About the Data Call
This data call is due May 31, 2024.
According to 31 s 89.780(b) of the Pennsylvania Insurance Regulations, the Pennsylvania Insurance Department has prescribed the Excel worksheets contained in the workbook linked below as the applicable Medicare Supplement Refund Calculation forms to be used by insurers to submit the required annual refund calculation data to the Department for each individual and group standardized Medicare Supplement benefit plan.
Insurers must submit the refund calculation data in the prescribed Excel format. The shaded areas on the worksheet are to be completed by the company; all other information will be calculated from the entered data.
Separate blank worksheets for individual and group business are contained in the linked workbook, which incorporate specific loss ratios to calculate the benchmark ratio for the applicable market (individual and group); otherwise, the two worksheets are identical. These worksheets should be completed for each standardized Medicare Supplement benefit plan (SMSBP): A, B, C, D, E, F, G, H, I, J, K, L, M, and N.
- Submit all of the insurer’s worksheets in one Excel workbook, with separate pages for each SMSBP and market (make as many copies of the individual and group worksheets as needed).
- Leave all formulas intact.
- Do not modify the formatting of the workbook, other than to hide, but not delete, rows or columns should the filer find this to be necessary.
- Do not convert the information to a pdf file.
- In the determination of the Benchmark Loss Ratio, all data for calendar years prior to 2008 will be included in the Calendar Year 2008 row for calculation purposes; this will be done automatically, so no adjustments by the company are necessary.
- Standard and Select plan experience must be reported on separate worksheets.
- 1990 and 2010 form series experience must be combined in one exhibit for each SMSPB.
- High deductible Plan F, G, and J experience must be included in the exhibits for Plan F, G, and J, respectively.
- Earned Premiums are to include all modal loads and fees charged.
- Incurred claims are to exclude active life reserves.
These worksheets must also be completed for any pre-standardized individual or group plans (SMSBP: P) for which business remained inforce in 2023. Again, individual and group plan experience must be submitted separately, with the combined experience for all applicable policies included on the appropriate worksheet (individual or group).
For purposes of calculating the refunds for pre-standardized plans, 1996 is considered the year of issue for all business. Therefore, in the Calendar Year Experience section of the worksheet, data will be entered only in Year of Issue 1996, for calendar years 1996 and subsequent.
If any of the experience submitted in the previous year’s filing differs from the experience for the same period submitted in the current year’s filing, provide an explanation of the reason(s) that the data has changed. This explanation must be included in a cover letter that accompanies the current year’s filing.
Submission Process
Please use the Medigap Refund Excel workbook to submit the refund calculation data as prescribed in the data call process above.
Medicare Supplement Refund Calculation filings must be submitted via SERFF, using:
- Type of Insurance (TOI) code MS-09 Medicare Supplement - Other 2010
- Sub-Type of Insurance (Sub-TOI) code MS09.000 Medicare Supplement Other 2010
- Filing Type Rate - Medicare Supplement Refund Calculation
*Note: The workbook is protected to preserve the formatting and formulas that generate the benchmark and experience loss ratios. If you have any questions or problems with the workbook, please contact Michael Gurgiolo at (717) 783-2115 or email mgurgiolo@pa.gov.
General issues and questions can be directed to Lindsi Swartz, Director of the Bureau of Life, Accident and Health Insurance at linswartz@pa.gov.
Questions or problems with the Medigap Refund Excel workbook, please contact Michael Gurgiolo at (717) 783-2115 or email mgurgiolo@pa.gov.