Filing Synopsis for Rates and or Rules"

shall be filed with all rate or rule filings.

      (2)(a) Form WC SIG: LC-1 P & C,

"Calculation of Loss Cost Multiplier" shall be filed with all rate

filings referencing loss costs formulated by any advisory organization.

      (b) Form WC SIG LC-2 P & C,

"Expense Constant Supplement" shall be filed with all rate filings

referencing loss costs formulated by an advisory organization in which an

expense constant is used.

      (3) Form WC SIG: EMA P & C,

"E-Mod Affidavit" shall be filed with all rate or rule filings

containing experience modification factors.

      (4)(a) All rate or rule filings

containing schedule rating plans shall identify the characteristics of the risk

not reflected in an experience modification factor.

      (b) Any application of the schedule

rating plan shall be based on evidence contained in the self-insured group’s

file at the time it is applied. The schedule rating plan debit or credit

factor(s) applied shall be made available to the member upon request.

      (c) If the reason for application of any

schedule debit is corrected by the member to the satisfaction of the

self-insured group, the debit may be removed when evidence of the correction is

received by the group.

 

      Section 4. Coverage Form Filings. (1)

Form WC SIG: S-2 P & C, "Filing Synopsis Form" and Form WC SIG:

F-2 P & C, "Forms Index" shall be filed with all coverage form

filings.

      (2) A coverage form shall not be used

until it has been approved by the executive director. If the rates pertaining

to a coverage form are required by law to be filed with or approved by the

executive director, the coverage form shall not be used until the appropriate

rates have been filed or approved as required.

      (3) A filing which amends, replaces, or

supplements a coverage form previously filed and approved shall include an

explanation setting forth all changes contained in the newly filed coverage

form, the effect, if any, the changes have upon the hazards purported to be

assumed by the policy, and an explanation as to the effect on the rates

applicable thereto.

      (4) A change of signature of the

executing officer on a coverage form shall not, because of this change alone,

require a new filing.

 

      Section 5. Advisory Organization Filings.

(1) A self-insured group that is a member, subscriber, or service purchaser of

an advisory organization, statistical agent or forms provider may choose to

adopt coverage forms, rating plans, rating rules, rating schedules, other

supplementary rating information, underwriting rules or guidelines, or

statistical plans of that advisory organization or statistical agent by doing so

in accordance with the procedures established in this administrative regulation

and shall clearly identify each filing of the advisory organization or

statistical agent it is adopting.

      (2) If a self-insured group chooses to

adopt only a specific filing of an advisory organization, statistical agent, or

form provider it shall do so in accordance with the procedures established in

this administrative regulation, and shall clearly identify which filing of the

advisory organization or statistical agent it is adopting. Loss cost filings

shall be specifically adopted.

      (3)(a) If a self-insured group chooses to

adopt all of the current and future coverage forms, rating plans, rating rules,

rating schedules, other supplementary rating information, underwriting rules or

guidelines and statistical plans, excluding loss costs, of an advisory

organization, statistical agent, or forms provider, it may file written notice

with the executive director that it is adopting by blanket reference all of the

current and future coverage forms, rating plans, rating rules, rating

schedules, other supplementary rating information, underwriting rules or

guidelines and statistical plans, excluding loss costs, as filed by the

advisory organization, statistical agent, or forms provider. Loss cost filings

shall not be adopted on this blanket reference basis.

      (b) If a self-insured group previously

notified the executive director of its adoption of all current and future

filings, excluding loss cost filings, by the advisory organization, statistical

agent, or forms provider and chooses not to adopt certain coverage forms,

rating plans, rating rules, rating schedules, other supplementary rating information,

underwriting rules or guidelines, or statistical plans, the group shall file

notice of the nonadoption with the executive director and shall pay the

appropriate filing fee, as set forth in 806 KAR 4:010, Section 1(21).

      1. If a self-insured group previously

notified the executive director of its adoption of all current and future

filings, excluding loss cost filings, by the advisory organization, statistical

agent, or forms provider and chooses to delay the effective date of its

adoption, it shall submit a letter to the executive director requesting the

revised date upon which it will adopt the filing.

      2. The delayed adoption date shall be

within six (6) months of the original effective date.

      3. If additional time is needed, a second

letter shall be submitted to the executive director, requesting a revised

delayed adoption date.

      4. All revised delayed adoption dates

shall be within one (1) year of the original effective date as filed by the

advisory organization, statistical agent or forms provider.

      5. If a self-insured group fails to adopt

the advisory organization, statistical agent, or forms provider filing within

one (1) year of the original effective date as filed by the advisory

organization, statistical agent or forms provider, the insurer shall submit a

filing to the executive director indicating it is nonadopting.

 

      Section 6. Incorporation by Reference.

(1) The following material is incorporated by reference:

      (a) Form WC SIG: F-1A P & C,

"Face Sheet and Verification Form for Workers Compensation Self Insurance

Groups," March 2005, Office of Insurance;

      (b) Form WC SIG: F-2 P & C,

"Forms Index," March 2005, Office of Insurance;

      (c) Form WC SIG: S-1 P & C,

"Filing Synopsis for Rates and or Rules," March 2005, Office of

Insurance;

      (d) Form WC SIG: S-2 P & C,

"Filing Synopsis Form," March 2005, Office of Insurance;

      (e) Form WC SIG: LC-1 P & C,

"Calculation of Loss Cost Multiplier," March 2005, Office of

Insurance;

      (f) Form WC SIG: LC-2 P & C,

"Expense Constant Supplement," March 2005, Office of Insurance; and

      (g) Form WC SIG: EMA P & C,

"E-mod Affidavit," March 2005, Office of Insurance.

      (2) This material may be inspected,

copied, or obtained, subject to applicable copyright law, from the Office of

Insurance, 215 West Main Street, Frankfort, Kentucky 40601, Monday through

Friday, 8 a.m. to 4:30 p.m. This material is also available on the Office of Insurance

Internet Web site http://doi.ppr.ky.gov/kentucky. (31

Ky.R. 2068; 32 Ky.R. 503; eff. 10-7-2005; TAm eff. 10-9-2008.)