Residual Premium Algorithm
before July 1, 2016
OVERVIEW | RESIDUAL MARKET DATA ENTRY (Algorithm PDF) | VOLUNTARY MARKET DATA ENTRY (Algorithm PDF) | WCRIBMA HOME


GO TO RESIDUAL MARKET DATA ENTRY EFFECTIVE JULY 1,2016.
 
Residual Market Data Entry


Employer Name  
Effective Date
Expiration Date
Cancellation Date
Cancellation Type
Was policy issue short term to replace a binder or to establish concurrency with other policies?
Waiver of Subrogation
Employers Liability
   
Small Deductible Programs applicable to Workers' Compensation only and not Employers Liability  
MA Benefits Deductible Program:
MA Benefits Claim & Aggregate Deductible Program:
Experience Modification(x.xx): Merit Rating:
MA Construction Credit(xx): ARAP Surcharge(x.xx):
QLMP Credit(xx.xx): Former Self-Insurers Charge(whole dollar):
Admiralty/FELA Lower Limit:
DIA Assessment:






Enter Class Codes


Class Code*Exposure(Not subject to waiver)Exposure(Subject to waiver)USL&H
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 
$  $ 

* Refer to the algorithm Part I (1): enter class codes for the following: admiralty/FELA classes, non-admiralty/FELA payroll classes, per capita classes, supplemental rate disease classes, the aircraft seat surcharge class, supplemental non-ratable classes, and/or the supplemental rate atomic energy exposure.