Residual Premium Algorithm
OVERVIEW
|
RESIDUAL MARKET DATA ENTRY
(Algorithm PDF)
|
VOLUNTARY MARKET DATA ENTRY
(Algorithm PDF)
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GO TO RESIDUAL MARKET DATA ENTRY BEFORE JULY 1,2016.
Residual Market Data Entry
Employer Name
Effective Date
Expiration Date
Cancellation Date
Cancellation Type
Not Applicable
Pro Rata
Short Rate
Was policy issue short term to replace a binder or to establish concurrency with other policies?
No
Yes
Waiver of Subrogation
No
Yes
Employers Liability
9845 - Standard Limits
9803 - 100/100/1000
9807 - 500/500/500
9808 - 500/500/1000
9812 - 1000/1000/1000
Small Deductible Programs applicable to Workers' Compensation only and not Employers Liability
MA Benefits Deductible Program:
None
$500
$1,000
$2,000
$2,500
$5,000
MA Benefits Claim & Aggregate Deductible Program:
No
Yes
Experience Modification(x.xx):
Merit Rating:
None
.95
1.00
1.05
MA Construction Credit(xx):
ARAP Surcharge(x.xx):
QLMP Credit(xx.xx):
Former Self-Insurers Charge(whole dollar):
Admiralty Employers Liability Limit:
None
10,000 Standard
50,000
100,000
DIA Assessment:
Private
Public
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 classes, non-admiralty payroll classes, per capita classes, supplemental rate disease classes, supplemental non-ratable classes, and/or the supplemental rate atomic energy exposure.