date: 12/3/19 conference call · y, part 2 and schedule d, part 6, section 1 for reciprocal...

© 2019 National Association of Insurance Commissioners 1

Date: 12/3/19 Conference Call

BLANKS (E) WORKING GROUP

Tuesday, December 17, 2019 10:30 – 11:30 a.m. CT

ROLL CALL

Jake Garn, Chair Utah Patricia Gosselin New Hampshire Kim Hudson, Vice Chair California John Sirovetz New Jersey Jeffery Bethel Alaska Tracy Snow Ohio William Arfanis Connecticut Joel Sander Oklahoma Dave Lonchar Delaware Ryan Keeling Oregon N. Kevin Brown District of Columbia Joe DiMemmo Pennsylvania Carolyn Morgan Florida Trey Hancock Tennessee Roy Eft Indiana Shawn Frederick Texas Daniel Mathis Iowa Steve Drutz Washington Dan Schaefer Michigan Jamie Taylor West Virginia Debbie Doggett Missouri Randy Milquet Wisconsin Lindsay Crawford/Justin Schrader Nebraska NAIC Support Staff: Mary Caswell/Calvin Ferguson/Julie Gann

AGENDA

1 Consider Adoption of its Oct. 22 Meeting Minutes—Jake Garn (UT) Attachment A

2. Discuss Items Previously Exposed—Jake Garn (UT)

a) 2019-25BWG Modified – Modify the instructions for Column 10, Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement, removing instruction to exclude adjusting other reserves from the column. Add instructions to include those with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

Attachment B

b) 2019-26BWG Modified –Add instruction and crosscheck for Line 34 on the Analysis of

Operations by Lines of Business – Summary. Add instruction for Column 5 – Indexed Life on the Analysis of Operations by Lines of Business – Individual Life. Add clarifying instruction to the Analysis of Operations by Lines of Business for Individual Life and Group Life regarding reporting consistent with policy type language in the contract and reporting of policies issued with secondary guarantees that have expired.

Attachment C

c) 2019-27BWG – Remove the alphabetic index from inclusion at the back of the annual

statement blank, instructions and Blanks Working Group Web page.

Attachment D

3. Discuss Blanks Procedures Exposed—Jake Garn (UT) Attachment E 4. Consider Exposure of New Items—Jake Garn (UT)

a) 2019-28BWG – Modify the instruction for Supplemental Investment Risk Interrogatories Lines 13.02 through 13.11 clarifying when to identify the actual equity interests within a fund and aggregate those equity interests for determination of the ten largest equity interests.

Attachment F


g:\frs\data\blanks\national meeting\2019\dec 2019\12 17 2019 agenda.docx

b) 2019-29BWG – Modify the instruction and blank for Supplemental Investment Risk Interrogatories Question 14.01.

Attachment G

c) 2019-30BWG – Add a category and instructions for Reciprocal Jurisdiction Companies in

Schedule S for the life/fraternal and health blanks and to Schedule F for the property and title blanks. Add a list of identification numbers is instruction to Schedule Y, Part 1A, Schedule Y, Part 2 and Schedule D, Part 6, Section 1 for Reciprocal Jurisdiction Companies. Add a reference to Reciprocal Jurisdiction Companies in the Trusteed Surplus Statement instructions for life/fraternal, health and property statements.

Attachment H

5. Consider Adoption of Editorial Listing—Jake Garn (UT) Attachment I 6 Discuss Any Other Matters Brought Before the Working Group—Jake Garn (UT) 7. Adjournment The following documents are being provided as reference materials: Summary of Comment Letters Attachment J Comment Letters Attachment K

Attachment A


Draft: 10/30/19

Blanks (E) Working Group Conference Call October 22, 2019

The Blanks (E) Working Group of the Accounting Practices and Procedures (E) Task Force met via conference call Oct. 22, 2019. The following Working Group members participated: Jake Garn, Chair (UT); Kim Hudson, Vice Chair (CA); Michael Estabrook (CT); N. Kevin Brown (DC); Adrienne Lupo (DE); Carolyn Morgan, Jason Reynolds and Robert Ridenour (FL); Daniel Mathis (IA); Roy Eft (IN); Dan Schaefer (MI); Debbie Doggett (MO); Lindsay Crawford (NE); Patricia Gosselin (NH); Amal Mechaiel (NJ); Dale Bruggeman and Tracy Snow (OH); Joel Sander (OK); Greg Lathrop (OR); Joe DiMemmo (PA); Hui Wattanaskolpant (TN); Shawn Frederick (TX); Steve Drutz and Patrick McNaughton (WA); Randy Milquet (WI); and Justin Parr (WV). 1. Adopted its Sept. 5 and Aug. 20 Minutes The Working Group conducted an e-vote that concluded Sept. 5 to expose proposal 2019-24BWG, which requests the addition of a life experience data conduct to the electronic Jurat page for life/fraternal company filers only with an effective date for first quarter 2020. During its Aug. 20 meeting, the Working Group took the following action: 1) adopted its July 2 and June 24 minutes; 2) adopted items previously exposed; 3) discussed its procedures; 4) exposed three new items for public comment; and 5) adopted the editorial listing. Mr. Hudson made a motion, seconded by Mr. Drutz, to adopt the Working Group’s Sept. 5 (Attachment Two-A) and Aug. 20 (Attachment Two-B) minutes. The motion passed unanimously. 2. Adopted Items Previously Exposed

a. For Note 33, Modify the Illustrations to Disclosure Individually Separate Account with Guarantees Products and Separate Account Nonguaranteed Products (2019-21BWG) Effective 12/31/2020

Mr. Garn stated that this proposal breaks out the separate accounts disclosure and related illustration in Note 33 to show the Separate Account with Guarantees products and Separate Account Nonguaranteed products separately. He indicated that there were no interested party comments on this proposal. Ms. Crawford made a motion, seconded by Mr. Drutz, to adopt the proposal (Attachment Two-C). The motion passed unanimously.

b. Add a Question Regarding the Executive Summary of the PBR Actuarial Opinion to the Supplemental Exhibits and Schedules Interrogatories (2019-22BWG) Effective 12/31/2020

Jennifer Frasier (NAIC) stated that this proposal is sponsored by the Life Actuarial (A) Task Force, with an annual 2020 effective date. It adds a question to the Supplemental Exhibits and Schedules Interrogatories asking if the Executive Summary of the PBR Actuarial Report would be filed with the state of domicile by April 1. Mr. Hudson made a motion, seconded by Ms. Gosselin, to adopt the proposal (Attachment Two-D). The motion passed unanimously.

c. Modify the Instructions and Illustration for Note 8 – Derivatives for Disclosures Adopted by SSAP No. 108. Add Instructions and a Blanks Page for Schedule DB, Part E, to the Quarterly Statement (2019-23BWG) Effective 1/1/2020

Mr. Bruggeman stated that this proposal pertains to Statement of Statutory Accounting Principles (SSAP) No. 108—Derivatives Hedging Variable Annuity Guarantees. When the annual proposal was adopted in June with proposal 2019-14BWG, the quarterly disclosure was not included. At the Summer National Meeting, it was noted, and the interested parties agreed, that the intent of the Statutory Accounting Principles (E) Working Group change was to capture a quarterly disclosure as well. This agenda item, which was exposed in August, adds that quarterly 2020 disclosure. There was a minor column reference modification, which should be included as a friendly amendment. Mr. Bruggeman made a motion, seconded by Ms. Gosselin, to adopt the proposal, including the column reference modification as a friendly amendment (Attachment Two-E). The motion passed unanimously.

Attachment A


d. Add a Life Experience Data Contact to the Electronic Jurat Page for Life/Fraternal Companies Only. Health, Property and Title are Included in the Proposal Due to the Jurat Instructions Being Uniform for all Statement Types (2019-24BWG) Effective 1/1/2020

Ms. Frasier stated that the purpose of this proposal is that under the Standard Valuation Law (#820) and supporting Valuation Manual included in each state’s laws, the NAIC serves as the data collection agent for various studies of data (e.g., mortality experience data). NAIC staff need a contact person from each legal entity life insurance company to facilitate communication regarding these data studies and submission of the data to the NAIC. This company contact should be filed in the electronic-only Jurat and will not be included on the hard copy/portable document format (PDF) Jurat. Interested parties had no comments other than the timing of the request. Mr. Hudson made a motion, seconded by Mr. Milquet, to adopt the proposal (Attachment Two-F). The motion passed unanimously. 3. Exposed its Procedures Mr. Garn stated the there are several pending issues with regards to the Blanks (E) Working Group procedures. He stated that there has been discussion with the software vendors regarding the changes within the Blanks (E) Working Group procedures document. He stated that during the discussions, for the most part, the vendor software representatives were in favor of the changes. John Bauer (Prudential Financial) stated that while interested parties are in favor of the need for the procedure changes, they would like additional time to review the time frames. He indicated that interested parties would prefer to hold one in-person meeting at one of the NAIC national meetings and to incorporate that language within the procedures document. Connie Woodroof (Sapiens) indicated that while she agrees with the proposed time frames, she wants to encourage state insurance regulators and interested parties to have proposals and comments in early. This way, the proposals should be able to be processed within the given time frames and not have so many last-minute issues. She encouraged everyone to follow related working group and task force projects to be informed of possible impacts to the blanks and instructions. These issues could then be discussed during a Blanks (E) Working Group meeting to get a head start on the issues where possible. Ms. Caswell confirmed that approval had been obtained to allow the Blanks (E) Working Group time on the 2020 NAIC Spring National Meeting agenda. She also suggested a minor revision to the current edited version of the procedures. The “parent groups” should be defined to include groups above the Blanks (E) Working Group in the statutory hierarchy. This would include the Statutory Accounting Principles (E) Working Group. With the significant amount of changes from the previous exposure, Mr. Garn indicated that there should be another 30-day exposure period to receive comments. Mr. Drutz made a motion, seconded by Mr. Lathrop, to expose the procedures for a public comment period ending Nov. 22. The motion passed unanimously. 4. Exposed New Items

a. Modify the Instructions for Column 10, Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-Out Supplement, Removing Instructions to Exclude Adjusting Other Reserves from the Column. Add Instructions to Include Those with the Defense and Cost Containment Reserves. Add a New Instruction for Column 12 for the Same Schedules. Add Crosschecks to Schedule P, Part 1 (2019-25BWG)

Mr. Snow stated that this proposal modifies the instructions for column 10 in the Property Schedule F, Part 3, Ceded Reinsurance, and Schedule F Part 2 for the Workers’ Compensation Carve-out Supplement, Schedule F, Part 2 in the Life/Fraternal statement removing the “exclude” instructions for adjusting other reserves from that column. The proposal adds instructions to include the defense and cost containment reserves in column 10. It adds a new instruction for column 12 for each of those schedules for the “IBNR LAE Reserves” column to include defense and cost containment and adjusting and other expenses consistent with that reported in Schedule P, Part 1. Mr. Hudson made a motion, seconded by Ms. Crawford, to expose the proposal for a public comment period ending Nov. 22. The motion passed unanimously.

Attachment A


b. Add Instructions and Crosschecks for Line 34 on the Analysis of Operations by Lines of Business – Summary. Add Instructions for Column 5 – Indexed Life on the Analysis of Operations by Lines of Business – Individual Life. Add Clarifying Instructions to the Analysis of Operations by Lines of Business for Individual Life and Group Life Regarding Reporting Consistent with Policy Type Language in the Contract and Reporting of Policies Issued with Secondary Guarantees That Have Expired (2019-26BWG)

Ms. Crawford made a motion, seconded by Ms. Gosselin, to expose the proposal for a public comment period ending Nov. 22. The motion passed unanimously.

c. Remove the Alphabetic Index from Inclusion at the Back of the Annual Statement Blank, Instructions and Blanks (E) Working Group Web page (2019-27BWG)

Mr. Hudson stated that this proposal requests the removal of the alphabetic index from inclusion at the back of the annual statement blank, instructions and the Blanks (E) Working Group web page. Most people now either use the bookmarks in the PDF, the search features in the PDFs, or the table of contents in the front of the blank. Therefore, the alphabetical index is no longer needed. Mr. Hudson made a motion, seconded by Mr. Drutz, to expose the proposal for a public comment period ending Nov. 22. The motion passed unanimously. 5. Adopted the Editorial Listing Mr. Hudson made a motion, seconded by Mr. Milquet, to adopt the editorial listing (Attachment Two-G). The motion passed unanimously. 6. Reviewed the State Filing Checklists Mr. Garn asked the Working Group members and interested parties if there were any issues detected upon review of the State Filing Checklists. Receiving no comments, the members approved the checklists and directed NAIC staff to proceed with posting to the appropriate NAIC web page. 7. Approved Guidance Mr. Garn asked the Working Group members and interested parties if there were any issues identified with the Analysis of Operations by Lines of Business 2019 instructional clarification guidance document. Receiving no comments, the members approved the guidance document for posting to the Blanks (E) Working Group web page (Attachment Two-H). 8. Discussed Life/Fraternal Blank Statement Cover Bill Tank (Tank Consulting) asked for clarification as to whether the brown cover would still be used for the fraternal companies filing on the life blank or if they would instead use the blue cover. Ms. Caswell indicated that if both colors cannot appear on the cover, the blue cover should be used by the licensed life filers, and the brown cover should still be used by the licensed fraternal filers that are using the life blank. The reason for retaining the color system is for situations where a state law or regulation might refer to a particular blank color in place of the statement title. The NAIC uses both colors on its blanks and instructions publications.

Mr. Garn stated that this proposal adds instructions and crosschecks for line 34 on the Analysis of Operations by Lines of Business – Summary. It adds instructions for column 5, Indexed Life on the Analysis of Operations by Lines of Business for individual life. It adds clarifying instructions to the Analysis of Operations by Lines of Business for individual life and group life indicating that the reporting should be consistent with policy-type language in the contract and reporting of policies issued with secondary guarantees that have expired. He stated that this proposal is to be effective with the annual 2020 filing. There is a guidance document with this language being presented at this meeting, for posting to the NAIC web page to assist companies in reporting the annual 2019 filing.

Attachment A


9. Discussed Other Matters Mr. Garn asked the Working Group members and industry to be mindful of other groups’ work that might affect the annual or quarterly statement blank. As the members or interested parties become aware of potential impacts, those could be reviewed or discussed during future meetings. This could help members and industry prepare for expansive changes, participate in the process and allow more time for vetting of the issue. Having no further business, the Blanks (E) Working Group adjourned. w:\national meetings\2019\fall\tf\app\blankswg\minutes\10 blanks.docx

Attachment B

© 2019 National Association of Insurance Commissioners 2019-25BWG_Modified.doc 1

NAIC BLANKS (E) WORKING GROUP

Blanks Agenda Item Submission Form

DATE: 09/24/2019

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS: ON BEHALF OF:

NAME: Tracy Snow

TITLE: Chief, Captive Insurance

AFFILIATION: Ohio Department of Insurance

ADDRESS: 50 W Town St, 3rd Fl, Ste 300

Columbus, OH 43215

FOR NAIC USE ONLY Agenda Item # 2019-25BWG MOD Year 2020 Changes to Existing Reporting [ X ] New Reporting Requirement [ ]

REVIEWED FOR ACCOUNTING PRACTICES AND PROCEDURES IMPACT

No Impact [ X ] Modifies Required Disclosure [ ]

DISPOSITION [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ X ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)

BLANK(S) TO WHICH PROPOSAL APPLIES

[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)

Anticipated Effective Date: Annual 2020

IDENTIFICATION OF ITEM(S) TO CHANGE Modify the instruction for Column 10 (Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement) to remove instruction to exclude adjusting other reserves from the column and add instruction include along with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is ensure adjusting other and defense and cost containment reserves are reported properly as Known Case LAE Reserves or IBNR LAE Reserves.

NAIC STAFF COMMENTS Comment on Effective Reporting Date: Other Comments: ___________________________________________________________________________________________________ ** This section must be completed on all forms. Revised 7/18/2018

Attachment B


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY

SCHEDULE F – PART 3

CEDED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR

Detail Eliminated to Conserve Space

Column 9 – Known Case Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 2A, Line 35, Column 3.

Column 10 – Known Case LAE Reserves

Include: Defense and Cost Containment from Schedule P, Part 1, Columns 18

Adjusting and Other from Schedule P, Part 1, Column 22, in part

The sum of Schedule F, Part 3, Columns 10 and 12 should equal the sum of Schedule P, Part 1, Columns 18, 20 and 22.

Exclude: Adjusting & Other Expense Reserves.

Column 11 – IBNR Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 2A, Line 35, Column 7.

Column 12 – IBNR LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part Column 13 – Unearned Premiums

Total multiplied by 1000 should equal Page 3, Line 9 parenthetical amount.


Attachment B


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL

WORKERS’ COMPENSATION CARVE-OUT SUPPLEMENT



CEDED REINSURANCE


Column 9 – Known Case Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 4, Column 2. Column 10 – Known Case LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part

The sum of Schedule F, Part 2, Columns 10 and 12 should equal the sum of Schedule P, Part 1, Columns 18, 20 and 22.

Exclude: Adjusting and other Expense reserves.

Column 11 – IBNR Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 4, Column 5. Column 12 – IBNR LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part Column 14 – Contingent Commissions

Include: Contingent commissions receivable from a reinsurer. Regular commissions should be netted with ceded balances payable in Column 16.


W:\QA\BlanksProposals\2019-25BWG_Modified.doc

Attachment B


This page intentionally left blank.

Attachment C




DATE: 10/02/2019

CONTACT PERSON:

TELEPHONE:


NAME: Justin C. Schrader

TITLE: Chair, Liquidity Assessment (EX) Subgroup

AFFILIATION:

ADDRESS:

FOR NAIC USE ONLY Agenda Item # 2019-26BWG MOD Year 2020 Changes to Existing Reporting [ X ] New Reporting Requirement [ ]


No Impact [ ] Modifies Required Disclosure [ ]



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)


IDENTIFICATION OF ITEM(S) TO CHANGE Add instruction and crosscheck for Line 34 on the Analysis of Operations by Lines of Business – Summary. Add instruction for Column 5 – Indexed Life on the Analysis of Operations by Lines of Business – Individual Life. Add clarifying instruction to the Analysis of Operations by Lines of Business for Individual Life and Group Life regarding reporting consistent with policy type language in the contract and reporting of policies issued with secondary guarantees that have expired.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** Add clarifying instructions to address questions that have come up regarding reporting on the new Analysis of Operations by Lines of Business pages.


Attachment C



ANALYSIS OF OPERATIONS BY LINES OF BUSINESS – SUMMARY


Column 9 – YRT Mortality Risk Only

The lines in this column should equal the Analysis of Operations by Lines of Business – Individual Life Column 12 plus Analysis of Operations by Lines of Business – Group Life Column 9.

Line 34 – Policies/Certificates in Force End of Year

The number provided should be count of direct written policies/certificates in force at the end of the year.

The sum of Columns 2, and 3, 4 and 5 should equal Line 23, Column 9 of Life Insurance (state page).

The sum of Columns 4 and 5 should equal the Exhibit of Number of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities, Accident and Health and Other Policies Line 9 (Column 1 plus Column 3 for the Supplementary Contracts section) plus Line 9 (sum of Columns 1 through 4 for the Annuities section)

Column 6 should equal sum of Column 1, Column 3 and Column 5, Line 10 – Line 3 + Line 8 of the Exhibit of Number of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities, Accident and Health and Other Policies in the Accident and Health Insurance section.

Attachment C


ANALYSIS OF OPERATIONS BY LINES OF BUSINESS – INDIVIDUAL LIFE INSURANCE This exhibit shows Lines 1 through 33 of the Summary of Operations by Line of Business, in part. Reporting for the columns of this schedule should be consistent with the policy type language per the product contract. Policies where the product was issued with secondary guarantees, but those secondary guarantees have since expired should be reported consistent with how the policy was issued (i.e., still report product as one with secondary guarantees). For definitions of lines of business, see the appendix of these instructions. A company shall not omit the columns for any lines of business in which it is not engaged.


Column 1 – Total

The lines in this column are to agree with Page 4, Column 1, in part. Column 5 – Indexed Life

Include: Indexed universal life with secondary guarantees. Column 10 – Credit Life

Include: Business not exceeding 120 months.

This column are not applicable to Fraternal Benefit Societies. Column 11 – Other Individual Life

Include: All individual life insurance not included in columns 2 through 10. Column 12 – YRT Mortality Risk Only

This column should only be completed for assumed and retained (net) yearly-renewable-term reinsurance business where the only risk included is mortality.

If a company reports YRT assumed business in Columns 2 through 11, then that business should not be reported in column 12.


Attachment C


ANALYSIS OF OPERATIONS BY LINES OF BUSINESS – GROUP LIFE INSURANCE This exhibit shows Lines 1 through 33 of the Summary of Operations by Line of Business, in part. Reporting for the columns of this schedule should be consistent with the policy type language per the product contract. Policies where the product was issued with secondary guarantees, but those secondary guarantees have since expired should be reported consistent with how the policy was issued (i.e., still report product as one with secondary guarantees). For definitions of lines of business, see the appendix of these instructions. A company shall not omit the columns for any lines of business in which it is not engaged.


W:\QA\BlanksProposals\2019-26BWG_Modified.doc

Attachment D

© 2019 National Association of Insurance Commissioners 2019-27BWG.doc 1



DATE: 10/03/2019

CONTACT PERSON:

TELEPHONE:


NAME: Kim Hudson

TITLE:

AFFILIATION: California Department of Insurance

ADDRESS: 300 South Spring St.

Los Angeles, CA 90013

FOR NAIC USE ONLY Agenda Item # 2019-27BWG Year 2020 Changes to Existing Reporting [ X ] New Reporting Requirement [ ]





[ X ] ANNUAL STATEMENT [ ] QUARTERLY STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ X ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ X ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)


IDENTIFICATION OF ITEM(S) TO CHANGE Remove the alphabetic index from inclusion at the back of the annual statement blank, instructions and Blanks Working Group Web page.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** When the index was added back to being included in the hard copy of the annual statement states were still primarily using hard copies of the statement and the index make finding pages in the statement easier. Now the PDF copies of the statement are primarily used and are book marked, inclusion of the index in the statement is no longer needed.


Attachment D


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

INSTRUCTIONS


INDEX

The annual statement shall contain an alphabetized index on the last page of the hardcopy statement, which references the title and page number of all of the pages that are required to be included in that filing. The NAIC shall maintain, and place on its Website at www.naic.org/cmte_e_app_blanks.htm, the alphabetized index for all statement types that is required to be included in the hardcopy of the statement. The above is only required on the March 1 filing, and specifically excludes any supplements.

GENERAL


ANNUAL STATEMENT INSTRUCTIONS – SEPARATE ACCOUNTS

INSTRUCTIONS

FOR COMPLETING SEPARATE ACCOUNTS ANNUAL STATEMENT BLANK

INDEX

The annual statement shall contain an alphabetized index on the last page of the hard copy statement which references the title and page number of all of the pages that are required to be included in that filing. The NAIC shall maintain, and place on its Website at www.naic.org/cmte_e_app_blanks.htm, the alphabetized index for all statement types that is required to be included in the hard copy of the statement. The above is only required on the March 1 filing, and specifically excludes any supplements.

GENERAL


ANNUAL STATEMENT INSTRUCTIONS –PROTECTED CELL

INSTRUCTIONS

For Completing Protected Cell Annual Statement Blank

INDEX

The annual statement shall contain an alphabetized index on the last page of the hard copy statement which references the title and page number of all of the pages that are required to be included in that filing. The NAIC shall maintain, and place on its Website at www.naic.org/cmte_e_app_blanks.htm, the alphabetized index for all statement types that is required to be included in the hard copy of the statement. The above is only required on the March 1 filing, and specifically excludes any supplements.


W:\QA\BlanksProposals\Proposals In Progress\Alphbetic Index\Remove_Alphebetic_Index_Proposal.doc

Attachment E

© 2019 National Association of Insurance Commissioners 1 Rev. 10-2019

PROCEDURES OF THE FINANCIAL CONDITION (E) COMMITTEE BLANKS WORKING GROUP IN CONNECTION WITH PROPOSED AMENDMENTS TO

ANNUAL AND QUARTERLY STATEMENT BLANKS AND INSTRUCTIONS The following establishes procedures and rules of the Financial Condition (E) Committee Blanks Working Group (Blanks (E) Working Group) with respect to proposed amendments to the annual and quarterly statement blanks and instructions. 1. The Blanks (E) Working Group may consider relevant proposals to change the NAIC annual and/or quarterly financial

statement blanks and instructions at any meeting/conference call as scheduled by the Working Group. 2. Suggested changes and amendments filed with the NAIC Central Office shall be considered at the next regularly

scheduled meeting of the Blanks (E) Working Group if the proposal is filed at least thirty days prior to the meeting. Items filed less than thirty days prior to a regularly scheduled meeting will be considered at the following regularly scheduled meeting.

3. All proposals shall be stated in a concise and complete form. The submission form and instructions are available online

at https://naic.org/documents/committees_e_app_blanks_blanksagenda_formdoc.doc. An illustration of the format of exhibits or schedules should accompany the submission form. In addition, if another NAIC committee, task force or working group is known to have considered this proposal, that committee, task force or working group should provide any relevant information.

4. The Blanks (E) Working Group will hold meetings/conference calls as needed in order to meet scheduled deadlines (e.g.,

publications and distribution of blanks, instructions, specs., etc.). 5. The proposals should comply with the following time guidelines:

Quarterly proposals: Any proposal that affects a quarterly statement must be effective at the beginning of the year. It must be submitted to the Blanks (E) Working Group staff no later than July 1st of the preceding year, properly proofed, including sponsorship, and exposed no later than July 15th by email or conference call upon approval by the Working Group Chair. Once exposure has occurred, the proposal(s) will be posted to the Blanks (E) Working Group web page referencing comment deadlines, and an email notification will be sent to the Working Group members, interested regulators and interested parties on the NAIC contact list for the Blanks (E) Working Group. Any quarterly proposal must be adopted by August 31st.

Annual proposals: Changes that only affect the annual statement can be submitted at any time and will be addressed at the next scheduled meeting. Those that must be adopted for the current reporting year must be submitted to the Blanks (E) Working Group staff no later than April 1st of the current year (e.g., April 1, 2020, for an annual 2020 change), properly proofed, including sponsorship, and exposed no later than April 15th of the current year by email or conference call upon approval by the Working Group Chair. Following proper exposure, the proposal(s) will be posted to the Blanks (E) Working Group web page referencing comment deadlines. Proposals with an annual effective date of the current year must be adopted no later than June 1st of the current year. Subsequent requests by parent groups of the Blanks (E) Working Group: Proposals presented by a parent group (defined as a group above of the Blanks (E) Working Group in the statutory hierarchy) after the deadlines noted above will be processed as directed by the parent group. Any proposal which includes data capture elements will be evaluated individually as to whether the data capture may be accommodated in that year. Data capture elements received after June 15th of the year of the change (change effective with annual data capture elements statement 2020) will not have vendor crosschecks run until the following year.

Proposals sponsored by other working groups, task forces and subgroups, should have been well vetted at the group level. The Blanks (E) Working Group exposure comment period will be agreed upon by the members as needed to meet the needs of the issue being addressed. Changes that do not conform to the time guidelines above are limited to: (a) disclosures required in the current year by the Accounting Practices and Procedures Manual and (b) those items providing instructional clarification of current reporting requirements. These proposals will modify the instructions only, including Notes to Financial Statements, and will not be data captured. If the proposal is to add a Note to Financial Statements that should be data captured, the Note

Attachment E

© 2019 National Association of Insurance Commissioners 2 Rev. 10-2019

may be added to the instructions in the current year and data captured the first subsequent year-end. The disclosure will not be data captured on a quarterly basis until the first subsequent year end. Any new Note will be added as the last Note to avoid renumbering existing Notes. If necessary, the Note will be renumbered at the first subsequent year-end. If a Note is deleted, the remaining Notes will not be renumbered in the current year but will be renumbered at the first subsequent year-end.

Once proposals are exposed, a meeting/conference call will be scheduled where the Blanks (E) Working Group will review the proposal and determine whether to 1) adopt the proposal 2) reject the proposal, or 3) defer/refer the proposal. The Blanks (E) Working Group will limit the number of deferrals to “two” based upon the belief the proposal should be revised and resubmitted if it requires further work or input after two meetings At the third meeting, the proposal cannot be deferred again and must be otherwise acted upon. The Blanks (E) Working Group may also refer proposals to other NAIC groups due to their technical expertise or for other review. If a proposal has been referred to another NAIC group, the proposal will come off the Working Group’s agenda and will only be considered again in the form of a new proposal.

6. The NAIC Central Office shall prepare an agenda of all suggestions. One copy of the meeting materials including the

agenda shall be sent to each member of the Blanks (E) Working Group or his/her representative, via email PDF at least 2 business days prior to the next scheduled meeting.

7. The agenda shall be divided into two sections. NAIC staff will complete the initial classification of the submissions into

one of the two sections prior to exposure of the agenda. The criteria for classification into one of the two sections are as follows:

a. ITEMS PREVIOUSLY EXPOSED - The first section of the agenda will be limited to items that the Blanks (E)

Working Group received for public comment at its prior meeting. b. NEW ITEMS - The second section of the agenda will be limited to new items. 8. At each meeting, the Blanks (E) Working Group shall not hold any discussions on any substantive item in the agenda

under the Items Previously Exposed until (1) the chair or proposal sponsor has briefly stated the agenda item and (2) the chair has called for a motion from the members. If a motion is made and seconded, the item is then discussed and voted upon. A motion is not required for the exposure of New Items. Per NAIC procedures, the Working Group Chair should ask if there are any objections to exposing.

9. NAIC staff will present to the Blanks (E) Working Group a list of necessary non-substantive changes discovered in the

process of implementing proposals., e.g., reference changes due to new SSAPs or required changes discovered in the process of implementing proposals. The Working Group will review these changes and may adopt the appropriate items at any regularly scheduled meeting. Such actions will be documented in the minutes of the Working Group. NAIC staff may also request that the Working Group reconsider items adopted, if these items contain substantial errors.

10. The Blanks (E) Working Group may, when deemed necessary, appoint an Ad Hoc Group to study and propose resolution

of certain issues.

Attachment E

© 2015 2019 National Association of Insurance Commissioners 1 Rev. 810-20152019

PROCEDURES OF THE FINANCIAL CONDITION (E) COMMITTEE BLANKS WORKING GROUP IN CONNECTION WITH PROPOSED AMENDMENTS TO

ANNUAL AND QUARTERLY STATEMENT BLANKS AND INSTRUCTIONS The following establishes procedures and rules of the Financial Condition (E) Committee Blanks Working Group (Blanks (E) Working Group) with respect to proposed amendments to the annual and quarterly statement blanks and instructions. 1. The Blanks (E) Working Group may consider relevant proposals to change the NAIC annual and/or quarterly financial

statement blanks and instructions at any interim or national meeting/conference call as scheduled by the Working Group. 2. Suggested changes and amendments filed with the NAIC Executive HeadquartersCentral Office shall be considered at

the next regularly scheduled meeting of the Blanks (E) Working Group if the proposal is filed at least thirty days prior to the meeting. Items filed less than thirty days prior to a regularly scheduled meeting will be considered at the following regularly scheduled meeting. In rare circumstances, suggested changes and amendments can be considered as an exception to the above stated process and timeframe based on a super majority (two-thirds) consent of the Working Group members present.

3. All proposals shall be stated in a concise and complete form. The submission form and instructions are available online

at https://naic.org/documents/committees_e_app_blanks_blanksagenda_formdoc.doc.http://www.naic.org/documents/committees_e_app_blanks.htm BlanksAgenda_Form.doc. An illustration of the format of exhibits or schedules should accompany the submission form. In addition, if another NAIC committee, task force or working group is known to have considered this proposal, that committee, task force or working group should provide any relevant information.

4. The following time guidelines apply:

The Blanks (E) Working Group will meet four times per year. Three of the meetings will be held during the NAIC Spring, Summer and Fall National Meeting, and one will be held hold meetingsby /conference calls, tentatively scheduled in for March, June, August and November as needed in order to meet scheduled contractualdeadlines (e.g., publications and distribution of blanks, instructions, specs., etc.). of each year. Other conference calls may be held as deemed necessary by the Working Group.

5. The proposals should comply with the following time guidelines:

Quarterly proposals: Any proposal that affects a quarterly statement must be effective at the beginning of the year. It must be submitted to the Blanks (E) Working Group staff no later than July 1st of the preceding year, properly proofed, including sponsorship, and exposed no later than July 15th by email or conference call upon approval by the Working Group Chair. Once exposure has occurred procedures, the proposal(s) will be posted to the Blanks (E) Working Group web page referencing comment deadlines, and an email notification will be sent to the Working Group members, interested regulators and interested parties on the NAIC contact list for the Blanks (E) Working Group. and Aany quarterly proposal must be adopted by August 31st no later than the the NAIC Summer National MeetingAugust interim meeting of the preceding year to be scheduled on the first available date within the week prior to the Labor Day holiday. conference call for changes effective the following year (change effective 1st quarter 2016 2020 must be adopted no later than the 2015 Summer National Meeting2019 August conference call). To meet this requirement, quarterly proposals must be filed at least thirty days prior to the June conference call.

Annual proposals: Changes that only affect the annual statement can be submitted at any time and will be addressed at the next scheduled meeting. Those that must be adopted for the current reporting year must be submitted to the Blanks (E) Working Group staff no later than April 1st of the current year (e.g., April 1,st 2020, for an annual 2020 change), properly proofed, including sponsorship, and exposed no later than April 15th of the current year by email or conference call upon approval by the Working Group Chair. Following proper exposure, the proposal(s) wouldwill be posted to the Blanks (E) Working Group web page referencing comment deadlines. Proposals with an annual effective date of the current year must be adopted no later than June 1st of the current year .the scheduled May call, to be the first available date during the week prior to the Memorial Day holiday.

Attachment E


Subsequent requests by Pparent Ggroups of the Blanks (E) Working Group: Proposals presented by a parent group (defined as a group above of the Blanks (E) Working Group in the statutory hierarchy), after the deadlines noted above will be processed as directed by the parent group. Any proposal which includes data capture elements will be evaluated individually as to whether the data capture may be accommodated in that year. Data capture elements received after June 15th of in the year of the change (change effective with annual data capture elements statement 201620) will not have vendor crosschecks run until the following year. must be adopted no later than June 201620). To meet this requirement, annual proposals must be filed no later than 30 days prior to the NAIC Spring National MeetingMarch conference call.

The pProposals sponsored by other working groups, task forces and subgroups, should have been well vetted at the group level. The Blanks (E) Working Group exposure comment period will be agreed upon by the members as needed to meet the needs of the issue being addressed. Changes that do not conform to the time guidelines above are limited to: (a) disclosures required in the current year by the Accounting Practices and Procedures Manual and (b) those items providing instructional clarification of current reporting requirements. These proposals will modify the instructions only, including Notes to Financial Statements, and will not be data captured. If the proposal is to add a Note to Financial Statements that should be data captured, the Note may be added to the instructions in the current year and data captured the first subsequent year-end. The disclosure will not be data captured on a quarterly basis until the first subsequent year end. Any new Note will be added as the last Note to avoid renumbering existing Notes. If necessary, the Note will be renumbered at the first subsequent year-end. If a Note is deleted, the remaining Notes will not be renumbered in the current year but will be renumbered at the first subsequent year-end.

Once proposals are exposed, Upon receipt of a proposal 30 days prior to a meeting/conference call will be a scheduled meeting, where the Blanks (E) Working Group will review the proposal at the next scheduled meeting and determine whether to 1) adopt receive the proposal for public comment or 2) reject the proposal, or 3) defer/refer the proposal. The public comment period ends 30 days prior to the next designated national or interim meeting of the Working Group. The Working Group will consider comments received on each proposal at its next meeting and take action. Proposals under consideration may be deferred by the Working Group until the following scheduled meeting. However, Tthe Blanks (E) Working Group will limit the number of deferrals to “two” based upon the belief the proposal should be revised and resubmitted if it required requires further work or input after two meetings At the third meeting, the proposal cannot be deferred again and must be otherwise acted upon. The Blanks (E) Working Group may also refer proposals to other NAIC groups due to their technical expertise or for other review. If a proposal has been referred to another NAIC group, the proposal will come off the Working Group’s agenda and will only be considered again in the form of a new proposal.

46. The NAIC Executive HeadquartersCentral Office shall prepare an agenda of all suggestions. One copy of the meeting

materials including the agenda shall be sent to each member of the Blanks (E) Working Group or his/her representative, via email PDF at least 2 business days two weeks prior to the next regularly scheduled meeting.




Working Group received for public comment at its prior meeting. b. NEW ITEMS - The second section of the agenda will be limited to new items. 8. At each meeting, the Blanks (E) Working Group shall not hold any discussions on any substantive item in the agenda

under the Items Previously Exposed until (1) the chair or proposal sponsor has briefly stated the agenda item and (2) the chair has called for a motion from the members. If a motion is made and seconded, the item is then discussed and voted upon. A motion is not required for the exposure of New Items. Per NAIC procedures, the Working Group Chair should ask if there are any objections to exposing.

69. NAIC Staff staff will present to the Blanks (E) Working Group a list of necessary non-substantive changes discovered in

the process of implementing proposals., e.g., reference changes due to new SSAP’s or required changes discovered in the

Attachment E


process of implementing proposals. The Working Group will review these changes and may adopt the appropriate items at any regularly scheduled meeting. Such actions will be documented in the minutes of the Working Group. NAIC staff may also request that the Working Group reconsider items adopted, if these items contain substantial errors.


of certain issues. 811. The NAIC Executive HeadquartersCentral Office will publish each agenda approximately two weeks prior to each

interim or national meeting (including proposals received for comment and comments received) on the NAIC Web site. 912. The NAIC Executive HeadquartersCentral Office will publish the Blanks and Annual Statement Instructions for the next

subsequent year on, or about November 1 each year. NAIC Staff will post to the NAIC Web site any subsequent corrections to these publications

Attachment E

4


Attachment F




DATE: 11/12/2019

CONTACT PERSON:

TELEPHONE:


NAME: Dale Bruggeman

TITLE: Chair SAPWG


ADDRESS: 50W. Town St., 3rd Fl., Ste. 300

Columbus, OH 43215




DISPOSITION [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)


[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)


IDENTIFICATION OF ITEM(S) TO CHANGE Modify the instruction for Supplemental Investment Risk Interrogatories Lines 13.02 through 13.11 clarifying when to identify the actual equity interests within a fund and aggregate those equity interests for determination of the ten largest equity interests.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is to clarify when reporting entities are required to identify actual equity interests within a fund and aggregate those equity interests to determine their ten largest equity interests.


Attachment F



SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES


Line 13.02 through 13.11 – Report the amounts and percentages of admitted assets held in the ten largest equity interests

(including equity funds that qualify individually as one of the largest equity interests and a look-through of investments in the shares of non-diversified mutual funds and ETFs, preferred stocks, publicly traded equity securities, and other equity securities (including Schedule BA equity interests), and excluding money market and bond mutual funds listed in Part Six, Sections 2(f) and (g) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office as exempt or NAIC 1). Equity interests in all funds that are diversified in accordance with the Investment Company Act of 1940 do not need to be individually assessed and aggregated to determine the ten largest equity interests. For funds that are not diversified within the meaning of the Investment Company Act of 1940, insurance reporting entities are required to identify actual equity interests within the fund and aggregate those equity interests to determine their ten largest equity interests.

Determine the ten largest equity interests by first aggregating investments included in this line by issuer. For example, the reporting entity owns preferred stock of the XYZ Company of $600,000, and common stock of the XYZ Company of $300,000 and $50,000 of XYZ identified through a look-through of a non-diversified stock closed-end fund reported on Schedule D-2-2. The total is $9500,000 ($600,000+$300,000+50,000). The reporting entity also owns bonds issued by the XYZ Company of $500,000 that are excluded from this calculation because bonds are debt instruments. The reporting entity may also have exposure to equity interests in XYZ through mutual funds that are excluded from this calculation as the funds are diversified within the meaning of the Investment Company Act of 1940. Other equity securities include partnerships and Limited Liability Companies (LLC) and any other investments reported in Schedule BA classified as equity.

The following funds shall also be excluded from aggregation as equity interests: SVO-Identified U.S. Direct Obligations / Full Faith And Credit Exempt List of Money Market Mutual Funds, SVO-Identified Bond ETFs, SVO-Identified Bond Mutual Funds and SVO Identified fund investments with underlying characteristics of fixed-income instruments, which do not contain underlying equities and that are outlined within the Purposes and Procedures Manual of the NAIC Investment Analysis Office.


W:\QA\BlanksProposals\2019-28BWG.doc

Attachment G




DATE: 11/12/2019

CONTACT PERSON:

TELEPHONE:


NAME: Dale Bruggeman

TITLE: Chair SAPWG


ADDRESS: 50W. Town St., 3rd Fl., Ste. 300

Columbus, OH 43215






[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)


IDENTIFICATION OF ITEM(S) TO CHANGE Modify the instruction and blank for Supplemental Investment Risk Interrogatories Question 14.01.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is to clarify that Interrogatories 14.06 through 14.15 are to be completed regardless of the answer to Supplemental Investment Risk Interrogatories Question 14.01.


Attachment G



SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES


Line 14.06 through 14.15 – These lines should be completed even if the answer to Question 14.01 is “YES.”

Report the investments held in the ten largest fund managers, with allocation between funds that are diversified or non-diversified in accordance with the meaning of the Investment Company Act of 1940. This should include all “funds” regardless of the type of fund (private placement, mutual fund, exchange-traded fund, closed-end fund, money market mutual fund, etc), reporting schedule or underlying investments captured in a fund.


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES For The Year Ended December 31, 2019

(To Be Filed by April 1)


14. Amounts and percentages of the reporting entity’s total admitted assets held in nonaffiliated, privately placed equities:

14.01 Are assets held in nonaffiliated, privately placed equities less than 2.5% of the reporting entity’s total admitted assets?

Yes [ ] No [ ]

If response to 14.01 above is yes, responses are not required for 14.02 through 14.05 the remainder of Interrogatory 14.



Attachment H




DATE: 11/14/2019

CONTACT PERSON: Jake Stultz

TELEPHONE: 816-783-8481

EMAIL ADDRESS: [email protected] ON BEHALF OF:

NAME: Chlora Lindley-Myers

TITLE: Chair, Reinsurance (E) Task Force

AFFILIATION:

ADDRESS:






[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ X ] Health (Life Supplement)


IDENTIFICATION OF ITEM(S) TO CHANGE See next page for details.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** See next page for details


Attachment H


REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE

On June 25, 2019, NAIC Executive (EX) Committee and Plenary adopted revisions to the Credit for Reinsurance Model Law (#785) and the Credit for Reinsurance Model Regulation (#786) to incorporate the relevant provisions from the “Bilateral Agreement Between the United States of America and the European Union on Prudential Measures Regarding Insurance and Reinsurance” (Covered Agreement). Under the revisions, credit for reinsurance is allowed for domestic ceding insurers for reinsurance that has been ceded to reinsurers from Reciprocal Jurisdictions, and that those reinsurers are not required to post collateral. As a result, it is necessary to consider revisions to the appropriate reinsurance schedules and instructions in order to collect the relevant information with respect to these reinsurance transactions.

IDENTIFICATION OF ITEM(S) TO CHANGE

Annual Statement Instructions

Life/Fraternal and Health

Schedule S General Instructions

Modify instructions to include section on numbers for Reciprocal Jurisdiction Companies.

Modify note on applying Reciprocal Jurisdiction.

Add Reciprocal Jurisdiction to the instruction for determining status.

Reference in certified reinsurer number paragraph.

Schedule S, Part 1, Section 1

Add Reciprocal Jurisdiction to list of type of reinsurers for Column 2.



Schedule S, Part 2



Add category lines for Reciprocal Jurisdiction Companies.





Schedule S, Part 4


Schedule S, Part 5


Life/Fraternal

Workers’ Compensation Cave-out Supplement

Schedule F General Instructions





Schedule F, Part 1


Attachment H


Schedule F, Part 2


Supplemental term and Universal Life Insurance Reinsurance Exhibit

Part 1


Part 2A


Part 2B


Trusteed Surplus Statement

Add instructions for Line 4.4 Reciprocal Jurisdiction Companies

Property






Schedule F, Part 1


Schedule F, Part 2


Schedule F, Part 3



Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 28 through 36.

Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 71 and 72.

Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 73 and 74.

Supplemental Schedule for Reinsurance Counterparty Reporting Acceptations – Asbestos and Pollution Contracts


Add Reciprocal Jurisdiction to list of type of reinsurers for Columns 1 and 5.

Notes to Financial Statement 23F(1)f

Add section to illustration for Reciprocal Jurisdiction Companies



Attachment H


Title






Schedule F, Part 1


Schedule F, Part 2



Schedule F, Part 3


Schedule F, Part 4


Operations and Investments Exhibit – Part 2B

For Line 2 remove the references to authorized, unauthorized and certified. Line is for all types of reinsurers sot specifying is not needed.

Notes to Financial Statement 23F(1)f

Add section to illustration for Reciprocal Jurisdiction Companies

Life/Fraternal, Health, Property, Title

Schedule Y, Part 1A

Add Reciprocal Jurisdiction to the list of ID numbers provided in Column 4

Schedule Y, Part 2


Schedule D, Part 6, Section 1


Quarterly Statement Instructions




Property



Attachment H



Schedule S


Modify instructions to include section on numbers for Reciprocal Jurisdiction Companies

Property and Title

Schedule F



Life/Fraternal, Health, Property, Title

Schedule Y, Part 1A

Add Reciprocal Jurisdiction to the list of ID numbers provided in Column 4.

Annual Statement Blank

Property

Schedule F, Part 3

Add the word Reciprocal Jurisdiction to the column descriptions for Columns 73, 74, and 75.

Title

Operations and Investments Exhibit – Part 2B

For Line 2 remove the references to authorized, unauthorized and certified. Line is for all types of reinsurers sot specifying is not needed.

Life/Fraternal and Property


Add Line 7.4 for Reciprocal Jurisdiction Companies

Quarterly Statement Blank

Life/Fraternal and Property


Add Line 7.4 for Reciprocal Jurisdiction Companies

Attachment H


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL AND HEALTH (INCLUDES HEALTH LIFE SUPPLEMENT)

SCHEDULE S – REINSURANCE These parts (except Part 1, which shows reinsurance assumed) provide an analysis by reinsurance carrier of reinsurance ceded data shown in total in various parts of the statement. Information is included on all reinsurance ceded to other entities authorized as well as unauthorized or certified in the state of domicile of the reporting entity. Additional data for unauthorized companies is displayed in Part 4; additional data for certified reinsurers is displayed in Part 5. NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal Jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule S. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for Reciprocal Jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Effective date as used in this schedule is the date the contract originally went into effect.


Index to Schedule S

Part 1, Section 1 – Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits

Part 1, Section 2 – Reinsurance Assumed Accident and Health Insurance

Part 2 – Reinsurance Recoverable on Paid and Unpaid Losses

Part 3, Section 1 – Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits

Part 3, Section 2 – Reinsurance Ceded Accident and Health Insurance

Part 4 – Reinsurance Ceded to Unauthorized Companies

Part 5 – Reinsurance Ceded to Certified Reinsurers

Part 6 – Five-Year Exhibit of Reinsurance Ceded Business

Part 7 – Restatement of Balance Sheet to Identify Net Credit for Ceded Reinsurance ID Number

Most parts of Schedule S require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not to be listed, because Schedule S is intended to identify the risk-bearing entities. A ceding insurer can have unauthorized reinsurance, certified reinsurance and Reciprocal Jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report

Attachment H


all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for Reciprocal Jurisdiction reinsurance.

Use of Federal Employer Identification Number

The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “ID Number” for other alien insurers even if the federal government has issued such a number.

Alien Insurer Identification Number (AIIN)

In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule S instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.

Newly assigned numbers are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC also provides this information to annual statement software vendors for incorporation into the software.

Pool and Association Numbers

In order to report transactions involving non-risk bearing pools or associations consisting of nonaffiliated companies correctly, the company must include on Schedule S the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Certified Reinsurer Identification Number (CRIN)

In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule S instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Reciprocal Jurisdiction Reinsurer Identification Number (RJIN)

In order to report transactions involving Reciprocal Jurisdiction reinsurers correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN, AIIN or CRIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.

Attachment H



NAIC Company Code

Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the “Pool and Association Numbers” section above for details on assignment of Pool/Association Identification Numbers. Risk-bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk-bearing entity (e.g., risk-bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Determination of Authorized Status

The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule S shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment H


SCHEDULE S PART 1 – SECTION 1

REINSURANCE ASSUMED LIFE INSURANCE, ANNUITIES, DEPOSIT FUNDS AND OTHER LIABILITIES WITHOUT LIFE OR DISABILITY CONTINGENCIES, AND RELATED BENEFITS LISTED BY REINSURED

COMPANY AS OF DECEMBER 31, CURRENT YEAR

This section should include data on all reinsurance assumed for life insurance, annuities, deposit fund and other liabilities without life or disability contingencies, and related benefits by reinsured company as of December 31, current year.


Column 2 – ID Number

Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) Certified Reinsurer Identification Number (CRIN) Pool/Association Identification Number


SCHEDULE S PART 1 – SECTION 2

REINSURANCE ASSUMED ACCIDENT AND HEALTH INSURANCE LISTED BY REINSURED COMPANY AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number:






Attachment H


SCHEDULE S PART 2

REINSURANCE RECOVERABLE ON PAID AND UNPAID LOSSES LISTED BY REINSURING COMPANY AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number:






Attachment H


SCHEDULE S PART 3 SECTION 1

REINSURANCE CEDED LIFE INSURANCE, ANNUITIES, DEPOSIT FUNDS AND OTHER LIABILITIES WITHOUT LIFE OR DISABILITY CONTINGENCIES, AND RELATED BENEFITS LISTED BY REINSURING

COMPANY AS OF DECEMBER 31, CURRENT YEAR NOTE: This schedule is to include Exhibit 7 cessions. Include actual reinsurance ceded on group cases but exclude

jointly underwritten group contracts. If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number: Group or Category Line Number General Account

Authorized

Affiliates

U.S.

Captive ................................................................................................................ 0199999 Other .................................................................................................................. 0299999 Total .................................................................................................................... 0399999

Non-U.S.


Total Authorized Affiliates ................................................................................................ 0799999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 0899999 Non-U.S. Non-Affiliates .................................................................................................... 0999999 Total Authorized Non-Affiliates ........................................................................................ 1099999

Total General Account Authorized .................................................................................................. 1199999

Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates ............................................................................................ 1899999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 1999999 Non-U.S. Non-Affiliates .................................................................................................... 2099999 Total Unauthorized Non-Affiliates .................................................................................... 2199999

Total General Account Unauthorized ............................................................................................... 2299999

Attachment H


Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates .................................................................................................... 2999999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 3099999 Non-U.S. Non-Affiliates .................................................................................................... 3199999 Total Certified Non-Affiliates ............................................................................................ 3299999

Total General Account Certified .................................................................................................................... 3399999

Reciprocal Jurisdiction

Affiliates

U.S.


Non-U.S.


Total Reciprocal Jurisdiction Affiliates ............................................................................. 4099999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 4199999 Non-U.S. Non-Affiliates .................................................................................................... 4299999 Total Reciprocal Jurisdiction Non-Affiliates ..................................................................... 4399999

Total General Account Reciprocal Jurisdiction .............................................................................................. 4499999

Total General Account Authorized, Reciprocal Jurisdiction, Unauthorized and Certified............... 34999994599999

Separate Accounts

Authorized

Affiliates

U.S.

Captive ................................................................................................... 35999994699999 Other ..................................................................................................... 36999994799999 Total ....................................................................................................... 37999994899999

Non-U.S.


Total Authorized Affiliates .................................................................................. 41999995299999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 42999995399999 Non-U.S. Non-Affiliates ...................................................................................... 43999995499999 Total Authorized Non-Affiliates .......................................................................... 44999995599999

Total Separate Accounts Authorized .................................................................................. 45999995699999

Attachment H


Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates .............................................................................. 52999996399999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 53999996499999 Non-U.S. Non-Affiliates ...................................................................................... 54999996599999 Total Unauthorized Non-Affiliates ...................................................................... 55999996699999

Total Separate Accounts Unauthorized .............................................................................. 56999996799999

Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates ...................................................................................... 63999997499999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 64999997599999 Non-U.S. Non-Affiliates ...................................................................................... 65999997699999 Total Certified Non-Affiliates .............................................................................. 66999997799999

Total Separate Accounts Certified .................................................................................................... 67999997899999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total Separate Accounts Reciprocal Jurisdiction ........................................................................................... 8999999

Total Separate Accounts Authorized, Reciprocal Jurisdiction, Unauthorized and Certified ............ 68999999099999

Attachment H


Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2599999, 3099999, 37999993699999, 42999994199999, 4899999, 5399999, 5999999, 6499999, 7099999, 7599999, 8199999 and 64999998699999) ............................................................................................................................. 69999999199999

Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2899999, 3199999, 40999993999999, 43999994299999, 5199999, 5499999, 6299999, 6599999, 7399999, 7699999, 8499999 and 65999998799999) ............................................................................................................................. 70999999299999

Total (Sum of 3499999 and 6899999) ......................................................................................................................... 9999999 Column 2 – ID Number




Attachment H


SCHEDULE S PART 3 SECTION 2

REINSURANCE CEDED ACCIDENT AND HEALTH INSURANCE LISTED BY REINSURING COMPANY AS OF DECEMBER 31, CURRENT YEAR

Include actual reinsurance ceded on group cases but exclude jointly underwritten group contracts. If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number: Group or Category Line Number General Account

Authorized

Affiliates

U.S.


Non-U.S.


Total Authorized Affiliates ................................................................................................ 0799999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 0899999 Non-U.S. Non-Affiliates .................................................................................................... 0999999 Total Authorized Non-Affiliates ........................................................................................ 1099999

Total General Account Authorized .................................................................................................. 1199999

Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates ............................................................................................ 1899999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 1999999 Non-U.S. Non-Affiliates .................................................................................................... 2099999 Total Unauthorized Non-Affiliates .................................................................................... 2199999

Total General Account Unauthorized ............................................................................................... 2299999

Attachment H


Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates .................................................................................................... 2999999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 3099999 Non-U.S. Non-Affiliates .................................................................................................... 3199999 Total Certified Non-Affiliates ............................................................................................ 3299999

Total General Account Certified .................................................................................................................... 3399999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total General Account Reciprocal Jurisdiction .............................................................................................. 4499999

Total General Account Authorized, Unauthorized and Certified ..................................................... 34999994599999

Separate Accounts

Authorized

Affiliates

U.S.


Non-U.S.


Total Authorized Affiliates .................................................................................. 41999995299999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 42999995399999 Non-U.S. Non-Affiliates ...................................................................................... 43999995499999 Total Authorized Non-Affiliates .......................................................................... 44999995599999

Total Separate Accounts Authorized .................................................................................. 45999995699999

Attachment H


Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates .............................................................................. 52999996399999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 53999996499999 Non-U.S. Non-Affiliates ...................................................................................... 54999996599999 Total Unauthorized Non-Affiliates ...................................................................... 55999996699999

Total Separate Accounts Unauthorized .............................................................................. 56999996799999

Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates ...................................................................................... 63999997499999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 64999997599999 Non-U.S. Non-Affiliates ...................................................................................... 65999997699999 Total Certified Non-Affiliates .............................................................................. 66999997799999

Total Separate Accounts Certified .................................................................................................... 67999997899999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total Separate Accounts Reciprocal Jurisdiction ........................................................................................... 8999999

Total Separate Accounts Authorized, Reciprocal Jurisdiction, Unauthorized and Certified ............ 68999999099999

Attachment H


Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2599999, 3099999, 37999993699999, 42999994199999, 4899999, 5399999, 5999999, 6499999, 7099999, 7599999, 8199999 and 64999998699999) ............................................................................................................................. 69999999199999

Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2899999, 3199999, 40999993999999, 43999994299999, 5199999, 5499999, 6299999, 6599999, 7399999, 7699999, 8499999 and 65999998799999) ............................................................................................................................. 70999999299999

Total (Sum of 3499999 and 6899999) ......................................................................................................................... 9999999





Attachment H


SCHEDULE S PART 4

REINSURANCE CEDED TO UNAUTHORIZED COMPANIES Contains data on life and accident and health insurance in force that is reinsured with companies not authorized in the state of domicile of the reporting insurance company. The purpose of this schedule is to display reinsurance ceded data used in the development of the liability for reinsurance in unauthorized companies. This liability serves to offset those assets and liability reductions that reflect the result of reinsurance ceded with unauthorized companies.






SCHEDULE S PART 5

REINSURANCE CEDED TO CERTIFIED REINSURERS NOTE: This schedule is to be completed by those reporting entities whose domiciliary state has enacted the Credit for

Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.






Attachment H


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY

SCHEDULE F – REINSURANCE Index to Schedule F

Part 1 – Assumed Reinsurance

Part 2 – Portfolio Reinsurance

Part 3 – Ceded Reinsurance

Part 4 – Issuing or Confirming Banks for Letters of Credit from Schedule F, Part 3

Part 5 – Interrogatories for Schedule F, Part 3

Part 6 – Restatement of Balance Sheet to Identify Net Credit for Ceded Reinsurance NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal Jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule F. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for Reciprocal Jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Due Date

All parts of Schedule F are to be filed with the annual statement.

Please note that Parts 1, 3, 4 and 5 of this schedule are reported with thousands omitted. Parts 2 and 6 are reported in whole dollars.

ID Number

Most parts of Schedule F require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities.

A ceding insurer can have unauthorized reinsurance, certified reinsurance and Reciprocal Jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule F by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for Reciprocal Jurisdiction reinsurance.

Attachment H



The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “ID Number” for other alien insurers, even if the federal government has issued such a number.


In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact with the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Alien pools and associations should be reported on Schedule F under the category “Other Non-U.S. Insurers” rather than under “Pools, Associations and Similar Facilities.” Pools and associations consisting of affiliated companies should be listed by individual company names rather than by pool or association identification.


In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule F instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment H



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN, Alien Insurer Identification Number (AIIN) or Certified Reinsurer Identification Number (CRIN). The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


NAIC Company Code





The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment H



ASSUMED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number:



Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F General Instructions for more information on these identification numbers.




PREMIUM PORTFOLIO REINSURANCE EFFECTED OR (CANCELED) DURING CURRENT YEAR

This schedule should list by portfolio any original premiums and reinsurance premiums for portfolio reinsurance transactions affected or canceled during the year. Portfolio reinsurance is the transfer of the entire liability of a reporting entity for in force policies as respects a described segment of the reporting entity’s business. Column 1 – ID Number



Attachment H



CEDED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:


Group or Category Line Number Total Authorized

Affiliates U.S. Intercompany Pooling ............................................................................................................. 0199999 U.S. Non-Pool

Captive .............................................................................................................................. 0299999 Other ................................................................................................................................. 0399999 Total .................................................................................................................................. 0499999

Other (Non-U.S.) Captive .............................................................................................................................. 0599999 Other ................................................................................................................................. 0699999 Total .................................................................................................................................. 0799999

Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999 Pools

Mandatory Pools*@ ........................................................................................................................ 1099999 Voluntary Pools*% ......................................................................................................................... 1199999

Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Protected Cells ............................................................................................................................................... 1399999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999 Total Unauthorized




Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Protected Cells ............................................................................................................................................... 2799999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment H


Total Certified Affiliates

U.S. Intercompany Pooling ............................................................................................................. 2999999 U.S. Non-Pool



Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Protected Cells ............................................................................................................................................... 4199999 Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and

4099999) ......................................................................................................................................... 4299999 Total Reciprocal Jurisdiction




Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Protected Cells ............................................................................................................................................... 5599999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999 Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of

1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999 Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999 Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * – Pools and Associations consisting of affiliated companies should be listed by individual company names.

@ – Include in Mandatory Pools all U.S. Government programs (e.g., National Flood Insurance, National Crop Insurance Corporation), all state residual market mechanisms, the Workers Compensation Reinsurance Pool, and the National Council on Compensation Insurance.

% – Include in Voluntary Pools all pool participation that is voluntary on the part of the reporting entity. Include participation in any state program for which participation is not mandatory.

# – Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.”

Attachment H






Ceded Reinsurance Credit Risk – Columns 28 Through 36 Only complete columns 28 through 36 for the following required groups, categories or subcategories (Line Numbers); otherwise leave blank. Group or Category Line Number Total Authorized

Affiliates Other (Non-U.S.)


Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999

Pools Voluntary Pools*% ......................................................................................................................... 1199999

Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999

Total Unauthorized



Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment H


Total Certified



Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999


Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and

4099999) ......................................................................................................................................... 4299999

Total Reciprocal Jurisdiction



Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999

Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of 1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999

Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999


Provision for Certified Reinsurance – Columns 54 Through 69 NOTE: Columns 54 through 69 are to be completed by those reporting entities whose domiciliary state has enacted the

Credit for Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.

Only complete columns 54 through 69 for the following required groups, categories, or subcategories (Line Numbers); otherwise leave blank. Group or Category Line Number

Total Certified

Affiliates



Attachment H



Total Certified – Affiliates .............................................................................................................. 3699999

Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999

Pools Mandatory Pools*@ ........................................................................................................................ 3899999 Voluntary Pools*% ......................................................................................................................... 3999999

Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Protected Cells ............................................................................................................................................... 4199999

Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and 4099999) ......................................................................................................................................... 4299999


Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999

Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999


Provision for Unauthorized Reinsurance – Columns 71 and 72 Only complete columns 71 and 72 for the following required groups, categories or subcategories (Line Numbers); otherwise enter zero. Group or Category Line Number

Total Unauthorized

Affiliates




Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Protected Cells ............................................................................................................................................... 2799999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment H


Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of 1499999, 2899999 and 4299999) .................................................................................................................. 4399999

Total Protected Cells (Sum of 1399999, 2799999 and 4199999) ................................................................................ 4499999

Totals (Sum of 4399999 and 4499999) ....................................................................................................................... 9999999 Provision for Overdue Authorized and Reciprocal Jurisdiction Reinsurance – Columns 73 and 74 Only complete columns 73 and 74 for the following required groups, categories or subcategories (Line Numbers); otherwise enter zero. Group or Category Line Number Total Authorized

Affiliates




Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999


Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Protected Cells ............................................................................................................................................... 1399999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999


Affiliates

U.S. Intercompany Pooling ............................................................................................................. 4399999

U.S. Non-Pool Captive .............................................................................................................................. 4499999 Other ................................................................................................................................. 4599999 Total .................................................................................................................................. 4699999


Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999



Other Non-U.S. Insurers# .............................................................................................................................. 5499999

Protected Cells ............................................................................................................................................... 5599999

Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999, 5399999 and 5499999) .................................................................................................................... 5699999

Attachment H




Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999

Columns 73 & 74 – Provisions for Overdue Authorized Reinsurance

Amounts reported in the detail lines cannot be less than 0. If the calculated amounts are less than 0, then enter 0.

Columns 75 through 78 – Total Provisions for Reinsurance

Amounts reported in the detail lines cannot be less than 0. If the calculated amounts are less than 0, then enter 0.

Attachment H


SUPPLEMENTAL SCHEDULE FOR REINSURANCE COUNTERPARTY REPORTING EXCEPTION – ASBESTOS AND POLLUTION CONTRACTS

DETAIL OF ORIGINAL REINSURERS AGGREGATED ON SCHEDULE F AS OF DECEMBER 31, CURRENT YEAR


Group or Category Line Number Total Authorized

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 0299999

Other ................................................................................................................................. 0399999

Total .................................................................................................................................. 0499999

Other (Non-U.S.)

Captive .............................................................................................................................. 0599999

Other ................................................................................................................................. 0699999

Total .................................................................................................................................. 0799999

Total Authorized – Affiliates .......................................................................................................... 0899999


Pools

Mandatory Pools*@ ........................................................................................................................ 1099999

Voluntary Pools*% ......................................................................................................................... 1199999


Protected Cells ............................................................................................................................................... 1399999

Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and 1299999) ......................................................................................................................................... 1499999

Total Unauthorized

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 1699999

Other ................................................................................................................................. 1799999

Total .................................................................................................................................. 1899999

Other (Non-U.S.)

Captive .............................................................................................................................. 1999999

Other ................................................................................................................................. 2099999

Total .................................................................................................................................. 2199999

Total Unauthorized – Affiliates ....................................................................................................... 2299999

Attachment H



Pools

Mandatory Pools*@ ........................................................................................................................ 2499999

Voluntary Pools*% ......................................................................................................................... 2599999


Protected Cells ............................................................................................................................................... 2799999

Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and 2699999) ......................................................................................................................................... 2899999

Total Certified

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 3099999

Other ................................................................................................................................. 3199999

Total .................................................................................................................................. 3299999

Other (Non-U.S.)

Captive .............................................................................................................................. 3399999

Other ................................................................................................................................. 3499999

Total .................................................................................................................................. 3599999

Total Certified – Affiliates .............................................................................................................. 3699999


Pools

Mandatory Pools*@ ........................................................................................................................ 3899999

Voluntary Pools*% ......................................................................................................................... 3999999


Protected Cells ............................................................................................................................................... 4199999



Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 4499999

Other ................................................................................................................................. 4599999

Total .................................................................................................................................. 4699999

Other (Non-U.S.)

Captive .............................................................................................................................. 4799999

Other ................................................................................................................................. 4899999

Total .................................................................................................................................. 4999999

Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999


Attachment H


Pools

Mandatory Pools*@ ........................................................................................................................ 5299999

Voluntary Pools*% ......................................................................................................................... 5399999


Protected Cells ............................................................................................................................................... 5599999

Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999, 5399999 and 5499999) .................................................................................................................... 5699999



Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * – Pools and Associations consisting of affiliated companies should be listed by individual company names.

@ – Include in Mandatory Pools all U.S. Government programs (e.g., National Flood Insurance, National Crop Insurance Corporation), all state residual market mechanisms, the Workers Compensation Reinsurance Pool, and the National Council on Compensation Insurance.

% – Include in Voluntary Pools all pool participation that is voluntary on the part of the reporting entity. Include participation in any state program for which participation is not mandatory.

# – Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” Column 1 – ID Number (Original Reinsurer)




Column 5 – ID Number (Retroactive Reinsurer)




Attachment H


ANNUAL STATEMENT INSTRUCTIONS – TITLE

SCHEDULE F – REINSURANCE Index to Schedule F


Part 2 – Ceded Reinsurance

Part 3 – Provision for Unauthorized Reinsurance

Part 4 – Provision for Reinsurance Ceded to Certified Reinsurers NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal Jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule F. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for Reciprocal Jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Due Date

All parts of Schedule F are to be filed with the annual statement.

Please note that Parts 1, 2, 3 and 4 of this schedule are reported with thousands omitted. ID Number

Schedule F require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities. A ceding insurer can have unauthorized reinsurance, certified reinsurance and Reciprocal Jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for Reciprocal Jurisdiction reinsurance.



Attachment H



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst. at [email protected] for numbers assigned since the last publication or information for on having a number assigned.



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.







In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN, Alien Insurer Identification Number (AIIN) or Certified Reinsurer Identification Number (CRIN). The RJIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment H


NAIC Company Code





The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment H



ASSUMED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number:







CEDED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number: Group or Category Line Number Total Authorized

Affiliates

U.S. Intercompany Pooling ................................................................................................................. 0199999

U.S. Non-Pool

Captive .................................................................................................................................. 0299999 Other ..................................................................................................................................... 0399999 Total ...................................................................................................................................... 0499999

Other (Non-U.S.)


Total Authorized – Affiliates .............................................................................................................. 0899999

Attachment H


Other U.S. Unaffiliated Insurers ........................................................................................................................ 0999999

Pools

Mandatory Pools* ............................................................................................................................... 1099999 Voluntary Pools* ................................................................................................................................. 1199999

Other Non-U.S. Insurers# .................................................................................................................................. 1299999

Total Authorized ................................................................................................................................................ 1399999

Total Unauthorized

Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Unauthorized – Affiliates ........................................................................................................... 2199999


Pools

Mandatory Pools* ............................................................................................................................... 2399999 Voluntary Pools* ................................................................................................................................. 2499999

Total Unauthorized – Other Non-U.S. Insurers# ............................................................................................... 2599999

Total Unauthorized ............................................................................................................................................ 2699999

Total Certified

Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Certified – Affiliates .................................................................................................................. 3499999


Pools Mandatory Pools*@ ............................................................................................................................ 3699999 Voluntary Pools*% ............................................................................................................................. 3799999


Total Certified .................................................................................................................................................................. 3999999

Attachment H



Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Reciprocal Jurisdiction – Affiliates............................................................................................ 4799999


Pools Mandatory Pools*@ ............................................................................................................................ 4999999 Voluntary Pools*% ............................................................................................................................. 5099999


Total Reciprocal Jurisdiction ........................................................................................................................................... 5299999

Totals ............................................................................................................................................................................... 9999999 * Pools and Associations consisting of affiliated companies should be listed by individual company names.

# Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” NOTE: Disclosure of the five largest provisional commission rates should exclude mandatory pools and joint underwriting

associations. Column 1 – ID Number




Attachment H



PROVISION FOR UNAUTHORIZED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:







PROVISION FOR REINSURANCE CEDED TO CERTIFIED REINSURERS AS OF DECEMBER 31, CURRENT YEAR

NOTE: This schedule is to be completed by those reporting entities whose domiciliary state has enacted the Credit for

Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.






Attachment H


OPERATIONS AND INVESTMENT EXHIBIT

PART 2B – UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES This schedule reports unpaid loss and loss adjustment expenses on direct and agency operations. Affiliated agencies are those that meet the affiliation standards defined by SSAP No. 25—Affiliates and Other Related Parties. Refer to SSAP No. 57—Title Insurance, paragraphs 8–13, for accounting guidance.


Line 2 – Reinsurance Recoverable from Authorized, Unauthorized and Certified Companies

The amounts shown on this line represents reinsurance ceded recoverables (from authorized, unauthorized and certified companies) on unpaid losses of which notice has been received. This can be done through reinsurance ceded treaties, facultative reinsurance assumed agreements, or under transfer and assumption agreements.

The amounts shown on this line should reconcile to amounts reported in Schedule F, Part 2, Column 9, Total.

The amount shown in Column 1 should agree to Schedule P, Part 1A, Column 19, Line 12.

The amount shown in Column 2 plus the amount shown in Column 3 should as agree to Schedule P, Part 1B, Column 19, Line 12.


Attachment H



WORKERS’ COMPENSATION CARVE-OUT SUPPLEMENT The Workers’ Compensation Carve-out Supplement shall be completed by those reporting entities that assume or cede workers’ compensation carve-out business. Workers’ compensation carve-out business is defined as reinsurance (including retrocessional reinsurance) assumed by life and health insurers of medical, wage loss and death benefits of the occupational illness and accident exposures, but not the employer’s liability exposures, of business originally written as workers compensation insurance.


SCHEDULE F – REINSURANCE NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal Jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule FS. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Index to Schedule F


Part 2 – Ceded Reinsurance ID Number

Schedule F requires that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities. A ceding insurer can have unauthorized reinsurance, certified reinsurance and Reciprocal Jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for Reciprocal Jurisdiction reinsurance.

Attachment H





In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Pools and Association Numbers

In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The NAIC Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.






Attachment H



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


NAIC Company Code

Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the “Pool and Association Numbers” section above for details on assignment of Pool/Association Identification Numbers. Risk-bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.




The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.


Attachment H



ASSUMED REINSURANCE If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number.







CEDED REINSURANCE If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, categories, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number. Group or Category Line Number Total Authorized

Affiliates

Affiliates – U.S. Intercompany Pooling ......................................................................................... 0199999 U.S. Non-Pool



Total Authorized – Affiliates .......................................................................................................... 0899999


Attachment H


Pools

Mandatory Pools* ........................................................................................................................... 1099999 Voluntary Pools* ............................................................................................................................. 1199999


Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and 1299999) ......................................................................................................................................... 1499999

Total Unauthorized

Affiliates




Total Unauthorized – Affiliates ...................................................................................................... 2299999


Pools

Mandatory Pools* ........................................................................................................................... 2499999 Voluntary Pools* ............................................................................................................................. 2599999


Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and 2699999) ......................................................................................................................................... 2899999

Total Certified

Affiliates




Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999




Attachment H


Total Reciprocal Jurisdiction Affiliates




Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Protected Cells ............................................................................................................................................... 5599999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999 Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of

1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999 Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999 Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * Pools and Associations consisting of affiliated companies should be listed by individual company names.

# Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” Column 1 – ID Number




Attachment H


SUPPLEMENTAL TERM AND UNIVERSAL LIFE INSURANCE REINSURANCE EXHIBIT

PART 1 – ALL CESSIONS OF TERM AND UNIVERSAL LIFE INSURANCE WITH SECONDARY GUARANTEES



Enter one of the following as appropriate for the assuming insurer reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) Certified Reinsurer Identification Number (CRIN)



PART 2A – TRANSACTIONS SUBJECT TO PART 2 DISCLOSURE (GRANDFATHERED OR SPECIAL EXEMPTION)

Column 1 – Cession ID

Enter a unique Cession ID for each line (01 – 99). Column 2 – NAIC Company Code

Provide the NAIC code of the assuming insurer. Column 3 – ID Number

Enter one of the following as appropriate for the assuming insurer being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.



Attachment H



PART 2B – TRANSACTIONS SUBJECT TO PART 2 DISCLOSURE (NON-GRANDFATHERED)

Column 1 – Cession ID

Enter a unique Cession ID for each line (01 – 99).

To differentiate between cessions that contain risks subject to the provisions of AG48 and those that contain risks subject to the provisions of a state regulation equivalent to Model #787, append an A or B after the cession ID.

In the event that a cession contains risks subject to both the provisions of AG48 and the provisions of a state regulation equivalent to Model #787, the reporting of the cession shall be bi-furcated accordingly and listed on two distinct lines.

Use “A” for cessions that contain risks subject to the provisions of AG48.

Use “B” for cessions that contain risks subject to the provisions of a state regulation.

Column 2 – NAIC Company Code

Provide the NAIC code of the assuming insurer. Column 3 – ID Number

Enter one of the following as appropriate for the assuming insurer being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.



Attachment H


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY AND TITLE

NOTES TO FINANCIAL STATEMENTS Notes to the Annual Statement are to be filed on March 1.


23. Reinsurance

Instruction:

A. Unsecured Reinsurance Recoverables

If the company has with any individual reinsurers (authorized, reciprocal jurisdiction, unauthorized or certified), an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses, and unearned premium that exceeds 3% of the company’s policyholder surplus, list each individual reinsurer and the unsecured aggregate recoverable pertaining to that reinsurer. If the individual reinsurer is part of a group, list the individual reinsurers, each of its related group members having reinsurance with the reporting company, and the total unsecured aggregate recoverables for the entire group.

Include: The NAIC group code number, where appropriate, and the Federal Employer

Identification Number for each individual company.


F. Retroactive Reinsurance (1) Provide the following information for all retroactive reinsurance agreements that transfer liabilities

for losses that have already occurred and that will generate special surplus transactions:


f. List the total Paid Loss/LAE amounts recoverable (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers), any amounts more than 90 days overdue (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers) and for amounts recoverable the collateral held (for unauthorized and certified reinsurers).

The insurer (assuming or ceding) shall assign a unique number to each retroactive reinsurance agreement and shall utilize this number for as long as the agreement exists. Do not report transactions utilizing deposit accounting in this note.


Attachment H


Illustration:

A. Unsecured Reinsurance Recoverables

The Company does not have an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses and unearned premium with any individual reinsurers, authorized or unauthorized, that exceeds 3% of the Company’s policyholder surplus.


THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION.

F. Retroactive Reinsurance

(1) Reported Company


f. Total Paid Loss/LAE amounts recoverable (for authorized, reciprocal jurisdiction,

unauthorized and certified reinsurers), any amounts more than 90 days overdue (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers), and for amounts recoverable the collateral held (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers) as respects amounts recoverable from authorized, reciprocal jurisdiction, unauthorized and certified reinsurers:

1. Authorized Reinsurers

Total Paid/Loss/LAE Amounts Over 90 Company Recoverable Days Overdue $ $ Total $ $

2. Unauthorized Reinsurers

Total Amounts Paid/Loss/LAE Over 90 Collateral Company Recoverable Days Overdue Held

$ $

Total $ $ $

Attachment H


3. Certified Reinsurers


$ $

Total $ $ $

4. Reciprocal Jurisdiction Reinsurers


$ $

Total $ $ $


Attachment H


ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH, PROPERTY & TITLE

SCHEDULE Y

PART 1A – DETAIL OF INSURANCE HOLDING COMPANY SYSTEM All insurer and reporting entity members of the holding company system shall prepare a schedule for inclusion in each of the individual annual statements that is common for the group with the exception of Column 10, Relationship to Reporting Entity.



Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) * Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) * Certified Reinsurer Identification Number (CRIN) *

* RJIN, AIINs or CRINs are only reported if the entity in Column 8 is a reinsurer that has had

an RJIN, AIIN or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another entity regardless of whether the entity in Column 8 is part of reporting entity’s group.

If not applicable for the entity in Column 8, leave blank.


Attachment H



SCHEDULE Y

PART 2 – SUMMARY OF INSURER’S TRANSACTIONS WITH ANY AFFILIATES This schedule was designed to provide an overview of transactions among insurance holding company system members. It is intended to demonstrate the scope and direction of major fund and/or surplus flows throughout the system. This schedule should be prepared on an accrual basis.





* RJIN, AIIN or CRIN numbers are only reported if the entity in Column 3 is a reinsurer that

has had an RJIN, AIIN or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another entity regardless of whether the entity in Column 3 is part of reporting entity’s group or not.

If not applicable for the entity in Column 3, leave blank.


Attachment H


SCHEDULE D – PART 6 – SECTION 1

VALUATION OF SHARES OF SUBSIDIARY, CONTROLLED OR AFFILIATED COMPANIES If a reporting entity has any common stock or preferred stock reported for any of the following required categories or subcategories, it shall report the subtotal amount of the corresponding category or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:





* RJIN, AIINs or CRINs are only reported if the entity is a reinsurer that has had an RJIN, AIIN

or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another reporting entity.

If not applicable for the entity, leave blank.


Attachment H


ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL

TRUSTEED SURPLUS STATEMENT


Page 3 Line 1 – Total Liabilities

Should agree with the amount reported on Page 3, Line 28 of the quarterly statement.


Line 4 – Amounts Recoverable From Reinsurers

Line 4.1 – Authorized Companies

Include: Any reinsurance recoverable on paid losses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 4.2 – Unauthorized Companies

Include: Any reinsurance recoverables on paid losses from unauthorized

companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 4.3 – Certified Companies

Include: Any reinsurance recoverable on paid losses from certified companies

that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 4.4 – Reciprocal Jurisdiction Companies

Include: Any reinsurance recoverable on paid losses from Reciprocal

Jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Attachment H


ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS – PROPERTY

TRUSTEED SURPLUS STATEMENT


Page 3 Line 1 – Total Liabilities

Should agree with the amount reported on Page 3, Line 28 of the quarterly statement.


Line 7 – Reinsurance Recoverable on Paid Losses and Loss Adjustment Expenses

Line 7.1 – Authorized Companies

Include: Any reinsurance recoverables on paid losses and loss adjustment expenses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 7.2 – Unauthorized Companies

Include: Any reinsurance recoverables on paid losses and loss adjustment

expenses from unauthorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 7.3 – Certified Companies


expenses from certified companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.

Line 7.4 – Reciprocal Jurisdiction Companies


expenses from reciprocal jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Attachment H


QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL AND HEALTH

SCHEDULE S – CEDED REINSURANCE

SHOWING ALL NEW REINSURANCE TREATIES – CURRENT YEAR TO DATE



Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the instruction for Column 2 for details on assignment of Pool/Association Identification Numbers. Risk bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk bearing entity (e.g., risk bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule S General Instructions in the annual statement instructions for more information on these identification numbers.


Federal ID Number (FEIN)

The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “Federal ID Number” for other alien insurers even if the federal government has issued such a number.


In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule S instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.

Newly assigned numbers are incorporated in revised editions of the NAIC Listing of Companies, which are available semiannually. The NAIC provides this information to annual statement software vendors for incorporation into the software.

Attachment H



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule S the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule S instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



Column 7 – Type of Reinsurer

The determination of the authorized, certified or unauthorized status of an insurer or reinsurer shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.

Enter “Authorized” “Reciprocal Jurisdiction” “Certified” or “Unauthorized” to indicate the type of reinsurer.


Attachment H


QUARTERLY STATEMENT INSTRUCTIONS – PROPERTY AND TITLE

SCHEDULE F – CEDED REINSURANCE

SHOWING ALL NEW REINSURERS – CURRENT YEAR TO DATE



Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the instruction for Column 2 for details on assignment of Pool/Association Identification Numbers. Risk bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk bearing entity (e.g., risk bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F General Instructions in the annual statement instructions for more information on these identification numbers.


Federal ID Number (FEIN)



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.


Attachment H



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule F instead, of the FEIN or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



Column 5 – Type of Reinsurer

The determination of the authorized, certified or unauthorized status of an insurer or reinsurer shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.

Enter “Authorized” “Reciprocal Jurisdiction” “Certified” or “Unauthorized” to indicate the type of reinsurer.


Attachment H


ANNUAL STATEMENT BLANK – PROPERTY

SCHEDULE F – PART 3 (Continued) Ceded Reinsurance as of December 31, Current Year ($000 Omitted)

(Total Provision for Reinsurance)

70 Provision for Unauthorized Reinsurance Provision for Overdue Authorized and Reciprocal

Jurisdiction Reinsurance Total Provision for Reinsurance

ID Number From Col. 1

Name of Reinsurer From Col. 3

20% of Recoverable on Paid Losses & LAE Over

90 Days Past Due Amounts Not in Dispute

(Col. 47 * 20%)

71

Provision for Reinsurance with

Unauthorized Reinsurers Due to

Collateral Deficiency (Col. 26)

72

Provision for Overdue Reinsurance from

Unauthorized Reinsurers and Amounts in Dispute

(Col. 70 + 20% of the Amount in Col. 16)

73 Complete if

Col. 52 = "Yes"; Otherwise Enter 0

20% of Recoverable on Paid Losses &

LAE Over 90 Days Past Due Amounts

Not in Dispute + 20% of Amounts in

Dispute ([Col. 47 * 20%] + [Col. 45 * 20%])

74 Complete if

Col. 52 = "No"; Otherwise Enter 0

Greater of 20% of Net

Recoverable Net of Funds Held &

Collateral, or 20% of Recoverable on Paid

Losses & LAE Over 90 Days Past Due

(Greater of Col 26 * 20% or

[Cols. 40 + 41] * 20%)

75

Provision for Amounts Ceded to Authorized

and Reciprocal Jurisdiction Reinsurers

(Cols. 73 + 74)

76

Provision for Amounts Ceded to Unauthorized

Reinsurers (Cols. 71 + 72 Not in Excess

of Col. 15)

77

Provision for Amounts Ceded to Certified

Reinsurers (Cols. 64 + 69)

78

Total Provision for Reinsurance

(Cols. 75 + 76 +77) ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ 9999999 Totals

Attachment H


ANNUAL STATEMENT BLANK – TITLE

OPERATIONS AND INVESTMENT EXHIBIT PART 2B – UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES

1 Agency Operations 4 5

Direct

Operations

2 Non-Affiliated

Agency Operations

3 Affiliated Agency

Operations

Total Current

Year (Cols. 1+2+3)

Total Prior Year

1. Loss and allocated LAE reserve for title and other losses of which notice has been

received:

1.1 Direct (Schedule P, Part 1, Line 12, Col. 17) ........................................................

1.2 Reinsurance assumed (Schedule P, Part 1, Line 12, Col. 18) ...............................

...................

...................

...........................

...........................

.......................

.......................

.........................

.........................

............

............

2. Deduct reinsurance recoverable from authorized, unauthorized and certified

companies (Schedule P, Part 1, Line 12, Col. 19) ...........................................................

3. Known claims reserve net of reinsurance (Line 1.1 plus Line 1.2 minus Line 2) ........... ................... ........................... ....................... ......................... ............

4. Incurred But Not Reported:

4.1 Direct (Schedule P, Part 1, Line 12, Col. 20) ........................................................

4.2 Reinsurance assumed (Schedule P, Part 1, Line 12, Col. 21) ...............................

4.3 Reinsurance ceded (Schedule P, Part 1, Line 12, Col. 22) ....................................

...................

...................

...........................

...........................

.......................

.......................

.........................

.........................

............

............

4.4 Net incurred but not reported (Line 4.1 plus Line 4.2 minus Line 4.3) ................

5. Unallocated LAE reserve (Schedule P, Part 1, Line 12, Col. 23)....................................

...................

...................

...........................

......................

.......................

.......................

.........................

.........................

............

............

6. Less discount for time value of money, if allowed (Schedule P, Part 1, Line 12,

Col. 33) .............................................................................................................................

XXX

XXX

XXX

7. Total Schedule P reserves (Lines 3 + 4.4 + 5 - 6) (Schedule P, Part 1, Line 12,

Col. 34) .............................................................................................................................

XXX

XXX

XXX

.........................

............

8. Statutory premium reserve at year end (Part 1B, Line 2.6) ............................................. XXX XXX XXX ......................... ............

9. Aggregate of other reserves required by law (Page 3, Line 3) ........................................ XXX XXX XXX

10. Supplemental reserve (a) (Lines 7 - (3 + 8 + 9) XXX XXX XXX

(a) If the sum of Lines 3 + 8 + 9 is greater than Line 7, place a "0" in this Line.

Attachment H


ANNUAL AND QUARTERLY STATEMENT BLANK – LIFE/FRATERNAL

TRUSTEED SURPLUS STATEMENT LIABILITIES AND TRUSTEED SURPLUS

1

Current Quarter 1. Total Liabilities ..................................................................................................................................................................... ...................................... ADDITIONS TO LIABILITIES: 2. Aggregate write-ins for additions to liabilities .....................................................................................................................

......................................

3. Total (Lines 1 + 2) ................................................................................................................................................................ ...................................... DEDUCTIONS FROM LIABILITIES: 4. Amounts Recoverable From Reinsurers:

4.1 Authorized Companies ............................................................................................. ........................................... 4.2 Unauthorized Companies ......................................................................................... ........................................... 4.3 Certified Companies ................................................................................................. ........................................... 4.4 Reciprocal Jurisdiction Companies .......................................................................... ........................................... 5. Special State Deposits, not exceeding net liabilities carried: 5.1 Special State Deposits (submit schedule) ................................................................ ........................................... 5.2 Accrued interest on special state deposits ................................................................ ........................................... 6. Life insurance premiums and annuity considerations deferred and uncollected ............... ........................................... 7. Accident and health premiums due and unpaid ................................................................. ........................................... 8. Contract loans and premium notes: 8.1 Contract loans not exceeding reserves carried on such policies .............................. ........................................... 8.2 Premium notes .......................................................................................................... ........................................... 8.3 Interest due and accrued on contract loans and premium notes .............................. ........................................... 9. Aggregate write-ins for other deductions from liabilities .................................................. 10. Total Deductions (Lines 4.1 thru 9) ..................................................................................................................................... 11. Total Adjusted Liabilities (Line 3 minus Line 10) ............................................................................................................... 12. Trusteed Surplus ................................................................................................................................................................... 13. Total

DETAILS OF WRITE-INS 0201. .............................................................................................................................................................................................. ...................................... 0202. .............................................................................................................................................................................................. ...................................... 0203. .............................................................................................................................................................................................. ...................................... 0298. Summary of remaining write-ins for Line 2 from overflow page ........................................................................................ ...................................... 0299. Totals (Lines 0201 thru 0203 plus 0298) (Line 2 above) 0901. .............................................................................................................................................................................................. ...................................... 0902. .............................................................................................................................................................................................. ...................................... 0903. .............................................................................................................................................................................................. ...................................... 0998. Summary of remaining write-ins for Line 9 from overflow page ........................................................................................ ...................................... 0999. Totals (Lines 0901 thru 0903 plus 0998) (Line 9 above)

INTERROGATORIES:

1.1 Have there been any changes made to any of the trust indentures during the period? Yes [ ] No [ ]

1.2 If yes, has the domiciliary or entry state approved the change? Yes [ ] No [ ]

Attachment H


ANNUAL AND QUARTERLY STATEMENT BLANK – PROPERTY

TRUSTEED SURPLUS STATEMENT LIABILITIES AND TRUSTEED SURPLUS

1

Current Quarter 1. Total Liabilities ..................................................................................................................................................................... ...................................... ADDITIONS TO LIABILITIES: 2. Ceded Reinsurance Balances Payable ..............................................................................

3. Agents' Credit Balances .................................................................................................... 4. Aggregate Write-ins For Other Additions to Liabilities .................................................. 5. Total Additions (Lines 2 + 3 + 4) ......................................................................................................................................... 6. Total (Lines 1 + 5) ................................................................................................................................................................ DEDUCTIONS FROM LIABILITIES: 7. Reinsurance Recoverable on Paid Losses and Loss Adjustment Expenses:

7.1 Authorized Companies ........................................................................................... ........................................... 7.2 Unauthorized Companies ....................................................................................... ........................................... 7.3 Certified Companies ............................................................................................... 7.4 Reciprocal Jurisdiction Companies ........................................................................ 8. Special State Deposits, not exceeding net liabilities carried in this statement on business

in each respective state:

8.1 Special State Deposits (submit schedule) .............................................................. ........................................... 8.2 Accrued interest on Special State Deposits............................................................ ........................................... 9. Agents' balances or uncollected premiums not more than ninety days past due, not exceeding unearned premium reserves carried thereon ...................................................

10. Unpaid Reinsurance Premiums Receivable, not exceeding losses and loss adjustment expenses due to reinsured:

10.1 Authorized Companies ........................................................................................... ........................................... 10.2 Unauthorized Companies ....................................................................................... ........................................... 11. Aggregate write-ins for other deductions from liabilities ................................................ 12. Total Deductions (Lines 7 thru 11) ...................................................................................................................................... 13. Total Adjusted Liabilities (Line 6 minus Line 12) ............................................................................................................... 14. Trusteed Surplus ................................................................................................................................................................... 15. Total

DETAILS OF WRITE-INS 0401. . ............................................................................................................................................................................................. ...................................... 0402. .............................................................................................................................................................................................. ...................................... 0403. .............................................................................................................................................................................................. ...................................... 0498. Summary of remaining write-ins for Line 4 from overflow page ........................................................................................ ...................................... 0499. Totals (Lines 0401 thru 0403 plus 0498) (Line 4 above) 1101. .............................................................................................................................................................................................. ...................................... 1102. .............................................................................................................................................................................................. ...................................... 1103. .............................................................................................................................................................................................. ...................................... 1198. Summary of remaining write-ins for Line 11 from overflow page ...................................................................................... ...................................... 1199. Totals (Lines 1101 thru 1103 plus 1198) (Line 11 above)


Attachment H



Attachment I


Blanks (E) Working Group Editorial Revisions to the Blanks and Instructions (presented at the December 17, 2019, Meeting) Statement Type: H = Health; L/F = Life/Fraternal Combined; P/C = Property/Casualty; SA = Separate Accounts; T = Title

Effective Table Name Description Statement Type

Filing Type

2020 Exhibit 6 CHANGE TO INSTRUCTION Modify the instructions as shown below to clarify loss/claims adjusting expenses are not to be included on the exhibit. Reserves or other amounts relating to uninsured accident and health plans and the uninsured portion of partially insured accident and health plans should be excluded from this exhibit. Do not include amounts for loss/claims adjusting expenses. Column 10 – Credit Accident and Health (Group and Individual)

Include: Business not exceeding 120 months.

Refer to SSAP No. 59—Credit Life and Accident and Health Insurance Contracts for accounting guidance.

This column is not applicable to Fraternal Benefit Societies.

L/F Annual

2020 Exhibit 8 CHANGE TO INSTRUCTION Modify the instructions as shown below to clarify loss/claims adjusting expenses are not to be included on the exhibit. Amounts relating to uninsured accident and health plans and the uninsured portion of partially insured accident and health plans should be excluded from this exhibit. Do not include amounts for loss/claims adjusting expenses.

L/F Annual

Attachment I


Effective Table Name Description Statement Type

Filing Type

2019 Schedule DB, Part E CHANGE TO BLANK Null column 9, Total line as it is a percentage.

All Annual

2019 Analysis of Reserves – Accident and Health

CHANGE TO BLANK Change name of table from Analysis of Increase in Reserves During the Year – Accident and Health to Analysis of Reserves During the Year – Accident and Health as the table does not calculate an increase (Similar to Exhibit 6 in Life Statement.)

SA Annual

2020 Schedule D, Parts 3 and 4 Footnote

CHANGE TO BLANK Delete footnote for market indicator to coincide with removal of market indicator and make consistent with annual.

All Quarterly

2020 Schedule DB, Part E CHANGE TO BLANK Header originally was for annual referring to December 31. Change to quarterly terminology: Derivatives Hedging Variable Annuity Guarantees as of Current Statement Date

All Quarterly

2020 General Interrogatories Part 1

CHANGE TO BLANK Add N/A as a choice on Line 15.2 to mimic annual statement. This will allow entities that answer NO on line 15.1 (do not enter into hedging transactions) to answer N/A.

All Quarterly

Attachment J


Blanks (E) Working Group Summary of Comments for August 4, 2018

National Meeting

ITEMS RECEIVED FOR COMMENT

Reference Number Description

2019-25BWG Modified

Modify the instructions for Column 10, Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement, removing instruction to exclude adjusting other reserves from the column. Add instructions to include those with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

Comment #1 – Industry Interested Parties Attachment K Page 1 of 6

The proposed crosscheck instruction between Schedule F – Part 3 and Schedule P – Part 1 is not valid. For companies which are participants in intercompany pooling arrangements, Schedule F – Part 3 includes amounts ceded by intercompany pool participants to the lead pool company. However, reporting entities that participate in an intercompany pooling arrangement only report their share of the pool business in Schedule P – Part 1 and would not include amounts ceded to the lead pool company. Therefore, we suggest deleting the proposed crosscheck instruction and adding additional references to “in part”, as shown below. In addition, the correct reference to “Adjusting Other” is “Adjusting and Other”: …

In addition, the above changes should be added to instructions for the Workers’ Compensation Carve-Out Supplement.

See comment letter for full details.

Attachment J



2019-26BWG Modified

Add instruction and crosscheck for Line 34 on the Analysis of Operations by Lines of Business – Summary. Add instruction for Column 5 – Indexed Life on the Analysis of Operations by Lines of Business – Individual Life. Add clarifying instruction to the Analysis of Operations by Lines of Business for Individual Life and Group Life regarding reporting consistent with policy type language in the contract and reporting of policies issued with secondary guarantees that have expired.


IPs believe that the proposed Line 34 instruction crosscheck on the Analysis of Operations by Lines of Business - Summary page is not accurate as currently written. Line 23, Column 9 of the State Page reports only Life insurance policies in force and does not include Annuity contracts; therefore, only the Life columns 2 and 3 on the new summary page should equal this line. The Annuities columns 4 and 5 should instead agree to the Supplementary Contracts and Annuities sections on the Exhibit of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities A&H and Other (page 27). Also, filing entities have the option of reporting YRT amounts (amounts assumed and retained (net) yearly-renewable-term reinsurance business) allocated into the type of business columns on the line of business schedules for Life business and report zero in the YRT column. Under this scenario, if this assumed business is not reported on the direct business State Page Line 23 then the cross-check proposed for the grand total State Page Line 23 Column 9 will not work.

Comment # 2 –State Farm Attachment K Page 6 of 6

… While adding clarifying instructions and a crosscheck are beneficial, we believe that the proposed Line 34 instruction crosscheck on the Analysis of Operations by Lines of Business - Summary page is not accurate as currently written. Line 23, Column 9 of the State Page reports only Life insurance policies in force and does not include Annuity contracts; therefore, only the Life columns 2 and 3 on the new summary page should equal this line. The Annuities columns 4 and 5 should instead agree to the Supplementary and Annuities sections on the Exhibit of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities A&H and Other (page 27.) …

Attachment J



2019-27BWG Remove the alphabetic index from inclusion at the back of the annual statement blank, instructions and Blanks Working Group Web page.


The NAIC Vendor Electronic Filing Submission Directive (“Vendor Directive”) also requires the Alphabetized Index. This requirement should be removed from this Vendor Directive and documented in the proposal. The proposed revision that should be made to the Vendor Directive is below.

12.2. Annual Statement Data PDF Files The last page in each of the March PDF files should be the Alphabetized Index for the statement type represented by the PDF file.

Blanks Procedures

Modify the Blanks Procedures to reflect that the Blanks Working Group will be conducting its business exclusively through conference calls as it will not be meeting at the National Meeting in the foreseeable future.


IPs are supportive of certain of the changes in the procedures of the BWG. We do have a few suggestions for improvement. Additionally, we have attached a marked version of the exposed Blanks procedures that reflect IP comments.

• We believe that the procedures should have firm dates for exposure and adoption. This is similar to how proposed amendments to RBC blanks and instructions are handled by the Capital Adequacy Task Force.

• On the October 22 BWG conference call, there appeared to be a consensus that there should be one in-person meeting each year of the BWG

with that meeting occurring during the NAIC Spring National Meeting. This would allow a face-to-face discussion of items and would take advantage of most everyone already being in attendance at the meeting. Has this been confirmed beginning with the 2020 Spring National Meeting?

• Currently, after each BWG meeting taking place at the NAIC national meetings, a meeting summary of the actions taken on each of the

agenda items is shared on the NAIC website. If the modified Blanks procedures are adopted and the meetings move to a primarily conference call format, it is critical that these meeting summaries continue to be shared timely following each conference call. These meeting summaries are used by the industry to identify the actions taken by the BWG during the call.

Attachment J



Attachment K

1

John Bauer, FLMI Vice President, Regulatory Reporting Prudential Financial Office: 973-802-5803 Email: [email protected]

Connie Jasper Woodroof, FLMI NAIC Liaison Sapiens, Inc. 800-373-3366 x 85761 Email: [email protected]

November 22, 2019 Mr. Jake Garn, Chair Blanks Working Group National Association of Insurance Commissioners 1100 Walnut St. Kansas City, MO 64106 SUBJECT: Blanks Working Group (“BWG”) Proposals Exposed on the BWG Conference Call Dear Mr. Garn: Interested parties (“IPs”) appreciate the opportunity to review and comment on the proposals that were exposed by the BWG on the October 22, 2019 BWG conference call with a comment deadline of November 22, 2019. 2019-25 The proposed crosscheck instruction between Schedule F – Part 3 and Schedule P – Part 1 is not valid. For companies which are participants in intercompany pooling arrangements, Schedule F – Part 3 includes amounts ceded by intercompany pool participants to the lead pool company. However, reporting entities that participate in an intercompany pooling arrangement only report their share of the pool business in Schedule P – Part 1 and would not include amounts ceded to the lead pool company. Therefore, we suggest deleting the proposed crosscheck instruction and adding additional references to “in part”, as shown below. In addition, the correct reference to “Adjusting Other” is “Adjusting and Other”: Column 10 – Known Case LAE Reserves

Include: Defense and Cost Containment from Schedule P, Part 1, Columns 18, in part Adjusting and Other from Schedule P, Part 1, Column 22, in part

The sum of Schedule F, Part 3, Columns 10 and 12 should equal the sum of Schedule P, Part 1, Columns 18, 20 and 22. Column 12 – IBNR LAE Reserves

Include: Defense and Cost Containment from Schedule P, Part 1, Columns 20, in part Adjusting and Other from Schedule P, Part 1, Column 22, in part

In addition, the above changes should be added to instructions for the Workers’ Compensation Carve-Out Supplement.

mailto:[email protected]

mailto:[email protected]

Attachment K

2

2019-26 IPs believe that the proposed Line 34 instruction crosscheck on the Analysis of Operations by Lines of Business - Summary page is not accurate as currently written. Line 23, Column 9 of the State Page reports only Life insurance policies in force and does not include Annuity contracts; therefore, only the Life columns 2 and 3 on the new summary page should equal this line. The Annuities columns 4 and 5 should instead agree to the Supplementary Contracts and Annuities sections on the Exhibit of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities A&H and Other (page 27). Also, filing entities have the option of reporting YRT amounts (amounts assumed and retained (net) yearly-renewable-term reinsurance business) allocated into the type of business columns on the line of business schedules for Life business and report zero in the YRT column. Under this scenario, if this assumed business is not reported on the direct business State Page Line 23 then the cross-check proposed for the grand total State Page Line 23 Column 9 will not work. 2019-27 The NAIC Vendor Electronic Filing Submission Directive (“Vendor Directive”) also requires the Alphabetized Index. This requirement should be removed from this Vendor Directive and documented in the proposal. The proposed revision that should be made to the Vendor Directive is below.

12.2. Annual Statement Data PDF Files The last page in each of the March PDF files should be the Alphabetized Index for the statement type represented by the PDF file.

Blanks Procedures IPs are supportive of certain of the changes in the procedures of the BWG. We do have a few suggestions for improvement. Additionally, we have attached a marked version of the exposed Blanks procedures that reflect IP comments.

• We believe that the procedures should have firm dates for exposure and adoption. This is similar to how proposed amendments to RBC blanks and instructions are handled by the Capital Adequacy Task Force.

• On the October 22 BWG conference call, there appeared to be a consensus that there

should be one in-person meeting each year of the BWG with that meeting occurring during the NAIC Spring National Meeting. This would allow a face-to-face discussion of items and would take advantage of most everyone already being in attendance at the meeting. Has this been confirmed beginning with the 2020 Spring National Meeting?

• Currently, after each BWG meeting taking place at the NAIC national meetings, a

meeting summary of the actions taken on each of the agenda items is shared on the NAIC website. If the modified Blanks procedures are adopted and the meetings move to a primarily conference call format, it is critical that these meeting summaries continue to be shared timely following each conference call. These meeting summaries are used by the industry to identify the actions taken by the BWG during the call.

Attachment K

3

John Bauer, FLMI Connie Jasper Woodroof, FLMI Vice President, Regulatory Reporting NAIC Liaison Prudential Financial Sapiens, Inc. CC: Rose Albrizio, AXA Financial Keith Bell, Travelers Mary Caswell, NAIC Calvin Ferguson, NAIC Kim Hudson, Vice-Chair, California

Attachment K

4

PROCEDURES OF THE FINANCIAL CONDITION (E) COMMITTEE BLANKS WORKING GROUP IN CONNECTION WITH PROPOSED AMENDMENTS TO ANNUAL AND QUARTERLY STATEMENT BLANKS AND INSTRUCTIONS

The following establishes procedures and rules of the Financial Condition (E) Committee Blanks Working Group (Blanks (E) Working Group) with respect to proposed amendments to the annual and quarterly statement blanks and instructions.

1. The Blanks (E) Working Group may consider relevant proposals to change the NAIC annual and/or quarterly financial

statement blanks and instructions at any meeting/conference call as scheduled by the Working Group.

2. Suggested changes and amendments filed with the NAIC Central Office shall be considered at the next regularly scheduled meeting of the Blanks (E) Working Group if the proposal is filed at least thirty days prior to the meeting. Items filed less than thirty days prior to a regularly scheduled meeting will be considered at the following regularly scheduled meeting.

3. All proposals shall be stated in a concise and complete form. The submission form and instructions are availa ble online

at https://naic.org/documents/committees_e_app_blanks_blanksagenda_formdoc.doc. An illustration of the format of exhibits or schedules should accompany the submission form. In addition, if another NAIC committee, task force or working group is known to have considered this proposal, that committee, task force or working group should provide any relevant information.

4. The Blanks (E) Working Group will hold meetings/conference calls as needed in order to meet scheduled deadlines (e.g.,

publications and distribution of blanks, instructions, specs., etc.).

5. The proposals should comply with the following time guidelines:

Quarterly proposals: Any proposal that affects a quarterly statement must be effective at the beginning of the year. It must be submitted to the Blanks (E) Working Group staff no later than July 1st of the preceding year, properly proof ed, including sponsorship, and exposed no later than July 15th by email or conference call upon approval by the Working Group Chair. Once exposure has occurred, the proposal(s) will be posted to the Blanks (E) Working Group web page referencing comment deadlines, and an email notification will be sent to the Working Group members, interested regulators and interested parties on the NAIC contact list for the Blanks (E) Working Group.

Any quarterly proposal must be adopted by August 31st Annual proposals: Changes that only affect the annual statement can be submitted at any time and will be addressed at the next scheduled meeting. Those that must be adopted for the current reporting year must be submitted to the Blanks (E) Working Group staff no later than April 1st of the current year (e.g., April 1, 2020, for an annual 2020 change), properly proofed, including sponsorship, and exposed no later than April 15th of the current year by email or conference call upon approval by the Working Group Chair. Following proper exposure, the proposal(s) will be posted to the Blanks (E) Working Group web page referencing comment deadlines. Proposals with an annual effective date of the current year must be adopted no later than June 1st of the current year. Subsequent requests by parent groups of the Blanks (E) Working Group: Proposals presented by a parent group (defined as a group above of the Blanks (E) Working Group in the statutory hierarchy) after the deadlines noted above will be processed as directed by the parent group. Any proposal which includes data capture elements will be evaluated individually as to whether the data capture may be accommodated in that year. Data capture elements received after June 15th of the year of the change (change effective with annual data capture elements statement 2020) will not have vendor crosschecks run until the following year.

Proposals sponsored by other working groups, task forces and subgroups, should have been well vetted at the group level. The Blanks (E) Working Group exposure comment period will be agreed upon by the members as needed to meet the needs of the issue being addressed.

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Changes that do not conform to the time guidelines above are limited to: (a) disclosures required in the current year by the Accounting Practices and Procedures Manual and (b) those items providing instructional clarification of current reporting requirements. These proposals will modify the instructions only, including Notes to Financial Statements, and will not be data captured. If the proposal is to add a Note to Financial Statements that should be data captured, the Note may be added to the instructions in the current year and data captured the first subsequent year-end. The disclosure will not be data captured on a quarterly basis until the first subsequent year end. Any new Note will be added as the last Note to avoid renumbering existing Notes. If necessary, the Note will be renumbered at the first subsequent year-end. If a Note is deleted, the remaining Notes will not be renumbered in the current year but will be renumbered at the first subsequent year-end.

Once proposals are exposed, a meeting/conference call will be scheduled where the Blanks (E) Working Group will review the proposal and determine whether to 1) adopt the proposal 2) reject the proposal, or 3) defer/refer the proposal.

The Blanks (E) Working Group will limit the number of deferrals to “two” based upon the belief the proposal should be revised and resubmitted if it requires further work or input after two meetings At the third meeting, the proposal cannot be deferred again and must be otherwise acted upon. The Blanks (E) Working Group may also refer proposals to other NAIC groups due to their technical expertise or for other review. If a proposal has been referred to another NAIC group, the proposal will come off the Working Group’s agenda and will only be considered again in the form of a new proposal.

6. The NAIC Central Office shall prepare an agenda of all suggestions. One copy of the meeting materials including the

agenda shall be sent to each member of the Blanks (E) Working Group or his/her representative, via email PDF at least 2 business days prior to the next scheduled meeting.




Working Group received for public comment at its prior meeting.

b. NEW ITEMS - The second section of the agenda will be limited to new items.

8. At each meeting, the Blanks (E) Working Group shall not hold any discussions on any substantive item in the agenda under the Items Previously Exposed until (1) the chair or proposal sponsor has briefly stated the agenda item and (2 ) the chair has called for a motion from the members. If a motion is made and seconded, the item is then discussed and voted upon. A motion is not required for the exposure of New Items. Per NAIC procedures, the Working Group Chair should ask if there are any objections to exposing.

9. NAIC staff will present to the Blanks (E) Working Group a list of necessary non-substantive changes discovered in the

process of implementing proposals., e.g., reference changes due to new SSAPs or required changes discovered in the process of implementing proposals. The Working Group will review these changes and may adopt the appropriate items at any regularly scheduled meeting. Such actions will be documented in the minutes of the Working Group. NAIC staf f may also request that the Working Group reconsider items adopted, if these items contain substantial errors.


of certain issues.

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Dear Mary and Calvin, Thank you for the opportunity to comment on Exposure Draft 2019-26BWG. While adding clarifying instructions and a crosscheck are beneficial, we believe that the proposed Line 34 instruction crosscheck on the Analysis of Operations by Lines of Business - Summary page is not accurate as currently written. Line 23, Column 9 of the State Page reports only Life insurance policies in force and does not include Annuity contracts; therefore, only the Life columns 2 and 3 on the new summary page should equal this line. The Annuities columns 4 and 5 should instead agree to the Supplementary and Annuities sections on the Exhibit of Policies, Contracts, Certificates, Income Payable and Account Values in Force for Supplementary Contracts, Annuities A&H and Other (page 27.) Thank you and please let us know if you agree or need any further information. Sincerely, Todd Miller

date: 12/3/19 conference call · y, part 2 and schedule d, part 6, section 1 for reciprocal...

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