Section 031-130-7 - Contract ReservesA.General(1) Contract reserves are required, unless otherwise specified in Section 7(A)(2) for: (a) All individual and group contracts with which level premiums are used; or(b) All individual and group contracts with respect to which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time. For products that are community rated or that use other rating methodology based on cross-subsidies among contracts within the block, this evaluation may be applied on a rating block basis provided that the total premiums for the block were developed to support the total risk assumed and expected expenses for the block each year, and a qualified actuary certifies the premium development. The actuary should state in the certification that premiums for the rating block were developed such that each year's premium was intended to cover that year's costs without any prefunding. If the premium is also intended to recover costs for any prior years, the actuary should also disclose the reasons for and magnitude of such recovery. If rates are determined such that each year's premium is intended to cover that year's cost, the rating block approach results in no contract reserves unless required by subsection D. If rates are designed to prefund future years' costs, contract reserves will be required. The values specified in this subparagraph (b) shall be determined on the basis specified in Section 7(B).(2) Contracts not requiring a contract reserve are:(a) Contracts that cannot be continued after one year from issue; or(b) Contracts already in force on the effective date of these standards for which no contract reserve was required under the immediately preceding standards.(3) The contract reserve is in addition to claim reserves and premium reserves.(4) The methods and procedures for contract reserves shall be consistent with those for claim reserves for any contract, or else appropriate adjustment must be made when necessary to assure provision for the aggregate liability. The definition of the date of incurral must be the same in both determinations.(5) The total contract reserve established shall incorporate provisions for moderately adverse deviations.B.Minimum Standards for Contract Reserves(1) Morbidity or Other Contingency. Minimum standards with respect to morbidity are those set forth in Appendix A. Valuation net premiums used under each contract must have a structure consistent with the gross premium structure at issue of the contract as this relates to advancing age of insured, contract duration and period for which gross premiums have been calculated. This requirement only applies to the premium structure applicable to each contract. The relationship among gross premiums for different contracts (e.g., variations by age) has no bearing on the net premium structure. If for a policy form there is no gross premium variation by age, the valuation net premiums will nonetheless vary based on age at issue for each contract since at issue the present value of valuation net premiums for a contract must equal the present value of tabular claim costs. Contracts for which tabular morbidity standards are not specified in Appendix A shall be valued using tables established for reserve purposes by a qualified actuary and acceptable to the Superintendent. The morbidity tables shall contain a pattern of incurred claims cost that reflects the underlying morbidity and shall not be constructed for the primary purpose of minimizing reserves.
(a) In determining the morbidity assumptions, the actuary shall use assumptions that represent the best estimate of anticipated future experience, but shall not incorporate any expectation of future morbidity improvement. Morbidity improvement is a change from the current morbidity tables or experience that will result in a reduction to reserves, taking into account the combined effect of claim frequency and the present value of future expected claim payments given that a claim has occurred. It is not the intent of this provision to restrict the ability of the actuary to reflect the morbidity impact for a specific known event that has occurred and that is able to be evaluated and quantified, such as a new drug release. However, such events are rare.(b) Business in force as of the effective date of Section 7(B)(3)(c) may be permitted to retain the original reserve basis which may not meet the provisions of subparagraph (a) above, subject to the acceptability to the Superintendent.(2) Interest. The maximum interest rate is specified in Appendix A.(3) Termination Rates. Termination rates used in the computation of reserves shall be on the basis of a mortality table as specified in Appendix A except as noted in the following items:(a) Under contracts for which premium rates are not guaranteed and where the effects of insurer underwriting are specifically used by policy duration in the valuation morbidity standard, or for return of premium or other deferred cash benefits, total termination rates may be used at ages and durations where these exceed specified mortality table rates, but not in excess of the lesser of: (i) Eighty percent of the total termination rate used in the calculation of the gross premiums, or(b) For long-term care individual policies or group certificates issued on or after January 1, 2007, the contract reserve shall be established on the basis of:(i) Mortality (as specified in Appendix A); and(ii) Terminations other than mortality, where the terminations are not to exceed:(I) For policy year one, the lesser of 80% of the voluntary lapse rate used in the calculation of gross premiums and 6%;(II) For policy years two through four, the lesser of 80% of the voluntary lapse rate used in the calculation of gross premiums and 4%; and(III) For policy years five and later, the lesser of 100% of the voluntary lapse rate used in the calculation of gross premiums and 2%, except for group long-term care insurance as defined in 24-A M.R.S.A. §5072(3) where the 2% shall be 3%.(c) Where a morbidity standard specified in Appendix A is on an aggregate basis, such morbidity standard may be adjusted to reflect the effect of insurer underwriting by policy duration. The adjustments must be appropriate to the underwriting and be acceptable to the Superintendent.(4) Reserve Method. (a) For insurance except long-term care insurance or nursing home care insurance as defined in Title 24-A M.R.S.A., Sections5051 or 5072, and return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated on the two-year full preliminary term method; that is, under which the terminal reserve is zero at the first and also the second contract anniversary.(b) Prior to December 31, 1993, for long-term care insurance or nursing home care insurance as defined in Title 24-A M.R.S.A., Section5051, and for riders (or policy provisions) which only provide return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated on the two-year full preliminary term method.(c) Effective December 31, 1993, for long-term care insurance or nursing home care insurance as defined in Title 24-A M.R.S.A., Sections5051 or 5072, the minimum reserve is the reserve calculated on the one-year full preliminary term method.(d) Effective December 31, 1993, for riders (or policy provisions) which only provide return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated as follows: (i) On the one-year full preliminary term method if benefits are provided at any time before the rider's (or policy's) twentieth anniversary; and(ii) On the two-year preliminary term method if benefits are only provided on or after the rider's (or policy's) twentieth anniversary. The preliminary term method may be applied only in relation to the date of issue of a contract. Reserve adjustments introduced later, as a result of rate increases, revisions in assumptions (e.g., projected inflation rates), or for other reasons, are to be applied immediately as of the effective date of adoption of the adjusted basis.
(5) Negative Reserves. Negative reserves on any benefit may be offset against positive reserves for other benefits in the same contract, but the total contract reserve with respect to all benefits combined may not be less than zero.(6) Nonforfeiture Benefits for Long-Term Care Insurance. The contract reserve on a policy basis shall not be less than the net single premium for the nonforfeiture benefits at the appropriate policy duration, where the net single premium is computed according to the above specifications.C.Alternative Valuation Methods and Assumptions GenerallyProvided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified above; an insurer may use any reasonable assumptions as to interest rates, termination and/or mortality rates, and rates of morbidity or other contingency. Also, subject to the preceding condition, the insurer may employ methods other than the methods stated above in determining a sound value of its liabilities under such contracts, including, but not limited to the following: the net level premium method; the one-year full preliminary term method; prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses; the use of approximations such as those involving age groupings, groupings of several years of issue, average amounts of indemnity, grouping of similar contract forms; the computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregate contract reserves exclusive of the benefit or benefits so valued; and the use of a composite annual claim cost for all or any combination of the benefits included in the contracts valued.
D.Tests for Adequacy and Reasonableness of Contract ReservesAnnually, an appropriate review shall be made of the insurer's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves giving consideration to future gross premiums. The insurer shall make appropriate increments to the tabular reserves if such tests indicate that the basis of such reserves is no longer adequate; subject, however, to the minimum standards of Section 7(B).
In the event a company has a contract or a group of related similar contracts, for which future gross premiums will be restricted by contract, insurance department regulations, or for other reasons, such that the future gross premiums reduced by expenses for administration, commissions, and taxes will be insufficient to cover future claims, the company shall establish contract reserves for such shortfall in the aggregate.
02-031 C.M.R. ch. 130, § 7