Unit Statistical Data State Programs and Exceptions

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1 Unit Statistical Data State Programs and Exceptions January 30 February 2, 2018 Palm Beach County Convention Center West Palm Beach, FL The Path to Data Excellence

2 Unit Statistical Data State Programs and Exceptions Presented by: Lynette Williams and Lory Mills Objective To become familiar with the reporting requirements for state specific programs and exceptions related to reporting unit statistical data. Objectives 1

3 Agenda State Rule References 2

4 Resources for State Exceptions/Programs Statistical Plan National rules for reporting Unit Statistical data State exception rules Unit Statistical Reporting Guidebook Instructions, guidelines, and examples for reporting Unit Statistical data State specific programs 5 Statistical Plan Enhancements Effective 1/1/18 Redesigned Part 6 Coding Values Data Elements Organization Header/Policy Exposure Loss Statistical Codes New Table Format Structure New Rule Cross References 6 3

5 Statistical Plan Prior to 1/1/18 7 Statistical Plan Effective 1/1/18 8 4

6 Statistical Plan Effective 1/1/18 9 Statistical Plan Statistical Codes 10 5

7 What Is a State Exception? National Rule Does Not Apply Modified Version of National Rule Unique State Exception/Program National Code Values Do Not Apply Unique Code Values and/or Statistical Codes 11 How to Identify State Exceptions Part 1 General Rules I. Date of Valuation and Filing 3. Three Year Fixed Rate Policies (Exceptions: FL, TX) A completed three year experience incurred under the policy must be reported as one complete policy. Cancellation penalty premium must be reported. State Exceptions Part 1 General Rules I. Date of Valuation and Filing 3. Three Year Fixed Rate Policies Change Part 1, Item I 3 as follows: Three year fixed rate policies are not permitted in Florida. 12 6

8 How to Identify State Exceptions Part 1 General Rules I. Date of Valuation and Filing 3. Three Year Fixed Rate Policies (Exceptions: FL, TX) A completed three year experience incurred under the policy must be reported as one complete policy. Cancellation penalty premium must be reported. State Exceptions Part 1 General Rules I. Date of Valuation and Filing 3. Three Year Fixed Rate Policies Change Part 1, Item I 3 as follows: Three year fixed rate policies are not permitted in Florida. 13 State Exceptions to National Rules 7

9 Penalties for Delays in Making Compensation Payments National Rule Carrier penalties for reasons beyond their control Included in indemnity loss Carrier penalties for reasons within their control Excluded from indemnity loss Maine, Florida, and Texas State Exceptions Maine All penalties must be excluded from medical losses, indemnity losses, and Allocated Loss Adjustment Expense (ALAE) Florida Penalties should not be reported as a loss or charged to claim expense Texas Rule does not apply Part 4 C 6 15 Oregon Anticipated Subrogation National Rule Subrogation based on when recovery is received Corrections required for previous reports (1st 5th), when net incurred loss < previously reported Total Incurred loss Oregon State Exception Subrogation Based on Anticipated Recovery Correction Report Not Allowed Part 4 A

10 State Specific Subrogation and Second Injury Fund (SIF) Rules National Rule Corrections to 1st 5th reports, when recovery or anticipated reimbursements occur Georgia, Louisiana, and Louisiana State Exceptions Corrections to all report levels for subrogation recoveries and SIF reimbursements Connecticut and Georgia (Subrogation) Louisiana (Subrogation and Second Injury Funds) Part 4 A 1 17 Florida Vocational Rehabilitation Reemployment Services and Medical Care Coordination Indemnity Loss First $2,500 of Reemployment Services expenses Medical Care Coordination costs and reemployment services for specific injuries: Traumatic brain Spinal cord Burns (5% or greater of total body) Amputation (including eyes) ALAE Reemployment Services expenses over $2,500 All other Medical Care Coordination costs Part 4 C

11 Deductible Programs Overview of Deductible Programs What Is a Deductible Program? What Does It Do? How Does It Impact You? Part 4 A 3 NCCI s 2017 Data Educational Program Copyright 2017 National Council on Compensation Insurance, Inc. All Rights Reserved

12 Deductible Programs Small and Large Deductible Programs Small < $100,000 Large >= $100, 000 Gross and Net Deductible Programs Gross Full value loss amounts Net Full value of loss less Deductible Amount Statistical Codes Code 9664 Subject to Experience Rating Code 9663 Not Subject to Experience Rating Code 9657 Not Part of Standard Premium Part 8 D NCCI s 2017 Data Educational Program Copyright 2017 National Council on Compensation Insurance, Inc. All Rights Reserved. 21 Deductible Reporting Example Header/Policy Information Deductible Type Type of Plan Deductible Amount Indemnity and Medical Per Accident $7,500 Classification Code Exposure Information Exposure State Statistical Code 16 (KY) 9664 Incurred Indemnity Loss Information Incurred Medical Deductible Reimbursement 8810 $3,000 $9,000 $7,500 Incurred Loss Deductible Reimbursement = Net Used for Experience Rating Calculation ($3,000 + $9,000) $7,500 = $4,

13 Unique Deductible Rules National Rule Report deductible reimbursement once received Report deductible reimbursement at next valuation when received between valuations Anticipated Reimbursement Colorado (Effective 1/1/13) Kansas (Effective 1/1/12) Report Corrections for Reimbursement when received Georgia 23 States With Deductible Reimbursement Caps Colorado $16,500 Georgia $2,500 Maine $5,000 Oklahoma $5,

14 Colorado Small Deductibles Colorado Small Deductible Programs Policy Effective Date Deductible Reimbursement Cap 01/01/17 $16,500 01/01/16 12/31/16 Upper limit of $16,000 01/01/15 12/31/15 Upper limit of $15,500 01/01/14 12/31/14 07/01/13 12/31/13 07/01/91 06/30/13 Upper limit of $13,500 Upper limit of $10,000 Upper limit of $5,000 Part 8 D 4 25 Colorado Deductible Program Claim Example Colorado Policy with Effective Date 1/1/15 One claim with total incurred loss = $20,000 1st report valued as of July 2016 What would you report in the Deductible Reimbursement Amount field? Total Incurred Loss $20,000 Deductible Reimbursement 26 13

15 Oklahoma Deductible Program Per Claim, Per Claim and Policy Aggregate, and Large and Mega Deductible Options Deductible Reimbursement Rules Small Deductible Per Claim program Report $5,000 per claim Small Deductible Per Claim and Policy Aggregate program Report up to $5,000 for total of all claims Large and Mega Deductibles Report $0 Statistical Code 9657 Premium Credit Not Part of Standard Premium Part 4 A 3 b Part 8 D Texas Small Deductible Programs Type of Deductible Indemnity and Medical Indemnity and Medical Medical Only Type of Plan Deductible Amount Per Accident (02) $1,000, $2,500, $5,000, $10,000, $25,000 Per Claim (01) $1,000, $2,500, $5,000, $10,000, $25,000 Per Claim (01) $500, $1,000, $1,500, $2,000, $2,500 Type of Deductible Indemnity and Medical Indemnity and Medical Medical Only Type of Plan Deductible Amount Negotiated (13) Per Accident Greater Than $25,000 Negotiated (13) Per Claim Greater Than $25,000 Negotiated (13) Per Claim Greater Than $2,500 Part 8 D

16 Employer Paid/Compensation Reimbursement Programs State Compensation Reimbursement Programs Idaho Indemnity and/or Medical $1,000 Limit Missouri Medical Only $3,300 Limit Oregon Medical Only $2,000 Limit Part

17 Idaho Compensation Reimbursement Option Claims less than or = 1,000 Report reimbursement in Deductible Reimbursement Amount field not to exceed 1,000 Claims greater than 1,000 Report 0 in Deductible Reimbursement Amount field Claim is initially <= 1,000 and subsequently becomes > 1,000 Submit corrections to all previous report levels, reducing the deductible reimbursement to 0 Part 9 A 31 Idaho Compensation Reimbursement Example As of the 1st report, the claim included $250 Incurred Indemnity and $500 Incurred Medical. 1st Unit Report Incurred Indemnity Incurred Medical Deductible Reimbursement $250 $500 As of the 2nd unit report, the claim included $1,000 Incurred Indemnity and $2,000 Incurred Medical. 2nd Unit Report Incurred Indemnity Incurred Medical Deductible Reimbursement $1,000 $2,

18 Idaho Compensation Reimbursement Example The claim amounts have developed to $3,000 on the 2nd report, what happens to the 1st report? 1st Unit Report Deductible Incurred Indemnity Incurred Medical Reimbursement $250 $500 $750 Since the claim has exceeded the $1,000 limit, a correction report is required. 1st Unit Report Correction Incurred Indemnity Incurred Medical Deductible Reimbursement 33 Missouri Employer Paid Medical Program Employer can pay for medical only claims up to 20% of current Primary and Excess Loss Split Point amount Current 20% of Split Point = $3,300 Split Point amount is provided in the rating values of NCCI s Experience Rating Plan Manual Report full amount, if < $3,300 Report $0, if >$3,300 Submit corrections to all previous report levels as necessary Part 9 B 34 17

19 Oregon Employer Paid Medical Claims Oregon employers may reimburse carriers for nondisabling medical only claims Maximum Medical Amount is determined annually by Oregon WCD (Bulletin 345) Program changes are based on Accident Date Accident Dates 1/1/17 and after $2,000 maximum medical claim reimbursement Part 9 C 35 State Premium Programs 18

20 Missouri 50% Rule If a claim s reserve causes the current experience modification to increase by more than 50% Paid Incurred Incurred Total Incurred Indemnity Paid Medical Indemnity Medical Loss 10,000 15,000 55,000 80, ,000 The carrier must revise the claim to equal the paid amount using a correction report Paid Incurred Incurred Total Incurred Indemnity Paid Medical Indemnity Medical Loss 10,000 15,000 10,000 15,000 25,000 Part 7 D 37 Florida Aggravated Inequity Experience rated risks Identify claims closed between unit report levels Apply revised (closed) claim and recalculate the experience rating modification Recalculate Standard Premium using revised experience modification Compare original and revised standard premium, determine if it is reduced by 5% or more Submit a correction report to reduce the claim to equal the closed claim value Part 7 A 38 19

21 Florida Aggravated Inequity Example A claim meets the requirements for Aggravated Inequity (revised standard premium is reduced by 10%) and the following information was reported: Paid Incurred Incurred Indemnity Paid Medical Indemnity Medical 7,000 8,000 50,000 50,000 The carrier must revise the claim to equal the paid amount using correction reports: Paid Indemnity Paid Medical 7,000 8,000 Incurred Indemnity Incurred Medical Correction Type Code 39 Maine Rule 450 Exclude claims involving aggravation of prior workrelated injuries are excluded from employer s experience rating modifications How to report: Type of Settlement Code 10 (Aggravation of Prior Work Related Injuries) Prior to 1st report, full value of losses Between 1st and 6th report levels, corrections required 6th through 10th report levels, report at next valuation Part 7 B 40 20

22 Risk Modeling Plan Carrier Independently Filed Program Texas Policies Effective 9/1/13 Missouri Policies Effective 1/1/14 Connecticut Policies Effective 10/1/17 (voluntary only) Statistical Codes 9147 Risk Modeling Plan Premium Credit 9148 Risk Modeling Plan Premium Debit Parts 3 U & 3 Z 41 District of Columbia Safe Workplace Safe Workplace Program certified by the Department of Employment Services Statistical Code 9765 Workplace Safety Premium Credit If employer misrepresented its compliance with the program, employer must reimburse the credit Report the reimbursed premium under Statistical Code 9766 Workplace Safety Premium Debit Do not remove the Safe Workplace Program premium credit reported with Statistical Code 9765 Part 3 U 4 a 42 21

23 Georgia Experience Rating Verification Carriers must provide Unit Statistical data to employers for experience rating purposes Submit Unit Statistical data along with Form GID 63 GA Form GID 63 is used to confirm or dispute the accuracy of the Unit Statistical data Units GA Georgia Experience Rating Verification Two Carrier Options Pre Reported Data Provide loss data to employer prior to unit reporting Following employer verification, submit unit report Post Reported Data Submit unit report to NCCI for the policy Provide loss data or unit report to employer As needed, submit unit report correction 44 22

24 Georgia Work Based Learning Program Administered by Georgia Department of Education Hire students and provide new work experiences Premium credit from 2% to 5%, depending on the number of students employed Maximum credit not to exceed $2,500 Statistical Code 9777 Work Based Learning Program Not Subject to Experience Rating 45 Oklahoma Certified Workplace Medical Plan Non Experience Rated Employers 10% Premium Reduction Statistical Code 9756 Part 3 U 4 a 46 23

25 Texas Premium Programs Group Purchase of Workers Compensation Policy Type Code 03 Group Policy Code Certified WC Healthcare Network Certified Healthcare Network Policy Indicator Y Statistical Code 9874 ( ) Managed Care Organization (MCO) Code 07 Part 3 U 5 b 47 Thank You for Attending 24