Effective Policy Reporting for Proof of Coverage. Objective

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1 Effective Policy Reporting for Proof of Coverage Presented by: Jorge Acevedo and Amy Royce Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 1 Objective Provide the knowledge necessary to improve your policy reporting for Proof of Coverage (POC). Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 2 1

2 Agenda Policy to POC NCCI Editing and POC Implications Electronic Policy Reporting for POC Specific POC State Processing NCCI POC Resources Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 3 NCCI s POC Process and Editing Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 4 2

3 Header The POC Process Name Address State PC1 PC2 Employer Insured Exposure Deductible Endorsement Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 5 NCCI Editing and POC Data Grades 4 and 6 Error Data is available for POC Data Grades 7, 8, and 9 Error Data is not available for POC Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 6 3

4 Data Grade 4 Priority Error Producer Name Class Code Legal Nature of Entity Prior Policy Number Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 7 Data Grade 4 POC Implications Can lead to a rejected transaction: Late Reporting Fines Compliance Fines Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 8 4

5 Data Grade 4 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 9 Data Grade 6 POC Error on single data element: Type of Plan ID Code Reason State Was Added Code Assignment Date Number of Employees Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 10 5

6 Data Grade 6 POC Implications Can lead to a rejected transaction: Late Reporting Fines Compliance Fines Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 11 Data Grade 6 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 12 6

7 Data Grade 7 POC Critical Error Name: Unlinked Name Missing/Invalid FEIN Missing/Invalid Unemployment Identification Number Address: Unlinked Address Missing/Invalid Industry Code Combination Name and Address: All names and addresses reported with same Name Link Identifier Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 13 Data Grade 7 POC Implications Data not sent to POC state POC Implications for Employer: Not in compliance stop work order May be subject to compliance fines POC Implications for Carrier: May be subject to timeliness fines when error is corrected Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 14 7

8 Data Grade 7 Monthly Outstanding Report Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 15 Data Grade 7 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 16 8

9 Data Grade 8 Single-record reject: Name Address State Premium Exposure Rejected record is viewable in the Policy Data Collection tool for informational purposes only Must correct with a subsequent transaction Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 17 Data Grade 8 POC Implications Data Grade 8 on existing record: Submitting correction on different day can have severe POC implications and lead to: Delete Employer transaction Add Employer transaction Late reporting fines Compliance fines Submitting correction on same day minimizes POC implications Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 18 9

10 Data Grade 9 Entire transaction reject Examples include: Missing Reason for Reinstatement (UT) Missing State Premium Record Missing Primary Insured Name/Address Duplicate transaction Transaction available in the Policy Data Collection tool for correction Note: Received date of transaction is date the transaction is accepted. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 19 Data Grade 9 POC Implications Transaction not available for POC Correct and resubmit in same day Minimal POC implications once it is corrected Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

11 NCCI Editing and POC Data Grade 0 Error Free Does not guarantee accepted POC Data Grades 4 and 6 Error Data is available for POC Data Grades 7, 8, and 9 Error Data is not available for POC Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 21 IAIABC POC Coverage Provider Reject & Error Report Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

12 Electronic Policy Reporting for POC Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 23 Acronyms You Need to Know NLI Name Link Identifier NCLI Name Link Counter Identifier CSN Continuation Sequence Number SCL State Code Link PED Policy Effective Date PXD Policy Expiration Date PCED Policy Change Effective Date PCXD Policy Change Expiration Date Data Elements Reported on WCPOLS Carrier-Generated Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

13 Acronyms You Need to Know NED Name Effective Date AED Address Effective Date NXD Name Expiration Date AXD Address Expiration Date SNN Split-Name Number Data Elements NOT Reported in WCPOLS NCCI-Generated Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 25 Acronyms You Need to Know PC1 IAIABC POC Insured Record PC2 IAIABC POC Employer Record TA Transaction Accepted TE Transaction Accepted With Errors TR Transaction Rejected Codes Reported in Acknowledgment State-Generated Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

14 Business Scenarios What POC Creates What the State Provides What NCCI Loads What You Report Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 27 Business Scenario #1 Establishing Transaction Jorge s Bagel Shop, Inc. needs workers comp coverage New policy is written Additional employer covered on the policy will be Amy s Sweet Shop, Inc. Both shops are located in Florida The policy will go into effect on January 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

15 What You Report Jorge s Bagel Shop, Inc. New Policy PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Bagel Shop Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St Code A/D State PCED PCXD 09 Florida Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 29 Jorge s Bagel Shop, Inc. New Policy PED: 01/01/15 What NCCI Loads Flag NLI CSN Name NED NXD PCED PCXD N Jorges Bagel Shop Inc 01/01/15 N Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 Flag State ST Eff Dt ST Exp Dt PCED PCXD N 09 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

16 Header The POC Process Name Address State PC1 PC2 Employer Insured Exposure Deductible Endorsement Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 31 The POC Process Primary Insured Info IAIABC Triplicate Code Trans Set Type Eff Dt Employer Information Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

17 What the POC Process Creates Jorge s Bagel Shop, Inc. PED: 01/01/15 Rec Type Name Address Triplicate Code Trans Set Eff Dt PC1 Jorges Bagel Shop Inc 1 Main St 00/10/01 (New) 01/01/15 PC2 Jorges Bagel Shop Inc 1 Main St PC2 Amys Sweet Shop Inc 10 South St ACK CODE TA TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 33 Business Scenario #2 Employer Change Transaction Insured reports a name change to the primary name. Name changes from Jorge s Bagel Shop, Inc. to Jorge s Deli, Inc. Change took effect on July 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

18 What You Report Jorge s Bagel Shop, Inc. Full Policy Replacement to Change Primary Name PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 35 What NCCI Loads Jorge s Bagel Shop, Inc Full Policy Replacement to Change Primary Name PED: 01/01/15 Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Bagel Shop Inc 01/01/15 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 Y Main St 01/01/15 Y South St 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

19 What the POC Process Generates Jorge s Bagel Shop, Inc. Changing Primary Name PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/32/84 (Change) 07/01/15 PC1 Jorges Deli Inc 1 Main St 00/31/54 (Add) 07/01/15 PC2 Jorges Deli Inc 1 Main St PC1 Jorges Deli Inc 1 Main St 00/33/56 (Delete) 07/01/15 PC2 Jorges Bagel Shop Inc 1 Main St ACK CODE TA TA TA TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 37 Reporting Names and Addresses Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved

20 Reporting Names Report one name per record. Example: What you report NLI CSN Name PCED PCXD Jorge Inc & Amy Inc dba JAAR Consulting Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 39 Name Standardization Names Split After: INC, CORP, LLC, LLP, CO, LTD, ASSOC, etc. Acronyms Always Moved to the End: DBA, LWF, TA, LCF, AKA, ATA, FKA, etc. Drops: (And other brackets), Attention:, etc. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

21 Reporting Names What NCCI loads Flag NLI CSN SNN Name NED NXD PCED PCXD N Jorge Inc 01/01/15 N Amy Inc 01/01/15 N JAAR Consulting dba 01/01/15 Each split name is assigned a unique Split Name Number. This is an internal two-digit code to prevent duplicate name errors. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 41 Reporting Names Example: All operating at the same locations. What you should report NLI CSN Name PCED PCXD Amy Inc Jorge Inc dba JAAR Consulting dba JA Accounting Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

22 Reporting Names Example: All operating at different locations. What you should report NLI CSN Name PCED PCXD Amy Inc Jorge Inc dba JAAR Consulting Amy Inc Jorge Inc dba JA Accounting Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 43 Address Reporting Employer records created from: Address Type 1 (Mailing Address) Address Type 2 (Location of Operations) Address Type 6 (No Specific Location in Jurisdiction) Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

23 Address Effective Date 1 Main Street, Boca Raton, FL Main Str., Boca Raton, FL Main St., Boca Raton, FL Standardizes to: 1 Main St, Boca Raton, FL Address Effective Date is based on the Standardized Address. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 45 Address Effective Date An Address Type 6 standardizes to the same address for each state. This means that every Address Type 6 record for a state has the same Address Effective Date. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

24 Business Scenario #3 Add Employer Transaction Jorge s Deli, Inc. (the primary insured) realizes that a second address was never reported for them The second location opened on February 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 47 What You Report Jorge s Deli, Inc. Full Policy Replacement Adding Location PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

25 What NCCI Loads Jorge s Deli Inc. Full Policy Replacement Adding Location PED: 01/01/15 Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Deli Inc 07/01/15 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 49 What the POC Process Generates Jorge s Deli, Inc. Add Employer PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/31/54 07/01/15 PC2 Jorges Deli Inc 5 North St ACK CODE TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

26 Dates, Dates, and More Dates! Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Deli Inc 07/01/15 07/01/15 Y Amy Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Flag State ST Eff Dt ST Exp Dt PCED PCXD N 09 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 51 How Do You Fix This? Jorge s Deli, Inc. Add Employer PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/31/54 07/01/15 PC2 Jorges Deli Inc 5 North St ACK CODE TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

27 What You Reported Jorge s Deli, Inc. Full Policy Replacement Adding Location PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 53 How Do You Fix This? What was the reporting error? Which employer was operating at 5 North St. on February 1, 2015? Jorge s Bagel Shop, Inc. or Jorge s Deli, Inc. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

28 How Do You Fix This? Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Deli Inc 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 55 How Do You Fix This? Fixing a gap in coverage is a two-step process: Add the employer effective February 1, 2015 Delete the employer effective July 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

29 What You Report Step 1 Jorge s Deli, Inc. Full Policy Replacement Adding Location PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc Jorges Bagel Shop Inc NLI SCL Address PCED PCXD Main St South St North St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 57 What NCCI Loads Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 N Jorges Bagel Shop Inc 01/01/15 01/01/15 Y Jorges Bagel Shop Inc 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

30 What NCCI Loads Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 N North St 02/01/15 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Y North St 02/01/15 02/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 59 What the POC Process Generates Jorge s Deli, Inc. Add Employer PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/31/54 (Add) 02/01/15 PC2 Jorges Bagel Shop Inc 5 North St ACK CODE TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

31 What You Report Step 2 Jorge s Deli, Inc. Full Policy Replacement Deleting Employer PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc Jorges Bagel Shop Inc NLI SCL Address PCED PCXD Main St South St North St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 61 What NCCI Loads Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Deli Inc 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Y Jorges Bagle Shop Inc 01/01/15 07/01/15 01/01/15 07/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

32 What NCCI Loads Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Y North St 02/01/15 Y North St 02/01/15 07/01/15 02/01/15 07/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 63 What the POC Process Generates Jorge s Deli, Inc. Delete Employer PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/33/56 (Delete) 07/01/15 PC2 Jorges Bagel Shop Inc 5 North St ACK CODE TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

33 POC State Coverage Primary insured Address Effective Date Expiration Date Jorges Bagel Shop Inc 1 Main St 01/01/15 07/01/15 Jorges Deli Inc 1 Main St 07/01/15 01/01/16 Employers Address Effective Date Expiration Date Jorges Bagel Shop Inc 1 Main St 01/01/15 07/01/15 Jorges Bagel Shop Inc 5 North St 02/01/15 07/01/15 Amys Sweet Shop Inc 10 South St 01/01/15 01/01/16 Jorges Deli Inc 1 Main St 07/01/15 01/01/16 Jorges Deli Inc 5 North St 07/01/15 01/01/16 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 65 How Do You Fix This? What was the reporting error? Which employer was operating at 5 North St on February 1, 2015? Jorge s Bagel Shop, Inc. or Jorge s Deli, Inc. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

34 How Do You Fix This? The reporting error was the effective date of the Name change of the Primary Insured from Jorge s Bagel Shop, Inc. to Jorge s Deli, Inc. Changing a Name, Address, or State Effective Date is a two-step process. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 67 How Do You Fix This? Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 07/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Deli Inc 07/01/15 07/01/15 Y Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

35 What You Report Step 1 Jorge s Deli, Inc. Name Change back to Original Primary Name PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Bagel Shop Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 69 What You Report Step 2 Jorge s Deli, Inc. 2nd Name Change PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Deli Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

36 What NCCI Loads Jorge s Deli, Inc. PED: 01/01/15 Flag NLI CSN Name NED NXD PCED PCXD N Jorges Deli Inc 02/01/15 02/01/15 N Amys Sweet Shop Inc 01/01/15 Y Jorges Bagel Shop Inc 01/01/15 02/01/15 01/01/15 Y Amys Sweet Shop Inc 01/01/15 Flag NLI SCL Address AED AXD PCED PCXD N Main St 01/01/15 N South St 01/01/15 N North St 02/01/15 Y Main St 01/01/15 Y South St 01/01/15 Y North St 02/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 71 What the POC Process Generates Jorge s Deli, Inc. PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Bagel Shop Inc 1 Main St 00/32/84 (Change) 01/01/15 PC1 Jorges Bagel Shop Inc 1 Main St 00/31/54 (Add) 01/01/15 PC2 Jorges Bagel Shop Inc 1 Main St PC1 Jorges Bagel Shop Inc 1 Main St 00/31/54 (Add) 02/01/15 PC2 Jorges Bagel Shop Inc 5 North St PC1 Jorges Bagel Shop Inc 1 Main St 00/33/56 (Delete) 07/01/15 PC2 Jorges Deli Inc 1 Main St PC2 Jorges Deli Inc 5 North St ACK CODE TA TA TA TA TA TA TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

37 What the POC Process Generates Jorge s Deli, Inc. PED: 01/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St 00/32/84 (Change) 02/01/15 PC1 Jorges Deli Inc 1 Main St 00/31/54 (Add) 02/01/15 PC2 Jorges Deli Inc 1 Main St PC2 Jorges Deli Inc 5 North St PC1 Jorges Bagel Shop Inc 1 Main St 00/33/56 (Delete) 02/01/15 PC2 Jorges Bagel Shop Inc 1 Main St PC2 Jorges Bagel ShopInc 5 North St ACK CODE TA TA TA TA TA TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 73 One Last Thing Rec Type Name Address Triplicate Trans Set Eff Dt PC2 Jorges Bagel Shop Inc 5 North St 00/31/54 (Add) 02/01/15 Rec Type Name Address Triplicate Trans Set Eff Dt PC2 Jorges Bagel Shop Inc 5 North St 00/33/56 (Delete) 02/01/15 If both policy transactions are submitted in the same day, these transactions will cancel each other out and will be discarded. This means that they will not be sent to the state. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

38 POC State Coverage Primary insured Address Effective Date Expiration Date Jorges Bagel Shop Inc 1 Main St 01/01/15 02/01/15 Jorges Deli Inc 1 Main St 02/01/15 01/01/16 Employers Address Effective Date Expiration Date Jorges Bagel Shop Inc 1 Main St 01/01/15 02/01/15 Amys Sweet Shop Inc 10 South St 01/01/15 01/01/16 Jorges Deli Inc 1 Main St 02/01/15 01/01/16 Jorges Deli Inc 5 North St 02/01/15 01/01/16 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 75 Add Employer Transaction Recap Transaction Set Type Effective Date = Later Date: Reported Policy Change Effective Date Name Record Address Record Name Update Effective Date Address Update Effective Date State Effective Date Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

39 Deleting POC Data Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 77 Deleting POC Data Now you see it Now you don t Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

40 Common Deleting Scenarios Formal Deletes Delete Date is reported carrier sets delete date Informal Deletes Delete Date is not reported NCCI sets delete date POC implications Gaps in Coverage Timeliness Reporting Fines Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 79 Four Ways to Cause an Informal Delete DG8 Record rejected DG7 POC Critical Error (hold condition) Not reporting a Name/Address/State Premium record that was previously accepted by a POC state Name and Address linking inconsistencies Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

41 Business Scenario #4 Informal Delete Due to Data Grade 8 ABC Builders LLC is no longer doing business in South Carolina effective July 1, 2015 Opened new location in Tennessee effective July 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 81 Business Scenario #4 Establishing ABC Builders LLC PED: 01/01/15 Record State Add/Del PCED PCXD Florida South Carolina Record State Class Code Payroll PCED PCXD Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

42 Business Scenario #4 The Error ABC Builders LLC Adding & Deleting States PED: 01/01/15 Record State Add/Del PCED PCXD Florida D South Carolina A Tennessee Record State Class Code Payroll PCED PCXD Where is the South Carolina Exposure Record? Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 83 How NCCI Processes Informal Delete Flag State ST Eff Dt ST Exp Dt PCED PCXD N 09 01/01/15 N 41 07/01/15 07/01/15 NY 09 01/01/15 NY 39 01/01/15 01/01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

43 The Fix Correction will require two transactions: Add Record Back Formally Delete Record Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 85 The Fix Part 1 ABC Builders LLC Adding State PED: 01/01/15 Record State Add/Del PCED PCXD Florida Tennessee A South Carolina Record State Class Code Payroll PCED PCXD Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

44 The Fix Part 2 ABC Builders LLC Deleting State PED: 01/01/15 Record State Add/Del PCED PCXD Florida Tennessee D South Carolina Record State Class Code Payroll PCED PCXD Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 87 Delete Employer Transaction Transaction Set Type Effective Date = Earlier Date Name Expiration Date Address Expiration Date State Expiration Date Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

45 Business Scenario #5 Informal Delete due to not reporting a name Primary Insured: Bob s Donuts Additional Employer: Amy s Sweets Change Scenario: Amy s Sweets takes on a partner in business and a name change is necessary Effective date of name change is July 1, 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 89 What You Report Bob s Donuts New Policy PED: 01/01/15 NLI CSN Name PCED PCXD Bobs Donuts Amys Sweets NLI SCL Address PCED PCXD Jackson St Franklin Lane Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

46 What You Report Bob s Donuts Full Policy Replacement Changing Name PED: 01/01/15 NLI CSN Name PCED PCXD Bobs Donuts A&J Sweets Inc NLI SCL Address PCED PCXD Jackson St Franklin Lane What happened to Amy s Sweets? Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 91 What You Report Bob s Donuts Full Policy Replacement Adding and Deleting Name PED: 01/01/15 NLI CSN Name PCED PCXD Bobs Donuts Amys Sweets A&J Sweets Inc NLI SCL Address PCED PCXD Jackson St Franklin Lane Franklin Lane Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

47 Business Scenario #6 Informal Delete due to name linking inconsistencies Jorge s Pies, Inc. is Primary Insured A&J Bakery is an additional name on policy Each operates in its own location What if Jorge s Pies, Inc. and A&J Bakery decide to change locations effective July 1, 2015? Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 93 What You Report Jorge s Pies, Inc. New Policy PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Pies Inc A&J Bakery NLI SCL Address PCED PCXD Main St South St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

48 What You Report Jorge s Deli, Inc. Full Policy Replacement Changing Addresses PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Pies Inc A&J Bakery NLI SCL Address PCED PCXD Main St South St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 95 What You Report Jorge s Pies, Inc. Full Policy Replacement Changing Addresses PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Pies Inc A&J Bakery NLI SCL Address PCED PCXD South St South St Main St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

49 What You Report Jorge s Pies, Inc. Full Policy Replacement Changing Addresses PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Pies Inc A&J Bakery NLI SCL Address PCED PCXD South St South St Main St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 97 What You Report Jorge s Pies, Inc. Full Policy Replacement Changing Addresses PED: 01/01/15 NLI CSN Name PCED PCXD Jorges Pies Inc A&J Bakery NLI SCL Address PCED PCXD South St South St Main St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

50 Informal Delete by Linking How POC chooses the Delete Date: Transaction Set Type Effective Date = Later Date Name Update Effective Date Address Update Effective Date State Effective Date Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 99 Informal Delete POC Transactions 00/33/56 Delete Employer With Location 00/33/87 Delete Employer Without Location 00/33/73 Delete Jurisdiction Clue on Accepted Report: Transaction Set Type Effective Date = Policy Effective Date Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

51 IAIABC POC Coverage Provider Accepted Report Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 101 Remember This Slide? Submitting Correction on Different Day Delete Employer transaction Add Employer transaction Submitting Correction on Same Day Not always the best plan when DG7 is on the establishing transaction Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

52 Business Scenario #7 How a Data Grade 7 Affects POC Reporting: New policy with three employers Policy needs to be reported or it will be late Employers reported without FEINs (zeros) Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 103 What You Report Jorge s Deli, Inc. New policy PED: 01/01/15 NLI CSN Name FEIN PCED PCXD Jorges Deli Inc Jorges Bagel Shop Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

53 What You Report Jorge s Deli, Inc. Changing FEINs PED: 01/01/15 NLI CSN Name FEIN PCED PCXD Jorges Deli Inc Jorges Bagel Shop Inc Amys Sweet Shop Inc NLI SCL Address PCED PCXD Main St South St North St Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 105 What NCCI Loads Flag NLI CSN Name FEIN NED NXD PCED PCXD N Jorges Deli Inc /01/15 N Jorges Bagel Shop Inc /01/15 N Amys Sweet Shop Inc /01/15 Y Jorges Deli Inc /01/15 Y Jorges Bagel Shop Inc /01/15 Y Amys Sweet Shop Inc /01/15 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

54 What the POC Process Generates Jorge s Deli, Inc. PED: 01/01/15 Rec Typ Name Address FEIN Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St /10/80 (New) 01/01/15 PC1 Jorges Deli Inc 1 Main St /33/76 (Before) 01/01/15 PC1 Jorges Deli Inc 1 Main St /32/76 (After) 01/01/15 PC1 Jorges Deli Inc 1 Main St /31/54 (Add) 01/01/15 PC2 Jorges Deli Inc 1 Main St PC2 Jorges Deli Inc 10 South St PC2 Amys Sweet Shop Inc 5 North St ACK CODE TR TR TR TR TR TR TR Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 107 What the POC Process Generates Jorge s Deli, Inc PED: 01/01/15 Rec Typ Name Address FEIN Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St /10/80 01/01/15 ACK CODE TR Wait for acknowledgement reject from state, then correct FEINs Rec Typ Name Address FEIN Triplicate Trans Set Eff Dt PC1 Jorges Deli Inc 1 Main St /10/01 01/01/15 PC2 Jorges Deli Inc 1 Main St PC2 Jorges Bagel Shop Inc 10 South St PC2 Amys Sweet Shop Inc 5 North St ACK CODE TA TA TA TA Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

55 POC State Update Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 109 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

56 Connecticut New IAIABC 3.0 State: Transitioned on December 1, 2014 No new requirements Not acknowledging Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 111 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

57 Idaho Record Type 43 Deductible Endorsement Record must be reported with State Code 11 for the Idaho Industrial Commission to receive the Losses Subject to Deductible Code value: Code Value Code Value Description 01 Medical Losses Only 02 Indemnity Losses Only 03 Medical and Indemnity Losses (Note: Deductible applies proportionately to the medical and indemnity portions of the loss) Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 113 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

58 Kentucky On and after January 1, 2015, the Kentucky DWC will require the NAICS code on the following POC transactions that it receives: New and Renewal Policies with Kentucky addresses Add Employers Add Jurisdictions Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 115 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

59 Maine Publicized updated rule language around 30-day filing requirement for POC Possibly implementing IAIABC rd Quarter 2015 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 117 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

60 New Hampshire Employer s out-of-state address or Address Type 6 (No Specific Location) must be reported. Address Type 2 (Location of Operations) Address Type 6 (No Specific Location) State Code Link = 28 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 119 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

61 Oregon FEIN requirement NAICS requirement effective for policies effective July 1, 2015 and later SIC codes will be rejected Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 121 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

62 Virginia Employer s out-of-state address or Address Type 6 (No Specific Location) must be reported. Address Type 2 (Location of Operations) Address Type 6 (No Specific Location) State Code Link = 45 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 123 NCCI POC Resources Copyright National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved

63 POC Resources Policy Pre-Edit Service Policy Data Collection via DCA Access Online Data Manager Dashboard Future Enhancements Additional Resources Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 125 Policy Pre-Edit Service Allows carriers to submit a policy data file via Data Transfer via the Internet to pre-edit and receive edit results to help correct data prior to production submission. Edit results are provided through the Policy Pre-Edit Service Submission Results Report. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

64 The Policy Data Collection Tool POC Features Enter and update Coverage Notice/Binders (Transaction 16) Link addresses to names using the drag-anddrop feature View state IAIABC POC acknowledgment edits Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 127 Names and Addresses Employer State View Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

65 Names and Addresses Employer State View Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 129 Names and Addresses Linking Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

66 State Acknowledgment Edits Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 131 Data Manager Dashboard POC Features Monitor reporting timeliness View data quality Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

67 Timeliness: State Coverage Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 133 Timeliness: State Coverage Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

68 Quality: Reject Rates Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 135 Quality: Reject Rates Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

69 Additional NCCI Policy and POC Resources Policy and Proof of Coverage Reporting Guidebook Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 137 Policy and Proof of Coverage Reporting Guidebook Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

70 POC State Guide Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 139 Additional NCCI Policy and POC Resources Coverage Verification Service (CVS) Public Web Service Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

71 Additional NCCI Policy and POC Resources Mobile App WC Coverage Verification Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 141 Questions Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

72

73 Supplemental Information

74

75 NCCI NAME STANDARDIZATION ABBREVIATIONS Also Known As * Also Trading As * And And/or * Associate Associates Associated Received As: * and any variations Association Certified Public Accountant * Company Companies Corporation Abbreviation to Apply: AKA ATA & &/OR ASSOC ASSN CPA CO CORP And: Move to the end of the name Doing Business As * DBA Move to the end of the name Et Al * Etal Et Cetera * Etc Drop all info following Formerly Known As * FKA Move to the end of the name General Contractor GC General Contractors General Partner GP General Partners Incorporated Incorp Incorporation INC Leased Clients For * Leased Company For * Leased Workers For * Limited LCF LWF LTD Move to the end of the name Limited Liability Company * Limited Liability Corporation * LLC Limited Liability Partnership LLP Limited Partnership LP Professional Association PA Project PROJ Trading As * TA Move to the end of the name Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved

76 SPECIAL CHARACTERS Character(s) Keep? Keep Only when: And: Reason / Comments (apostrophe) Yes always ) } }! " *? \ _ ~ + < + > #, : ^ ` No - No replace with a space. ; (semi-colon) No Excess No Spaces $ it is immediately followed by a number. & it is not the first or last character in a name field.. (period) it is between any 2 alphanumeric (A/N) characters (no spaces). / it is not the first or last character in a name field. single space i.e., $1.00 Stores New tech age it is not the first character followed by a space in a name or it is not the last character in a name. New tech age names. it immediately follows a number. i.e., 99 Stores Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

77 EXCESS VERBIAGE Character(s) * and any variations Keep? And: { ( [ No Drop all info following. (.) [ ] { }* No Drop all info between these two characters except (k) when preceded by 401. #s only No FEIN ######### Attention: * No Drop all info following. Care Of * Named Insured No Delete only these two words. Insured Name Per WC No Drop all info following. Reinstated No Drop all info following. See End, See Endorsement * No Drop all info following. See Extension Information Page * No Drop all info following. UI * UI # UI# No Drop all info following. Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

78 NAME SPLITTING Character(s) "A subsidiary of", "FKA", of" following INC, CO, CORP, LLP, LP, LTD, LLC, ASSOC, ASSN GC, GP, PA, PROJ Name Split Indicator No Use as Name Split Indicator Only when: And: Don't split until next Name Split Indicator is reached. it immediately follows: INC, CO, CORP, LLP, LP, LTD, LLC, ASSOC, ASSN. & Yes it follows INC, CO, CORP, LLP, LP, LTD, Move to the end of name. OR &/OR LLC, ASSOC, ASSN, GC, GP, PROJ, Joint Venture or A Joint Venture. Assoc, Assn, CO, CORP, INC, LLC, LLP, P, LTD Yes it is not immediately followed by: INC, CO, CORP, LLP, LP, LTD, LLC, ASSOC, ASSN, GC, GP, PROJ, OF, Joint Venture or A Joint Venture. AKA, ATA, DBA, LCF, LWF, TA Yes it is not the first 2 (or 3) characters. Always move to end of name. Joint Venture A Joint Venture Yes Split after Venture when it follows INC, CO, CORP, LLP, LP, LTD, LLC, ASSOC, ASSN, GC, GP, PROJ Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved

79 NON NAMES & &/OR A subsidiary of AKA ASSN ASSOC ATA CO CORP CPA DBA Etal Etc FKA GC When only the following appear in a Name field, remove the wording. GP INC A Joint Venture Joint Venture LCF LLC LLP LP LTD LWF OR PA PROJ TA Only 1, or 2 characters in the name field. Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved

80

81 IAIABC Triplicate History by POC Format Transaction Submission Code Transaction Triplicate POC 1.0 POC 2.1 POC 3.0 Notification of Coverage Assigned Risk Binder I X POC Binder POC Coverage Notice/Binder - some/all Employer locations within Jurisdiction A X X X POC POC Notice - some or all employer locations within Jurisdiction POC Binder - Insured has no physical location in jurisdiction POC Coverage Notice/Binder - Insured has no Physical location within Jurisdiction POC POC Notice - without location(s) within Jurisdiction I X X X POC Binder - Named Employer(s) with no jurisdiction address POC Coverage Notice/Binder - Employers with No Physical Address, but Operating within the Jurisdiction POC POC Notice - with no physical locations within jurisdiction but operating within the Jurisdiction POC New Policy POC New Policy - all/some employer locations with locations POC New Policy - some or all employer locations within Jurisdiction POC New Policy - Insured has not physical location in jurisdiction POC New Policy - Insured has no Physical Location within Jurisdiction POC New Policy - Without location(s) within Jurisdiction POC New Policy - Named Employer(s) with no jurisdiction address POC New Policy - Employers with No Physical Address, but Operating within the Jurisdiction POC New Policy - with no physical locations within the Jurisdiction but operating within the Jurisdiction POC Renew Policy POC Renewal - all/some employer locations within Jurisdiction POC Renewal - some or all employer locations within Jurisdiction POC Renew Policy - Insured has no physical location in jurisdiction POC Renewal - Insured has no Physical location with Jurisdiction POC Renewal - without location(s) within Jurisdiction POC Renew Policy - Named Employer(s) with no jurisdiction address POC Renewal Policy - Employers with No Physical Address, but Operating within the Jurisdiction POC Renewal Policy - with no physical locations within the Jurisdiction but operating within the Jurisdiction EN/M X X X A X X X I X X X EN/M X X X A X X X I X X X EN/M X X X POC Add Jurisdiction POC Endorsement - Notifying a New Jurisdiction when a New Location is added to Existing Policy POC Endorsement - notifying a new Jurisdiction when a location is added to existing policy POC Add Jurisdiction with no State location POC Endorsement - Notifying a New Jurisdiction when a New Employer with No jurisdiction location is added to Existing Policy POC Endorsement - notifying a new Jurisdiction when an employer with no Jurisdiction location is added to existing policy POC Add Jurisdiction - Named Employer(s) with no jurisdiction address POC Add New Employer - Add (Employer Not in Jurisdiction) POC Endorsement - notifying a new Jurisdiction when an employer with no physical location but operating within the Jurisdiction is added to existing policy POC Rewrite/Reissue Policy POC Rewrite/Reissue Policy - Employer Locations within Jurisdiction POC Rewrite/Reissue Policy - some or all employer locations within Jurisdiction A X X X I X X X EN/M X X X A X X X 1

82 IAIABC Triplicate History by POC Format Transaction Submission Code Transaction Triplicate POC 1.0 POC 2.1 POC 3.0 POC Rewrite/Reissue Policy - Insured has no physical location in Jurisdiction POC Rewrite/Reissue Policy - Insured has No Physical Location within Jurisdiction POC Rewrite/Reissue Policy - without location(s) within Jurisdiction POC Rewrite/Reissue Policy - Named Employer(s) with no jurisdiction address POC Rewrite/Reissue Policy - Employers with No Physical Address, but Operating within the Jurisdiction POC Rewrite/Reissue Policy - with no physical locations within the Jurisdiction but operating within the Jurisdiction Addition of Coverage POC Add Location(s) POC Add New Employer - Add - (Location in Jurisdiction) POC Add Employer location within Jurisdiction POC Add Employer(s) with no jurisdiction address POC Add Employer - Add (Employer not in Jurisdiction) POC Add New Employer with no Physical Location within Jurisdiction POC Include Corporate Officer/Partner/Sole Proprietor POC Submitting Corporate Officer/Partner/Sole Proprietor - Inclusion POC Corporate Officer/Partner/Sole Proprietor - Inclusion POC Exclude Corporate Officer/Partner/Sole Proprietor POC Submitting Corporate Officer/Partner/Sole Proprietor - Exclusion POC Corporate Officer/Partner/Sole Proprietor - Exclusion Change of Existing of Coverage POC Change - Change Legal Status, Change Insured Name, Change Governing Class Code, Change Total Payroll, Change Insured Address, Change Telephone Number, Change Business Market, Change Wrap Up Indicator, Change Assignment Date POC Change Insured Demographics Legal Status, Insured Name, Governing Class, Total Payroll, Insured Address, Telephone Number, Business Market, Wrap-Up Indicator, Assignment Date, Employee Leasing Policy Identification, Minimum Premium Policy Indicator Change Insured Demographics Legal Status, Insured Name, Governing Class, Total Payroll, Insured Address, Telephone Number, Business Market, Wrap-Up Indicator, Assignment Date, Employee Leading Policy Identification, Minimum Premium Policy Indicator, Losses Subject to Deductible Code, Basis of Deductible Calculation Code, Insured Sate Premium, PEO or Client Company Code, Reason State was Added to the Policy Code I X X X EN/M X X X E/M X X X E/M X X X I X X X I X X X I X X I X Change Prior Policy Number PI X Add new Insured FEIN PI X POC Change Erroneous Insured FEIN POC Change Insured FEIN Change Insured FEIN PI PI X X X POC Change Employer FEIN POC Change Employer FEIN - Employer Locations within Jurisdiction POC Change Employer FEIN - Employer locations within Jurisdiction PE X X X POC Change Employer UI POC Change Employer U/I - Employer Locations within Jurisdiction POC Change Employer UI Number - employer locations within Jurisdiction PE X X X 2

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