TOI: 16.0 Workers Compensation Sub-TOI: Standard WC

Transcription

1 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Workers' Compensation Conversion of LERs/ Filing at a Glance Companies: Accident Fund General Insurance Company, Accident Fund Insurance Company of America, Accident Fund National Insurance Company, United Wisconsin Insurance Company Product Name: Workers' Compensation SERFF Tr Num: ACCD State: TOI: 16.0 Workers Compensation SERFF Status: Closed-Approved State Tr Num: Sub-TOI: Standard WC Co Tr Num: NHR-2012-PRP State Status: Approved Filing Type: Rule Reviewer(s): James Young Author: Jenna Quasarano Disposition Date: 12/01/2011 Date Submitted: 10/31/2011 Disposition Status: Approved Effective Date Requested (New): 01/01/2012 Effective Date (New): 01/01/2012 Effective Date Requested (Renewal): 01/01/2012 Effective Date (Renewal): 01/01/2012 General Information Project Name: Conversion of LERs Status of Filing in Domicile: Project Number: Domicile Status Comments: Reference Organization: NCCI Reference Number: NH Reference Title: Advisory Org. Circular: NH Filing Status Changed: 12/01/2011 State Status Changed: 12/01/2011 Deemer Date: Created By: Judy Thomas Submitted By: Jenna Quasarano Corresponding Filing Tracking Number: Filing Description: Accident Fund Insurance Company of America and its subsidiaries, Accident Fund General Insurance Company, Accident Fund National Insurance Company, and United Wisconsin Insurance Company are filing revised Miscellaneous Values and Exceptions Pages to reflect the conversion of loss elimination ratios to premium reduction percentages on the hazard tables. No other changes are requested. Company and Contact Filing Contact Information Judy Thomas, Compliance Advisor judy.thomas@accidentfund.com 200 North Grand Avenue [Phone] [FAX] PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

2 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Lansing, MI Filing Company Information Accident Fund General Insurance Company CoCode: State of Domicile: Michigan 200 North Grand Avenue Group Code: 572 Company Type: Lansing, MI Group Name: State ID Number: (517) ext. [Phone] FEIN Number: Accident Fund Insurance Company of America CoCode: State of Domicile: Michigan 200 North Grand Avenue Group Code: 572 Company Type: Workers' Compensation Insurance Office of the General Counsel Group Name: State ID Number: Lansing, MI FEIN Number: (517) ext. [Phone] Accident Fund National Insurance Company CoCode: State of Domicile: Michigan 200 North Grand Avenue Group Code: 572 Company Type: Lansing, MI Group Name: State ID Number: (517) ext. [Phone] FEIN Number: United Wisconsin Insurance Company CoCode: State of Domicile: Wisconsin West Small Road Group Code: 572 Company Type: New Berlin, WI Group Name: State ID Number: (517) ext. [Phone] FEIN Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: Per Company: No No Yes COMPANY AMOUNT DATE PROCESSED TRANSACTION # Accident Fund General Insurance Company $ /31/2011 Accident Fund Insurance Company of America $ /31/2011 Accident Fund National Insurance Company $ /31/2011 PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

3 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ United Wisconsin Insurance Company $ /31/2011 State Specific Have you viewed and complied with 's General Instructions and Filing Requirements (Yes/No)? *Failure to comply will result in a filing rejection and require resubmission.: yes PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

4 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Correspondence Summary Dispositions Status Created By Created On Date Submitted Approved James Young 12/01/ /01/2011 Objection Letters and Response Letters Objection Letters Response Letters Status Created By Created On Date Submitted Responded By Created On Date Submitted Awaiting Company Reply James Young 11/17/ /17/2011 Jenna Quasarano 11/18/ /18/2011 Amendments Schedule Schedule Item Name Created By Created On Date Submitted Rate Miscellaneous Values & Exceptions AF Jenna Quasarano 11/29/ /29/2011 Rate Miscellaneous Values & Exceptions UWIC Jenna Quasarano 11/29/ /29/2011 Supporting Document Filing Memorandum Jenna Quasarano 11/29/ /29/2011 Rate Miscellaneous Values & Exceptions AF Jenna Quasarano 11/21/ /21/2011 Rate Miscellaneous Values & Exceptions UWIC Jenna Quasarano 11/21/ /21/2011 Supporting Document Filing Memorandum Jenna Quasarano 11/21/ /21/2011 PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

5 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Disposition Workers' Compensation Conversion of LERs/ Disposition Date: 12/01/2011 Effective Date (New): 01/01/2012 Effective Date (Renewal): 01/01/2012 Status: Approved Comment: Rate data does NOT apply to filing. Overall Rate Information for Multiple Company Filings Overall Percentage Rate Indicated For This Filing 0.000% Overall Percentage Rate Impact For This Filing 0.000% Effect of Rate Filing-Written Premium Change For This Program $0 Effect of Rate Filing - Number of Policyholders Affected 0 PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

6 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Schedule Schedule Item Schedule Item Status Public Access Supporting Document Actuarial Memorandum Completed Review Yes Supporting Document (revised) Filing Memorandum Completed Review Yes Supporting Document Supplemental Yes Experience Exhibit Supporting Document NH Retaliatory Fees Yes Supporting Document Package of Actuarial Exhibits and Completed Review Yes Supporting Data Supporting Document Reference Filing Adoption Form - Loss Yes Cost Filings Supporting Document Filing Memorandum Completed Review Yes Supporting Document Filing Memorandum Completed Review Yes Supporting Document Filing Memorandum Completed Review Yes Rate (revised) Miscellaneous Values & Exceptions AF Completed Review Yes Rate (revised) Miscellaneous Values & Exceptions Completed Review Yes UWIC Rate Miscellaneous Values & Exceptions AF Completed Review Yes Rate Miscellaneous Values & Exceptions AF Completed Review Yes Rate Miscellaneous Values & Exceptions AF Completed Review Yes Rate Miscellaneous Values & Exceptions Completed Review Yes UWIC Rate Miscellaneous Values & Exceptions Completed Review Yes UWIC Rate Miscellaneous Values & Exceptions UWIC Completed Review Yes PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

7 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Objection Letter Conversion of LERs/ Objection Letter Status Awaiting Company Reply Objection Letter Date 11/17/2011 Submitted Date 11/17/2011 Respond By Date 12/01/2011 Dear Judy Thomas, After review of this filing, we have the following question(s)/comment(s). Objection 1 - Miscellaneous Values & Exceptions AF, WCX-NH (Rate) - Miscellaneous Values & Exceptions UWIC, WCX-NH-UW (Rate) Comment: Since you are showing advisory loss elimination ratios converted into premium reduction percentages on your Miscellaneous Values page, the tables should be renamed as Premium Reduction Percentages or Premium Credit Percentages so there is no confusion on what the percentages are. Objection 2 - Miscellaneous Values & Exceptions AF, WCX-NH (Rate) - Miscellaneous Values & Exceptions UWIC, WCX-NH-UW (Rate) Comment: Your Miscellaneous Values Pages are showing approved NCCI values effective 1/1/2011 and should be updated to reflect the NCCI values that have been approved as of 1/1/2012. Review will continue when we receive your reply. In the absence of any response, by the Respond-By-Date noted above, this filing will be disapproved. Extensions will not be granted without good cause shown, RSA 400-A:16 II. Sincerely, James Young PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

8 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Response Letter Conversion of LERs/ Response Letter Status Submitted to State Response Letter Date 11/18/2011 Submitted Date 11/18/2011 Dear James Young, Comments: Response 1 Comments: Both WCX-NH and WCX-NH-UW have been updated to show Premium Reduction Percentages instead of Advisory Loss Elimination Ratios. Related Objection 1 Applies To: - Miscellaneous Values & Exceptions AF, WCX-NH (Rate) - Miscellaneous Values & Exceptions UWIC, WCX-NH-UW (Rate) Comment: Since you are showing advisory loss elimination ratios converted into premium reduction percentages on your Miscellaneous Values page, the tables should be renamed as Premium Reduction Percentages or Premium Credit Percentages so there is no confusion on what the percentages are. Changed Items: Supporting Document Schedule Item Changes Satisfied -Name: Filing Memorandum Comment: filing information is provided on general information tab. Side by side comparisons of the documents are attached here for your review. No Form Schedule items changed. Rate/Rule Schedule Item Changes Exhibit Name Rule # or Page # Rate Action Previous State Filing # Miscellaneous Values & WCX-NH Replacement ACCD Exceptions AF Previous Version Miscellaneous Values & WCX-NH Replacement ACCD PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

9 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Exceptions AF Miscellaneous Values & WCX-NH-UW Replacement ACCD Exceptions UWIC Previous Version Miscellaneous Values & Exceptions UWIC WCX-NH-UW Replacement ACCD Response 2 Comments: Both WCX-NH and WCX-NH-UWIC have been updated to show the correct values. I have also updated the comparison pages with these values. Related Objection 1 Applies To: - Miscellaneous Values & Exceptions AF, WCX-NH (Rate) - Miscellaneous Values & Exceptions UWIC, WCX-NH-UW (Rate) Comment: Your Miscellaneous Values Pages are showing approved NCCI values effective 1/1/2011 and should be updated to reflect the NCCI values that have been approved as of 1/1/2012. Changed Items: No Supporting Documents changed. No Form Schedule items changed. Rate/Rule Schedule Item Changes Exhibit Name Rule # or Page # Rate Action Previous State Filing # Miscellaneous Values & WCX-NH Replacement ACCD Exceptions AF Previous Version Miscellaneous Values & WCX-NH Replacement ACCD Exceptions AF Miscellaneous Values & WCX-NH-UW Replacement ACCD Exceptions UWIC Previous Version Miscellaneous Values & WCX-NH-UW Replacement ACCD PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

10 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Exceptions UWIC Thank you! Workers' Compensation Conversion of LERs/ Sincerely, Jenna Quasarano PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

11 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Amendment Letter Workers' Compensation Conversion of LERs/ Submitted Date: 11/29/2011 Comments: Miscellaneous Values & Exceptions Pages under the Rate/Rule Tab were updated with correct values, and the Comparison pages under the Supporting Documents Tab were updated with this correct information as well. Changed Items: Rate/Rule Schedule Item Changes: Exhibit Name: Rule # or Rate Previous State Attach Page #: Action: Filing Number: Document: Miscellaneous WCX-NH Replacement Previous State Filing Num: ACCD- WCX-NH.pdf Values & Exceptions AF Miscellaneous Values & Exceptions UWIC WCX-NH-UW Replacement Previous State Filing Num: ACCD WCX-NH-UW.pdf Supporting Document Schedule Item Changes: Satisfied -Name: Filing Memorandum Comment: filing information is provided on general information tab. Side by side comparisons of the documents are attached here for your review. WCX-NH Comparison.pdf WCX -NH-UW Comparison.pdf PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

12 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Amendment Letter Workers' Compensation Conversion of LERs/ Submitted Date: 11/21/2011 Comments: Miscellaneous Values & Exceptions Pages under the Rate/Rule Tab were updated with correct PRP's, and the Comparison pages under the Supporting Documents Tab were updated with this correct information as well. Changed Items: Rate/Rule Schedule Item Changes: Exhibit Name: Rule # or Rate Previous State Attach Page #: Action: Filing Number: Document: Miscellaneous WCX-NH Replacement Previous State Filing Num: ACCD- WCX-NH.pdf Values & Exceptions AF Miscellaneous Values & Exceptions UWIC WCX-NH-UW Replacement Previous State Filing Num: ACCD WCX-NH-UW.pdf Supporting Document Schedule Item Changes: Satisfied -Name: Filing Memorandum Comment: filing information is provided on general information tab. Side by side comparisons of the documents are attached here for your review. WCX-NH Comparison.pdf WCX-NH-UW Comparison.pdf Rate/Rule Schedule Schedule Item Exhibit Name: Rule # or Page Rate Action Previous State Filing Attachments Status: #: Number: Completed Review 12/01/2011 Miscellaneous Values & Exceptions AF WCX-NH Replacement ACCD WCX-NH.pdf Completed Review Miscellaneous Values WCX-NH-UW Replacement ACCD WCX-NH-UW.pdf & Exceptions UWIC PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

13 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: 12/01/2011 Workers' Compensation Conversion of LERs/ PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

14 Effective January 1, 2012 Page 1 of 2 MISCELLANEOUS VALUES & EXCEPTIONS PAGE WCX-NH I. Miscellaneous Values Premium Reduction Percentages The following percentages are applicable by deductible amount and hazard group for total losses: Per Accident or Disease Deductible Amount A B C D E F G $ % 2.6% 2.2% 1.8% 1.5% 1.0% 0.8% $ 1, % 4.5% 3.8% 3.2% 2.6% 1.8% 1.4% $ 1, % 5.8% 5.0% 4.2% 3.5% 2.5% 1.9% $ 2, % 6.9% 5.9% 5.0% 4.2% 3.0% 2.3% $ 2, % 7.7% 6.6% 5.6% 4.8% 3.4% 2.6% $ 5, % 10.9% 9.5% 8.2% 7.0% 5.2% 4.2% Per Claim Deductible Amount A B C D E F G $ % 2.6% 2.2% 1.8% 1.5% 1.0% 0.8% $ 1, % 4.5% 3.8% 3.2% 2.6% 1.8% 1.4% $ 1, % 5.8% 5.0% 4.2% 3.5% 2.5% 1.9% $ 2, % 6.9% 5.9% 5.0% 4.2% 3.0% 2.3% $ 2, % 7.7% 6.6% 5.7% 4.8% 3.4% 2.6% $ 5, % 11.0% 9.5% 8.2% 7.0% 5.2% 4.1% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $68, Leased or rented vehicle... $45, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

15 Effective January 1, 2012 Page 2 of 2 of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $45, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Endemic Disease Endorsement The purpose of this rule is to clarify that coverage for diseases peculiar to a locality or region is provided by endorsement WC Endemic disease is considered bodily injury.... $25 Repatriation Expense Endorsement The purpose of this rule is to offer continued medical treatment of an employee or burial expense of a deceased employee who has sustained an injury or death arising out of and in the course of employment outside the state(s) designated under item 3A of the policy. Conditions of endorsement WC are insured and insurer must agree upon the need for the repatriation.... $25 Group Discount % The purpose of this rule is to offer an insured that qualifies a group discount. An insured must be a member of a designated Accident Fund group (i.e. Chamber of Commerce, Grocers Association, etc.), and participates in the group communication program. Schedule Rating % The maximum allowable debit/credit Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

16 Effective January 1, 2012 Page 1 of 2 I. Miscellaneous Values MISCELLANEOUS VALUES & EXCEPTIONS PAGE WCX-NH-UW Premium Reduction Percentages The following percentages are applicable by deductible amount and hazard group for total losses: Per Accident or Disease Deductible Amount A B C D E F G $ % 2.6% 2.2% 1.8% 1.5% 1.0% 0.8% $ 1, % 4.5% 3.8% 3.2% 2.6% 1.8% 1.4% $ 1, % 5.8% 5.0% 4.2% 3.5% 2.5% 1.9% $ 2, % 6.9% 5.9% 5.0% 4.2% 3.0% 2.3% $ 2, % 7.7% 6.6% 5.6% 4.8% 3.4% 2.6% $ 5, % 10.9% 9.5% 8.2% 7.0% 5.2% 4.2% Per Claim Deductible Amount A B C D E F G $ % 2.6% 2.2% 1.8% 1.5% 1.0% 0.8% $ 1, % 4.5% 3.8% 3.2% 2.6% 1.8% 1.4% $ 1, % 5.8% 5.0% 4.2% 3.5% 2.5% 1.9% $ 2, % 6.9% 5.9% 5.0% 4.2% 3.0% 2.3% $ 2, % 7.7% 6.6% 5.7% 4.8% 3.4% 2.6% $ 5, % 11.0% 9.5% 8.2% 7.0% 5.2% 4.1% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $68, Leased or rented vehicle... $45, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, United Wisconsin Insurance Company

17 Effective January 1, 2012 Page 2 of 2 of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $45, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Foreign Coverage Coverage under endorsement WC applies only to employees hired within the limits of the United States of America while they are traveling or temporarily residing outside the United States of America, its territories or possessions, or Canada for a period of no longer than ninety days. a. Employer Liability Limits of $100/$500/$100 $25,000 each employee/$50,000 each accident $100 $50,000 each employee/$100,000 each accident $200 b. Employer Liability Limits of $500/$500/$500 $25,000 each employee/$50,000 each accident $150 $50,000 each employee/$100,000 each accident $250 c. Employer Liability Limits of $1,000/$1,000/$1,000 $25,000 each employee/$50,000 each accident $200 $50,000 each employee/$100,000 each accident $300 Schedule Rating % The maximum allowable debit/credit United Wisconsin Insurance Company

18 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Supporting Document Schedules Item Status: Status Date: Satisfied - Item: Actuarial Memorandum Completed Review 11/17/2011 Comments: Actuarial Memo. Attachment: Actuarial Memo.pdf Item Status: Status Date: Satisfied - Item: Filing Memorandum Completed Review 12/01/2011 Comments: filing information is provided on general information tab. Side by side comparisons of the documents are attached here for your review. Attachments: WCX-NH Comparison.pdf WCX -NH-UW Comparison.pdf Bypassed - Item: Bypass Reason: Comments: Supplemental Experience Exhibit not applicable. Item Status: Status Date: Bypassed - Item: Bypass Reason: Comments: NH Retaliatory Fees not applicable Item Status: Status Date: Item Status: Status PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

19 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Satisfied - Item: Comments: Supporting Data. Attachments: CW Exh AFICA.pdf PLR Calc.pdf Workers' Compensation Conversion of LERs/ Package of Actuarial Exhibits and Supporting Data Date: Completed Review 12/01/2011 Bypassed - Item: Reference Filing Adoption Form - Loss Cost Filings Bypass Reason: Comments: not applicable to this filing Item Status: Status Date: PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

20 UNITED WISCONSIN INSURANCE COMPANY Actuarial Memorandum Following is an example of how loss elimination ratio are converted into a premium credit percentage. For the purposes of this example, please use a $2,500 deductible amount per claim under Group A. The conversion of LER into PRP for a given deductible is as follows: PRP = 1 [((1-LER)*PLR + Fixed) / (PLR + Fixed)] Where, PLR = Permissable Loss Ratio. We use a value of 60% for. Fixed = Fixed Expense Ratio. We use a value of 15% for. LER = Loss Elimination Ratio. We refer to NCCI circular NH for the LER by deductible level and Group. For example, at a deductible of 2,500, Group A, the LER is 12.5%. The calculation of PRP is: PRP = 1 [((1-.125)* ) / ( )] = 10%. By: Peter Bartlett, Actuarial Analyst Date: 10/31/2011 Accident Fund is a group of companies including Accident Fund Insurance Company of America, Accident Fund National Insurance Company Accident Fund General Insurance Company and United Wisconsin Insurance Company

21 Effective January 1, Page 1 of 2 MISCELLANEOUS VALUES & EXCEPTIONS PAGE WCX-NH I. Miscellaneous Values Advisory Loss Elimination RatiosPremium Reduction Percentages The following percentages are applicable by deductible amount and hazard group for total losses on a per accident or disease basis or per claim basis for employers electing deductibles as designated below: Per Accident Per Accident or Disease or Disease Deductible Amount A B C D E F G $ % 2.76% 2.32% 1.98% 1.65% 1.10% 0.8% $ 1, % 4.65% % 3.32% 2.86% 1.98% 1.4% $ 1, % 5.98% 5.10% 4.32% 3.65% 2.65% % $ 2, % % % 5.0% 4.2% 3.0% 2.43% $ 2, % 7.87% 6.76% 5.86% 4.98% 3.54% 2.76% $ 5, % % 9.75% 8.32% 7.10% 5.32% 4.2% Per Claim Deductible Amount A B C D E F G $ % 2.76% 2.32% 1.98% 1.65% 1.10% 0.8% $ 1, % 4.65% % 3.32% 2.86% 1.98% 1.4% $ 1, % 5.98% 5.10% 4.32% 3.65% 2.65% % $ 2, % % % 5.0% 4.2% 3.0% 2.43% $ 2, % 7.87% 6.76% 5.87% 4.98% 3.54% 2.76% $ 5, % 11.0% 9.75% 8.32% 7.10% 5.32% 4.21% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Formatted Table Formatted: Font: Not Bold Formatted: Font: Not Bold Formatted: Left Formatted Table Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $66,80768, Leased or rented vehicle... $44,53845, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

22 Effective January 1, Page 2 of 2 Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $44,30045, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Endemic Disease Endorsement The purpose of this rule is to clarify that coverage for diseases peculiar to a locality or region is provided by endorsement WC Endemic disease is considered bodily injury.... $25 Repatriation Expense Endorsement The purpose of this rule is to offer continued medical treatment of an employee or burial expense of a deceased employee who has sustained an injury or death arising out of and in the course of employment outside the state(s) designated under item 3A of the policy. Conditions of endorsement WC are insured and insurer must agree upon the need for the repatriation.... $25 Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

23 Effective January 1, Page 3 of 2 Group Discount % The purpose of this rule is to offer an insured that qualifies a group discount. An insured must be a member of a designated Accident Fund group (i.e. Chamber of Commerce, Grocers Association, etc.), and participates in the group communication program. Schedule Rating % The maximum allowable debit/credit Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

24 Effective January 1, of 2 Page WCX-NH-UW I. Miscellaneous Values MISCELLANEOUS VALUES & EXCEPTIONS PAGE Advisory Loss Elimination RatiosPremium Reduction Percentages The following percentages are applicable by deductible amount and hazard group for total losses on a per accident or disease basis or per claim basis for employers electing deductibles as designated below: Per Accident Per Accident or Disease or Disease Deductible Amount A B C D E F G $ % 2.76% 2.32% 1.98% 1.65% 1.10% 0.8% $ 1, % 4.65% % 3.32% 2.86% 1.98% 1.4% $ 1, % 5.98% 5.10% 4.32% 3.65% 2.65% % $ 2, % % % 5.0% 4.2% 3.0% 2.43% $ 2, % 7.87% 6.76% 5.86% 4.98% 3.54% 2.76% $ 5, % % 9.75% 8.32% 7.10% 5.32% 4.2% Per Claim Deductible Amount A B C D E F G $ % 2.76% 2.32% 1.98% 1.65% 1.10% 0.8% $ 1, % 4.65% % 3.32% 2.86% 1.98% 1.4% $ 1, % 5.98% 5.10% 4.32% 3.65% 2.65% % $ 2, % % % 5.0% 4.2% 3.0% 2.43% $ 2, % 7.87% 6.76% 5.87% 4.98% 3.54% 2.76% $ 5, % 11.0% 9.75% 8.32% 7.10% 5.32% 4.21% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Formatted Table Formatted: Font: Not Bold Formatted: Font: Not Bold Formatted: Left Formatted Table Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $66,80768, Leased or rented vehicle... $44,53845, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 United Wisconsin Insurance Company

25 Effective January 1, of 2 Page Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, United Wisconsin Insurance Company

26 Effective January 1, of 2 Page of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $44,30045, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Foreign Coverage Coverage under endorsement WC applies only to employees hired within the limits of the United States of America while they are traveling or temporarily residing outside the United States of America, its territories or possessions, or Canada for a period of no longer than ninety days. a. Employer Liability Limits of $100/$500/$100 $25,000 each employee/$50,000 each accident $100 $50,000 each employee/$100,000 each accident $200 b. Employer Liability Limits of $500/$500/$500 $25,000 each employee/$50,000 each accident $150 $50,000 each employee/$100,000 each accident $250 c. Employer Liability Limits of $1,000/$1,000/$1,000 $25,000 each employee/$50,000 each accident $200 $50,000 each employee/$100,000 each accident $300 Schedule Rating % The maximum allowable debit/credit United Wisconsin Insurance Company

27 Premium and Loss Experience Name of Company: Accident Fund Insurance Company of America Premium and Losses Reported Are Calendar Year Line of Business: Workers Compensation Experience as of: December 31, 2010 Limits: Total Year: 2006 Year: 2007 Year: 2008 Year: 2009 Year: 2010 Total Amount % Amount % Amount % Amount % Amount % Amount % 1. Direct Premiums Earned 7,891 45, , , ,501 1,051, Direct Losses Incurred* 3, % 11, % 230, % 415, % 368, % 1,029, % 3. Defense and Cost Containment Expenses Incurred* % 2, % 4, % 42, % 48, % 97, % 4. Adjusting and Other Expenses Incurred* % % 16, % 36, % 30, % 83, % 5. Loss and Loss Adjustment Expenses Incurred (2+3+4)* 3, % 13, % 250, % 494, % 447, % 1,209, % 6. Direct Premiums Written 20,684 57, , , ,777 1,154, Commission and Brokerage Paid** 2, % 6, % 33, % 52, % 44, % 138, % 8. Other Acquisition, Field Supervision & Collection Exp Paid** 1, % 3, % 19, % 17, % 53, % 95, % 9. General Expenses Paid** % 2, % 14, % 17, % 24, % 59, % 10. Taxes, Licenses, and Fees Paid** 2, % 4, % 6, % 49, % 57, % 120, % 11. Total Expenses Paid ( )** 6, % 16, % 73, % 136, % 179, % 413, % Year: 2006 Year: 2007 Year: 2008 Year: 2009 Year: 2010 Total Countrywide (000's) Amount % Amount % Amount % Amount % Amount % Amount % 1. Direct Premiums Earned 529, , , , ,577 2,101, Direct Losses Incurred* 366, % 303, % 247, % 207, % 257, % 1,383, % 3. Defense and Cost Containment Expenses Incurred* 21, % 17, % 16, % 17, % 19, % 91, % 4. Adjusting and Other Expenses Incurred* 35, % 3, % 22, % 43, % 25, % 130, % 5. Loss and Loss Adjustment Expenses Incurred (2+3+4)* 423, % 325, % 286, % 268, % 302, % 1,606, % 6. Direct Premiums Written 514, , , , ,016 2,036, Commission and Brokerage Paid** 55, % 47, % 42, % 59, % 32, % 237, % 8. Other Acquisition, Field Supervision & Collection Exp Paid** 27, % 28, % 24, % 20, % 38, % 139, % 9. General Expenses Paid** 17, % 19, % 17, % 19, % 17, % 92, % 10. Taxes, Licenses, and Fees Paid** 21, % 11, % 8, % 12, % 9, % 63, % 11. Total Expenses Paid ( )** 121, % 105, % 93, % 112, % 99, % 532, % Notes: Selections *% of Line 1 (Same for each year and total) General Expenses 5.0% **% of Line 2 (Same for each year and total) Commissions 12.0% Other Acquisitions 7.0% Taxes, License & Fees 4.0% DCC 4.5% A&OE 6.0% C:\Documents and Settings\jennaq\Local Settings\Temporary Internet Files\Content.Outlook\0IGD2N53\Exp Exh ~ AFICA for PRP.xlsm

28 Worker's Compensation PERMISSIBLE LOSS RATIO WORKSHEET Projected 2011 Expense Provisions (% of net premium) Totals 1) Total Underwriting Expenses (other than LAE) (1a)+(1b) 12.0% a) General Expense Ratio 5.0% b) Other Acquisition Ratio 7.0% 2) Commission and Brokerage Ratio 12.0% 3) Misc Tax Ratio (Excl Assessments) 4.0% 4) Loss Adjustment Expense 10.5% 5) Dividends 0.0% 6) Underwriting Profit and Contingency Allowance* 1.5% 7) Expense Ratio 40.0% (1)+(2)+(3)+(4)+(5)+(6) 8) Permissible Loss Ratio (7) 60.0% * Reflects the target ROE

29 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Workers' Compensation Project Name/Number: Conversion of LERs/ Superseded Schedule Items Please note that all items on the following pages are items, which have been replaced by a newer version. The newest version is located with the appropriate schedule on previous pages. These items are in date order with most recent first. Creation Date: Schedule Schedule Item Name Replacement Creation Date Attached Document(s) 11/18/2011 Rate and Rule Miscellaneous Values & Exceptions 11/21/2011 WCX-NH.pdf (Superceded) AF 10/31/2011 Rate and Rule Miscellaneous Values & Exceptions AF 11/18/2011 WCX-NH 2012.pdf (Superceded) 11/21/2011 Rate and Rule Miscellaneous Values & Exceptions UWIC 11/29/2011 WCX-NH-UW.pdf (Superceded) 11/18/2011 Rate and Rule Miscellaneous Values & Exceptions UWIC 11/21/2011 WCX-NH-UW.pdf (Superceded) 10/31/2011 Rate and Rule Miscellaneous Values & Exceptions UWIC 11/18/2011 WCX-NH-UW 2012.pdf (Superceded) 11/21/2011 Supporting Document Filing Memorandum 11/29/2011 WCX-NH Comparison.pdf (Superceded) WCX-NH-UW Comparison.pdf (Superceded) 11/18/2011 Supporting Document Filing Memorandum 11/21/2011 WCX Comparison.pdf (Superceded) WCX-UW Comparison.pdf (Superceded) PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

30 SERFF Tracking Number: ACCD State: First Filing Company: Accident Fund General Insurance Company,... State Tracking Number: Company Tracking Number: NHR-2012-PRP TOI: 16.0 Workers Compensation Sub-TOI: Standard WC Product Name: Project Name/Number: Workers' Compensation Conversion of LERs/ 10/31/2011 Supporting Document Filing Memorandum 11/18/2011 Compare.pdf (Superceded) Compare UW.pdf (Superceded) 11/21/2011 Rate and Rule Miscellaneous Values & Exceptions 11/29/2011 WCX-NH.pdf (Superceded) AF PDF Pipeline for SERFF Tracking Number ACCD Generated 02/13/ :56 AM

31 Effective January 1, 2012 Page 1 of 2 MISCELLANEOUS VALUES & EXCEPTIONS PAGE WCX-NH I. Miscellaneous Values Premium Reduction Percentages The following percentages are applicable by deductible amount and hazard group for total losses: Per Accident or Disease Deductible Amount A B C D E F G $ % 1.9% 1.6% 1.3% 1.1% 0.8% 0.6% $ 1, % 3.3% 2.8% 2.4% 2.0% 1.4% 1.1% $ 1, % 4.3% 3.7% 3.1% 2.6% 1.8% 1.4% $ 2, % 5.1% 4.4% 3.7% 3.1% 2.2% 1.7% $ 2, % 5.7% 4.9% 4.2% 3.6% 2.6% 2.0% $ 5, % 8.1% 7.1% 6.1% 5.2% 3.9% 3.0% Per Claim Deductible Amount A B C D E F G $ % 1.9% 1.6% 1.3% 1.1% 0.8% 0.6% $ 1, % 3.3% 2.8% 2.4% 2.0% 1.4% 1.0% $ 1, % 4.3% 3.7% 3.1% 2.6% 1.8% 1.4% $ 2, % 5.1% 4.4% 3.7% 3.1% 2.2% 1.7% $ 2, % 5.7% 4.9% 4.2% 3.5% 2.5% 2.0% $ 5, % 8.1% 7.1% 6.1% 5.2% 3.8% 3.0% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $66, Leased or rented vehicle... $44, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

32 Effective January 1, 2012 Page 2 of 2 of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $44, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Endemic Disease Endorsement The purpose of this rule is to clarify that coverage for diseases peculiar to a locality or region is provided by endorsement WC Endemic disease is considered bodily injury.... $25 Repatriation Expense Endorsement The purpose of this rule is to offer continued medical treatment of an employee or burial expense of a deceased employee who has sustained an injury or death arising out of and in the course of employment outside the state(s) designated under item 3A of the policy. Conditions of endorsement WC are insured and insurer must agree upon the need for the repatriation.... $25 Group Discount % The purpose of this rule is to offer an insured that qualifies a group discount. An insured must be a member of a designated Accident Fund group (i.e. Chamber of Commerce, Grocers Association, etc.), and participates in the group communication program. Schedule Rating % The maximum allowable debit/credit Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

33 Effective January 1, 2012 Page 1 of 2 MISCELLANEOUS VALUES & EXCEPTIONS PAGE WCX-NH I. Miscellaneous Values Advisory Loss Elimination Ratios The following percentages are applicable by deductible amount and hazard group for total losses on a per accident or disease basis or per claim basis for employers electing deductibles as designated below: Per Accident or Disease Deductible Amount A B C D E F G $ % 2.6% 2.2% 3.4% 1.8% 1.5% 1.0% $1, % 4.5% 3.8% 5.8% 3.2% 2.6% 1.8% $1, % 5.8% 5.0% 7.4% 4.2% 3.5% 2.5% $2, % 6.9% 5.9% 8.7% 5.0% 4.2% 3.0% $2, % 7.7% 6.6% 9.8% 5.6% 4.8% 3.4% $5, % 10.9% 9.5% 13.6% 8.2% 7.0% 5.2% Per Claim Deductible Amount A B C D E F G $ % 2.6% 2.2% 3.4% 1.8% 1.5% 1.0% $1, % 4.5% 3.8% 5.8% 3.2% 2.6% 1.8% $1, % 5.8% 5.0% 7.5% 4.2% 3.5% 2.5% $2, % 6.9% 5.9% 8.7% 5.0% 4.2% 3.0% $2, % 7.7% 6.6% 9.8% 5.7% 4.8% 3.4% $5, % 11.0% 9.5% 13.7% 8.2% 7.0% 5.2% *The values shown for Groups A through D are for the reference of those carriers that have filed for the use of these hazard groups in accordance with Item B Basis of premium applicable in accordance with the footnote instructions for Code 7370 Taxicab Co. : Employee operated vehicle... $66, Leased or rented vehicle... $44, Catastrophe (other than Certified Acts of Terrorism) (Loss Cost)... $0.01 Foreign Terrorism (Loss Cost)... $0.01 Maximum Payroll applicable in accordance with Basic Manual footnote instructions for Code 9178 Áthletic Sports or Park: Non-Contact Sports, Code 9179 Athletic Sports or Park: Contact Sports, and Code 9186 Carnival Traveling... $3, of a corporation including members of limited liability companies... $3, Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company

34 Effective January 1, 2012 Page 2 of 2 of an unincorporated association... $1, of a corporation including members of limited liability companies... $ of an unincorporated association... $ Per Passenger Seat Surcharge - in accordance with Basic Manual footnote instructions for Code 7421, the surcharge is: Maximum surcharge per aircraft... $1, Per passenger seat... $ Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3... $44, United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A % (Multiply a Non- F classification loss cost by a factor of 2.14 to adjust for differences in benefits and loss-based expenses. This factor is the product of the adjustment for difference in benefits (2.10) and the adjustment for differences in loss-based expenses (1.019)). Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11,000. If more than two years, an average annual premium of at least $5,500 is required. Page A-1 of the Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state. II. Exceptions Endemic Disease Endorsement The purpose of this rule is to clarify that coverage for diseases peculiar to a locality or region is provided by endorsement WC Endemic disease is considered bodily injury.... $25 Repatriation Expense Endorsement The purpose of this rule is to offer continued medical treatment of an employee or burial expense of a deceased employee who has sustained an injury or death arising out of and in the course of employment outside the state(s) designated under item 3A of the policy. Conditions of endorsement WC are insured and insurer must agree upon the need for the repatriation.... $25 Group Discount % The purpose of this rule is to offer an insured that qualifies a group discount. An insured must be a member of a designated Accident Fund group (i.e. Chamber of Commerce, Grocers Association, etc.), and participates in the group communication program. Schedule Rating % The maximum allowable debit/credit Accident Fund Insurance Company of America Accident Fund General Insurance Company Accident Fund National Insurance Company