Sec. 21.18.084. Claim reserves for health insurance.

585 words·~3 min read·/ak/title-21/chapter-18/21-18-084

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(a)Claim reserves are required for all incurred and unpaid claims on all health insurance policies.

(b)Claim expense reserves are required for the estimated expense of settlement of all incurred and unpaid claims.

(c)Claim reserves for prior valuation years must be tested for adequacy and reasonableness using claim runoff schedules in accordance with the statutory annual statement, including consideration of any residual unpaid liability. Claim reserve adequacy must be determined in the aggregate.

(d)Claim reserves must be determined as follows:

(1)for policies that require policy reserves under AS 21.18.082 (a), based on a maximum interest rate equal to the maximum interest rate allowed under AS 21.18.110 for the valuation of whole life insurance issued on the same date as the date the claim was incurred;

(2)for policies that do not require policy reserves under AS 21.18.082 (b), based on a maximum interest rate equal to the maximum interest rate allowed under AS 21.18.110 for the valuation of single premium immediate annuities issued on the same date as the date the claim was incurred less 100 basis points;

(3)except as provided in

(4)and

(5)of this subsection, a morbidity assumption for

(A)individual disability income insurance must be equal to the morbidity assumption used in determining policy reserves under AS 21.18.082 (g)(5);

(B)group disability income insurance for policies issued

(i)after December 31, 1997, must be equal to the 1987 Commissioners Group Disability Table; and

(ii)before January 1, 1998, must be equal to the morbidity assumption in use by the insurer before January 1, 1998;

(C)accidental death benefits must be equal to the actual amount of claims incurred; and

(D)all other individual or group policy benefits must be equal to a morbidity table approved by the director and established for reserve determination by an actuary qualified to determine the morbidity table;

(4)for individual or group disability claims with a duration from disablement of less than two years, morbidity assumptions may be based on the insurer's experience if determined credible by the insurer or upon another basis designed to place a sound value on the liabilities as determined by the insurer;

(5)if approved by the director, reserves for group disability income claims with a duration from disablement of more than two years but less than five years may be based on the insurer's experience for which the insurer maintains control of underwriting and claim administration; request for approval to use this modified reserve basis must include

(A)an analysis of the credibility of the experience;

(B)a description of how all the insurer's experience is proposed to be used in setting the reserves;

(C)a description and quantification of the margins to be included;

(D)a summary of the financial impact that the proposed plan of modification would have on the insurer's last filed annual statement;

(E)a copy of the approval from the state of domicile; and

(F)all other information requested by the director;

(6)any generally accepted actuarial reserving method or other reasonable method approved by the director may be used; the method used to estimate liabilities may be an aggregate method; approximations based on groupings and averages may also be used.

(e)Claim reserves that are valued based on the 1964 or 1985 Commissioners' Individual Disability Tables must include a provision for a waiver of premium benefit with the minimum reserve for the benefit equal to the valuation net premium to be waived.