October 2 , 2017 R.C. 2446 Re: New York Workers ...

New York Compensation Insurance Rating Board 733 Third Avenue New York, NY 10017 Tel: (212) 697-3535

October 2, 2017

R.C. 2446

Re: New York Workers Compensation & Employers Liability Manual Premium Algorithm Effective Date: October 1, 2017

Members of the Rating Board:

I write to inform you that the New York State Department of Financial Services approved a filing made by the New York Compensation Insurance Rating Board ("Rating Board") amending the New York Workers Compensation and Employers Liability Manual ("Manual") to add statistical code 9884 at page AC-2, and to correct a typographical error on line 20 in the "TOTAL STANDARD PREMIUM" section at page AC-3.

Modified and final versions of Manual pages AC-2 and AC-3 are attached for your convenience. If you have any questions or concerns, please contact Phil Reda at preda@ or 212 697-3535, extension 113.

Very truly yours,

Enclosures

Jeremy Attie President and CEO

Page AC-2 APPENDIX C

NEW YORK WORKERS COMPENSATION

AND EMPLOYERS LIABILITY MANUAL

Effective October 1, 2017

4th 5th Reprint

PREMIUM ALGORITHM (Continued)

Sequence of Presentation

&/or Calculation*

17

Statistical Codes

9841

Premium Element Name Drug-Free Workplace Credit

18

9606

Repatriation Expense Premium

None

TOTAL SUBJECT PREMIUM

19

None

Experience Modification

TOTAL MODIFIED PREMIUM

20

9884, 9885, Merit Rating Adjustment 9886, 9896

21

9046

New York Construction Classification Premium

Adjustment Program (NYCCPAP)

22

9846

Drug-Free Workplace Credit

23

9874

Managed Care/PPO Premium Credit

24

9747

Compulsory Workplace Safety Program Surcharge

25

Various Non-ratable elements

26

9985

Radiation Exposure NOC

27

9663

Deductible Premium Credit (After Experience

Modification)

28

0931

Short Rate Cancellation Penalty

29

0990

Minimum Premium Balance Amount

30

9849

Employer Liability Increased Limits Minimum

Premium ? Admiralty or FELA Coverage

31

9034, 9036 Rate Deviation ? Method 3 (After Experience

Modification)

32

Reserved for future use

Calculation Procedure As per carrier filing (subject to experience rating)

Flat charge as per Rule VIII-D.4. of the NYWC&EL Manual

Sum of Manual Premium for all classifications + lines 7 thru 18

As per Experience Rating Plan; Promulgated by NYCIRB for intra-state risks; by NCCI for inter-state risks

Total Subject Premium x Experience Modification

Total Subject Premium x Merit Rating Factor; Factor calculated by NYCIRB

Total Modified Premium x NYCCPAP Factor; Factor calculated by NYCIRB

As per carrier filing (not subject to experience rating)

As per carrier filing

Total Modified Premium per Rule VI K. of the WC&EL Manual x Workplace Safety Surcharge Factor.

Payroll x Applicable Rate / 100

Supplemental rate x Payroll for operations subject to radiation exposure / 100

As per carrier filing with the Department of Financial Services.

As per Rule X-D of the NY WC&EL Manual.

Amount required to balance to risk minimum premium

Minimum Premium less Increased Limits Premium if applicable

(Modified Premium plus statistical codes not subject to experience rating) x deviation factor; not applicable as of 10/1/08

NEW YORK WORKERS COMENSATION AND EMPLOYERS LIABILITY MANUAL 5th 6th Reprint

Effective October 1, 2017

Page AC-3 APPENDIX C

Sequence of Presentation

&/or Calculation*

33

Statistical Codes

9753

Premium Element Name WSLPIP Drug & Alcohol Prevention Program Credit

34

9743

WSLPIP Return-To-Work Program Premium Credit

35

9748

WSLPIP Safety Incentive Program Premium Credit

36

9651

Safe Patient Handling Act Program Premium Credit

(NYSPHAP)

37

9887, 9889 Schedule Rating Plan

NONE

TOTAL STANDARD PREMIUM

38

0063, 0064 Premium Discount

39

0900

Expense Constant

40

9740

Terrorism

41

9741

Natural Disasters and Catastrophic Industrial

Accidents

NONE

TOTAL ESTIMATED ANNUAL PREMIUM

42

0932

New York State Assessment

43

NONE

Total Estimated Premium and Assessment

44

9749

New York Workers Compensation Security Fund

45

NONE

TOTAL ESTIMATED POLICY COST

Calculation Procedure Total modified premium per Rule VI K. of the WC&EL Manual x Drug & Alcohol Prevention Credit Factor

Total modified premium per VI K. of the WC&EL Manual x Return-To-Work Credit Factor

Total modified premium per VI.K of the WC&EL Manual x Safety Incentive Credit Factor

Total modified premium x SPHA Credit Factor as per Rule VI K-4 of the NY WC&EL Manual.

(Modified Premium plus statistical codes not subject to experience rating) x (1-SR Credit %) or (1+SR Debit %)

Total Modified Premium + all premium from classifications and statistical codes not subject to experience rating (items 1820 thru 37).

Tabular or formula value as specified by the carrier; not applicable in conjunction with retrospective rating

A fixed dollar amount per policy as specified by the carrier

Rate per $100 of total policy payroll; % of class premium for non-payroll classes.

Rate per $100 of total policy payroll; % of class premium for non-payroll classes.

Premium combining all applicable elements above

A percentage of Standard Premium as defined in Rule IX.L.3 of the NY WC&EL Manual.

Total Estimated Annual Premium + NY State Assessment Charge.

A percentage of the Total Estimated Annual Premium

Total Estimated Annual Premium + NY State Assessment Charge + NY WC Security Fund Charge.

*See Pages AC-4 through AC-6 for Premium Element Definitions

Page AC-2 APPENDIX C

NEW YORK WORKERS COMPENSATION

AND EMPLOYERS LIABILITY MANUAL

Effective October 1, 2017

5th Reprint

PREMIUM ALGORITHM (Continued)

Sequence of Presentation

&/or Calculation*

17

Statistical Codes

9841

Premium Element Name Drug-Free Workplace Credit

Calculation Procedure

As per carrier filing (subject to experience rating)

18

9606

Repatriation Expense Premium

Flat charge as per Rule VIII-D.4. of the NYWC&EL Manual

None

TOTAL SUBJECT PREMIUM

Sum of Manual Premium for all classifications + lines 7 thru 18

19

None

Experience Modification

As per Experience Rating Plan; Promulgated by NYCIRB for intra-state risks; by NCCI for inter-state risks

TOTAL MODIFIED PREMIUM

Total Subject Premium x Experience Modification

20

9884, 9885, Merit Rating Adjustment

9886, 9896

Total Subject Premium x Merit Rating Factor; Factor calculated by NYCIRB

21

9046

New York Construction Classification Premium

Total Modified Premium x NYCCPAP Factor;

Adjustment Program (NYCCPAP)

Factor calculated by NYCIRB

22

9846

Drug-Free Workplace Credit

As per carrier filing (not subject to experience rating)

23

9874

Managed Care/PPO Premium Credit

As per carrier filing

24

9747

Compulsory Workplace Safety Program Surcharge

Total Modified Premium per Rule VI K. of the

WC&EL Manual x Workplace Safety

Surcharge Factor.

25

Various Non-ratable elements

Payroll x Applicable Rate / 100

26

9985

Radiation Exposure NOC

Supplemental rate x Payroll for operations subject to radiation exposure / 100

27

9663

Deductible Premium Credit (After Experience

As per carrier filing with the Department of

Modification)

Financial Services.

28

0931

Short Rate Cancellation Penalty

As per Rule X-D of the NY WC&EL Manual.

29

0990

Minimum Premium Balance Amount

Amount required to balance to risk minimum premium

30

9849

Employer Liability Increased Limits Minimum

Minimum Premium less Increased Limits

Premium ? Admiralty or FELA Coverage

Premium if applicable

31

9034, 9036 Rate Deviation ? Method 3 (After Experience

Modification)

(Modified Premium plus statistical codes not subject to experience rating) x deviation factor; not applicable as of 10/1/08

32

Reserved for future use

NEW YORK WORKERS COMENSATION AND EMPLOYERS LIABILITY MANUAL 6th Reprint

Effective October 1, 2017

Page AC-3 APPENDIX C

Sequence of Presentation

&/or Calculation*

33

Statistical Codes

9753

Premium Element Name WSLPIP Drug & Alcohol Prevention Program Credit

34

9743

WSLPIP Return-To-Work Program Premium Credit

35

9748

WSLPIP Safety Incentive Program Premium Credit

36

9651

Safe Patient Handling Act Program Premium Credit

(NYSPHAP)

37

9887, 9889 Schedule Rating Plan

38

NONE

TOTAL STANDARD PREMIUM

0063, 0064 Premium Discount

39

0900

Expense Constant

40

9740

Terrorism

41

9741

Natural Disasters and Catastrophic Industrial

Accidents

NONE

TOTAL ESTIMATED ANNUAL PREMIUM

42

0932

New York State Assessment

43

NONE

Total Estimated Premium and Assessment

44

9749

New York Workers Compensation Security Fund

45

NONE

TOTAL ESTIMATED POLICY COST

Calculation Procedure Total modified premium per Rule VI K. of the WC&EL Manual x Drug & Alcohol Prevention Credit Factor

Total modified premium per VI K. of the WC&EL Manual x Return-To-Work Credit Factor

Total modified premium per VI.K of the WC&EL Manual x Safety Incentive Credit Factor

Total modified premium x SPHA Credit Factor as per Rule VI K-4 of the NY WC&EL Manual.

(Modified Premium plus statistical codes not subject to experience rating) x (1-SR Credit %) or (1+SR Debit %)

Total Modified Premium + all premium from classifications and statistical codes not subject to experience rating (items 20 thru 37).

Tabular or formula value as specified by the carrier; not applicable in conjunction with retrospective rating

A fixed dollar amount per policy as specified by the carrier

Rate per $100 of total policy payroll; % of class premium for non-payroll classes.

Rate per $100 of total policy payroll; % of class premium for non-payroll classes.

Premium combining all applicable elements above

A percentage of Standard Premium as defined in Rule IX.L.3 of the NY WC&EL Manual.

Total Estimated Annual Premium + NY State Assessment Charge.

A percentage of the Total Estimated Annual Premium

Total Estimated Annual Premium + NY State Assessment Charge + NY WC Security Fund Charge.

*See Pages AC-4 through AC-6 for Premium Element Definitions

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