Residual Premium Algorithm
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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 Employers Liability Limit:
DIA Assessment:






Enter Class Codes


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

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