Appendix D Potential Filing Form Ratemaking Disclosure Form To Be Submitted with Personal Lines Rate Filings Section A Insurer Name(s): Filing Line of Insurance: Product Name: Tracking Number: Section B Indicated and rating factors are those that correspond to an actuarially sound estimate of the expected costs of transferring the covered risk from the policyholder to the insurer. In the development of your proposed rates and rating factors, you use a model involving a) elasticity of demand or b) non-cost based information to select rates or rating factors that differ from the indicated? Yes No If you answered skip to Section D at the end of this form. “No,” Section C Please provide a high-level description of the workings of model that s used rates rating factors What does the seek to maximize or minimize? Underwriting profit If other, please explain: Renewal retention Other Under what specific constraints is the maximization/minimization performed? Identify each constrained variable and its minimum and maximum values. (Insert additional rows as needed by selecting a row and clicking the button on the right of the row.) “+” Constrained Variable Minimum Value Maximum Value
Appendix D Potential Filing Form Ratemaking Disclosure Form To Be Submitted with Personal Lines Rate Filings Section A Insurer Name(s): Filing Line of Insurance: Product Name: Tracking Number: Section B Indicated and rating factors are those that correspond to an actuarially sound estimate of the expected costs of transferring the covered risk from the policyholder to the insurer. In the development of your proposed rates and rating factors, you use a model involving a) elasticity of demand or b) non-cost based information to select rates or rating factors that differ from the indicated? Yes No If you answered “No,” skip to Section D at the end of this form. Section C Please provide a high-level description of the workings of model that s used rates rating factors What does the seek to maximize or minimize? Underwriting profit Renewal retention Other If other, please explain: Under what specific constraints is the maximization/minimization performed? Identify each constrained variable and its minimum and maximum values. (Insert additional rows as needed by selecting a row and clicking the “+” button on the right of the row.) Constrained Variable Minimum Value Maximum Value
C-17.docx