North Carolina Administrative Code

11 NCAC 13 .0537 ADMINISTRATION OF EXAMINATION (a) Professional bail bondsman, surety bail bondsman, or runner license applicants may use a simple function calculator during the examination. (b) Applicants shall not take cellular telephones, textbooks, other books or papers into …

11 NCAC 13 .0538 reserved for future codification

11 NCAC 13 .0539 BAIL BOND PRELICENSING EDUCATION PROVIDER (a) This Rule applies to all bail bond prelicensing providers offering a prelicensing course prescribed by G.S. 58-71-71. All providers desiring to conduct a prelicensing course shall be approved and issued a certificate …

11 NCAC 13 .0540 reserved for future codification

11 NCAC 13 .0541 BAIL BOND PRELICENSING EDUCATION COURSES (a) Providers shall offer no less than 12 instructional hours of prelicensing education. (b) The following requirements are course standards: (1) All courses shall consist of instruction on bail bonding licensing, regulati…

11 NCAC 13 .0542 BAIL BOND PRELICENSING AND BCEC INSTRUCTORS (a) A person desiring approval as a bail bond prelicensing or BCEC instructor shall make written application to the Commissioner. (b) Instructor applicants must be sponsored by a provider seeking to employ the applicant…

11 NCAC 14 .0308 ADMITTED ASSETS: HMO History Note: Filed as a Temporary Adoption Eff. December 18, 1990, For a Period of 180 Days to Expire on June 15, 1991; Statutory Authority G.S. 58-2-40(1); 58-67-20; 58-67-110(b); Eff. May 1, 1991; Repealed Eff. April 1, 1993.

11 NCAC 14 .0409 BIOGRAPHICAL AFFIDAVIT History Note: Authority G.S. 58-7-35; 58-7-40; 58-16-5; Eff. January 22, 1980; Amended Eff. April 1, 1990; Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.

11 NCAC 14 .0410 INSURANCE COMPANY LICENSE History Note: Authority G.S. 58-72; 105-228.4; Eff. January 22, 1980; Repealed Eff. July 1, 1988.

11 NCAC 14 .0415 PETITION FOR ADMISSION History Note: Authority G.S. 58-16-5(2); Eff. April 1, 1990; Repealed Eff. March 1, 2004.

11 NCAC 14 .0432 APPLICATION FOR LICENSE: INSURANCE COMPANY History Note: Authority G.S. 58-2-40; 58-7-40; 58-16-5; Eff. February 1, 1996; Repealed Eff. July 1, 2012.

section .0500 - ADMISSION OF A FOREIGN OR ALIEN INSURANCE COMPANY 11 NCAC 14 .0501 APPLICATION FORMS History Note: Authority G.S. 58-2-40; 58-16-5; Eff. April 1, 1990; Amended Eff. July 1, 2004; Repealed Eff. July 1, 2012.

11 NCAC 14 .0506 EXCEPTION TO IN FORCE POLICY REQUIREMENTS History Note: Authority G.S. 58-16-15; Eff. April 1, 1990; Pursuant to G.S. 150B-21.3A, rule Expired January 1, 2015.

11 NCAC 14 .0705 FILING AND PAYMENT OF PREMIUM TAXES History Note: Authority G.S. 58-22-20; 58-22-35; Eff. April 1, 1990; Repealed Eff. March 1, 2004.

11 NCAC 15 .0111 FEES AND CHARGES FOR DATA History Note: Authority G.S. 131E-211(k); 131E-212(b)(7); Eff. November 1, 1993; Repealed Eff. September 1, 2002.

11 NCAC 15 .0112 SUCCESSOR FORMS History Note: Authority G.S. 131E-212(b); Temporary Adoption Eff. January 1, 1994 For a Period of 180 Days or Until the Permanent Rule Becomes Effective, Whichever is Sooner; Eff. April 1, 1994; Amended Eff. November 1, 1994; Repealed Eff. Septemb…

CHAPTER 16 - ACTUARIAL SERVICES DIVISION SECTION .0100 - FIRE AND CASUALTY STATISTICAL DATA 11 NCAC 16 .0101 APPLICABILITY The following Rules describe statistical data that shall be submitted to the Actuarial Services Division. (1) 11 NCAC 16 .0103 shall apply to all companies t…

11 NCAC 16 .0102 LOSS RESERVES History Note: Authority G.S. 58-2-40; 58-2-190; Eff. December 1, 1990; Amended Eff. August 1, 1991; Repealed Eff. July 1, 2011.

11 NCAC 16 .0103 NONFLEET PRIVATE PASSENGER AUTOMOBILE INSURANCE All companies writing North Carolina nonfleet private passenger automobile insurance shall collect the statistical data described in this Rule and shall report such data to their statistical agent. The statistical a…

11 NCAC 16 .0104 PROFESSIONAL LIABILITY INSURANCE History Note: Authority G.S. 58-2-170; 58-2-190; Eff. December 1, 1990; Repealed Eff. July 1, 2011.

11 NCAC 16 .0105 PHYSICIANS AND SURGEONS PROFESSIONAL LIABILITY INSURANCE Companies that insure more than two percent of the insured physicians and surgeons in North Carolina shall submit the following data upon request, evaluated as of December 31 to the Actuarial Services Divis…

11 NCAC 16 .0106 CREDIT PROPERTY INSURANCE Each writer of North Carolina credit property insurance shall submit the data described in this Rule upon request to the Actuarial Services Division. (1) North Carolina premium, loss, and expense: (a) written premium; (b) earned premium;…

11 NCAC 16 .0107 NONFILING INSURANCE Writers of North Carolina nonfiling insurance shall submit the following information upon request to the Actuarial Services Division: (1) written premium; (2) earned premium; (3) earned exposures; (4) incurred losses; (5) number of incurred cl…

11 NCAC 16 .0108 SINGLE OR DUAL INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE Writers of North Carolina Single or Dual Interest Automobile Physical Damage Insurance shall submit the following data described in this Rule upon request to the Actuarial Services Division. (1) North C…

SECTION .0200 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE 11 NCAC 16 .0201 MINIMUM LOSS RATIO STANDARDS (a) For individual accident and health insurance policies and riders delivered in this State, the standard minimum guideline loss ratio for conditionally renewable, guaranteed r…

11 NCAC 16 .0202 ACCIDENT AND HEALTH INSURANCE RENEWABILITY DEFINITIONS With respect to all individual accident and health insurance in this State, the following renewability definitions or substantively similar wording as the Commissioner approves shall be used: (1) Conditionall…

11 NCAC 16 .0203 CONDITIONALLY RENEWABLE STATED REASON PROHIBITED For policies or riders permitting the adjustment of premiums for which the insurer retains the right to nonrenew, no insurer shall exercise a right not to renew for the following reason or any synonymous reason: "T…

11 NCAC 16 .0204 OPTIONALLY RENEWABLE PROHIBITED No policy of accident, health, or accident and health insurance shall contain a provision that permits the insurer to refuse to renew the coverage of an individual insured based upon the deterioration of health of an individual ins…

11 NCAC 16 .0205 DATA REQUIREMENTS FOR RATE REVISION SUBMISSION (a) With respect to any individual accident and health insurance policy governed by G.S. 58, Articles 1 through 64, for which an adjustment of premium rate is allowed by law, the insurer shall submit an actuarial mem…

11 NCAC 16 .0206 CLASS DEFINITION RESTRICTION With respect to individual accident and health insurance policies for which the adjustment of premium rates is allowed by law, the insurer shall not establish, for rate revision purposes, a class within a policy form or group of polic…

11 NCAC 16 .0207 COMMON BLOCK (a) As used in this Rule, "Common Block" means a grouping of similar policy form types for which the pooling of experience is actuarially justified and for which the rate revisions are based upon the common experience. A Common Block may include both…

11 NCAC 16 .0208 ANNUAL ACTUARIAL CERTIFICATIONS FOR LONG-TERM CARE FORMS For actuarial certifications required by G.S. 58-51-95(i): (1) The actuarial certification shall be made by an individual who is either a Fellow or an Associate of the Society of Actuaries, a Fellow or an A…

SECTION .0400 - CREDIT LIFE ACCIDENT AND HEALTH RATE DEVIATION 11 NCAC 16 .0401 DEFINITIONS As used in this Section: (1) "Class of Business" means one of the following determined by the source of the business: (a) Credit Unions; (b) Commercial Banks and Savings and Loan Associati…

11 NCAC 16 .0402 GENERAL SUBMISSION REQUIREMENTS (a) All rate deviation requests, including the data required by Rule .0403 of this Section, shall be submitted to the Life and Health Division. All rate deviation requests shall be submitted no later than March 31, of each calendar…

11 NCAC 16 .0403 CALCULATION PROCEDURE AND DATA REQUIREMENTS FOR RATE DEVIATIONS An insurer requesting a rate deviation shall submit to the Department of Insurance the following information, the results of each calculation as follows, and the corresponding data required to perfor…

SECTION .0500 - CREDIT UNEMPLOYMENT MINIMUM LOSS RATIO STANDARD 11 NCAC 16 .0501 MINIMUM INCURRED LOSS ratio The premium rates charged for credit unemployment insurance shall be reasonable in relation to the benefits provided as indicated by a minimum annual incurred loss ratio o…

11 NCAC 16 .0502 DEFINITIONS As used in this Section: (1) "Earned Premium" means North Carolina credit unemployment earned premium, during the experience period, restated as though the current North Carolina credit unemployment rate had been charged. (2) "Incurred Claims" means N…

11 NCAC 16 .0503 GENERAL SUBMISSION REQUIREMENTS (a) All credit unemployment minimum incurred loss ratio compliance demonstrations shall be submitted to the Life and Health Division upon request. (b) All experience used in the demonstration of compliance shall be only North Carol…

11 NCAC 16 .0504 CALCULATION PROCEDURE AND DEMONSTRATION OF COMPLIANCE Each credit unemployment insurer shall submit to the Department of Insurance the results of each calculation as follows and the corresponding data required to perform each calculation in accordance with this R…

SECTION .0600 - HEALTH MAINTENANCE ORGANIZATION FILINGS AND STANDARDS 11 NCAC 16 .0601 DEFINITIONS (a) The definitions contained in G.S. 58-67-5 shall apply in this Section. (b) As used in this Section: (1) "Adjusted community rating" means a rating method that allows an HMO to p…

11 NCAC 16 .0602 HMO GENERAL FILING REQUIREMENTS (a) All schedules of premiums for enrollee coverage for health care services and all amendments to schedules of premiums that are filed with the Department shall be submitted to and stamped received by the Life and Health Division …

11 NCAC 16 .0603 HMO RATE FILING DATA REQUIREMENTS All HMO rate filings shall include the following data: (1) identification and a brief description of the HMO model type; (2) identification of the enrollee issue basis, whether individual or group; (3) identification and a brief …

11 NCAC 16 .0604 INITIAL HMO RATE FILING DATA REQUIREMENTS AND STANDARDS (a) All initial HMO rate filings shall include, in addition to the data required by 11 NCAC 16 .0603, the following data: (1) a comparison of the rates to other HMO rates with the same effective date in Nort…

11 NCAC 16 .0605 HMO EXPANSION REQUEST DATA REQUIREMENTS All HMO expansion requests shall include, in addition to the data required by 11 NCAC .0603, the following data: (1) a comparison of the actual financial results, including total membership, revenues, and expenses, to the p…

11 NCAC 16 .0606 HMO RATE REVISION FILING DATA REQUIREMENTS All HMO rate revision filings shall include, in addition to the data required by 11 NCAC 16 .0603, the following data: (1) a brief, summary description of the scope and reason for any rate revision, including the methodo…

11 NCAC 16 .0607 HMO INCURRED LOSS RATIO STANDARDS (a) The following shall apply to all HMO rate revision filings: (1) The application of a requested rate increase or decrease shall result in an average incurred loss ratio projected for North Carolina over the period required in …

SECTION .0700 - HEALTH MAINTENANCE ORGANIZATION CLAIM RESERVE DATA REQUIREMENTS 11 NCAC 16 .0701 DEFINITIONS As used in this Section: (1) "Claim reserves" means reserves or liabilities held for claims incurred on or before the valuation date, but unpaid as of the valuation date. …

11 NCAC 16 .0702 CLAIMS (a) When an HMO has been informed that a claim has been incurred, if the date reported is on or before the valuation date, the claim shall be considered as a reported claim. (b) When an HMO has not been informed, on or before the valuation date, concerning…

11 NCAC 16 .0703 CLAIM RESERVE FILING REQUIREMENTS (a) A quarterly claim reserve data filing shall be made by any HMO that has been in operation for more than one full calendar year but less than three full calendar years. (b) An annual claim reserve data filing shall be made by …

11 NCAC 16 .0704 CLAIM RESERVE DATA AND FORMAT REQUIREMENTS (a) The data requirements in Paragraph (b) of this Rule shall be recorded for the following types of claims: (1) inpatient Claims; (2) physician Claims; (3) referral Claims; and (4) other. (b) For the most recent 24-mont…