MEMO WEB FILLABLE

STATE OF HAWAII INSURANCE DIVISION DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS P.O. Box 3614 September 3, 2010 Memorandum 2010-3R Honolulu, HI 96811 TO: All Motor Vehicle Insurers Authorized in the State of Hawaii FROM: Gordon I. Ito, Insurance Commissioner SUBJECT: Annual Publication of Motor Vehicle Insurers and Private Passenger Auto Premiums Pursuant to section 431:10C-210, Hawaii Revised Statutes, as amended by Act 116, Session Laws of Hawaii 2010, the Insurance Commissioner shall publish annually, in a newspaper of general circulation in the state, notice of availability of a list of all motor vehicle insurers with representative annual premiums for motor vehicle insurance. The Hawaii Insurance Division intends to make this listing available on the Division’s website based on insurers’ rates in effect on November 1, 2010. Each insurer shall furnish to the Commissioner representative annual premium quotations no later than October 4, 2010. PDF-fillable worksheets and complete filing instructions are posted at our website. See instructional box below. Any insurer desiring special annotations or exclusion from this publication listing may provide a written request for such consideration by the Commissioner in addition to the insurer’s premium quotations. (Insurers declaring that no new applicants are being accepted must complete worksheets for renewal business). A motor vehicle insurer that does not transact private passenger auto business in Hawaii shall submit a letter stating such exemption. As strict publication deadlines have been imposed, it is imperative that insurers submit accurate reports by the indicated deadline. Pursuant to §431:10C-215 and §431:14-117 HRS, failure to comply may subject your company to a civil penalty of not less than $500 and not to exceed $5,000. The premium quotations will be published as reported to the Commissioner. As such, in no instance shall the fine be less than the cost to reprint the entire premium publication if the reported premiums are determined to be inaccurate. 1. Obtain copies of the pdf-fillable worksheets and complete instructions from our website: Go to: www.hawaii.gov/dcca/areas/ins/commissioners_memo Select: Commissioner’s Memorandum 2010-3R You may submit a written request for printed copies by sending us a self-addressed 9x6 envelope 2. Paper copies of completed worksheets are required to be mailed to the Rate & Policy Analysis Branch: Attention: Rate & Policy Analysis Branch Insurance Division Mailing Address: P.O. Box 3614 Honolulu, HI 96811-3614 Street/Express Address: 335 Merchant Street, 2nd Floor, Room 213 Honolulu, HI 96813 To comply with the reporting deadline, completed worksheets may be e-mailed to RPAdatacall@dcca.hawaii.gov with hard copies to follow. NOTHING TO REPORT: Each Insurer who does not transact private passenger auto business in Hawaii must state such exemption in writing and mail to the Rate & Policy Analysis Branch. Do not e-mail these letters. Insurers who fail to respond may be subject to penalties. Questions may be directed to the Insurance Division’s Rate & Policy Analysis Branch at (808) 586-2809 or RPAdatacall@dcca.hawaii.gov. INSTRUCTIONS FOR COMPLETING THE MOTOR VEHICLE PREMIUM PUBLICATION WORKSHEETS IN COMPLIANCE WITH COMMISSIONER’S MEMORANDUM 2010-3R 1. Complete worksheets for rates in effect November 1, 2010 for a one year policy. 2. The representative premium listing will be based on a new applicant’s request for the minimum coverages required under the Hawaii Motor Vehicle Insurance Law, and may include required optional additional coverages, as follows: $20,000/$40,000 Bodily Injury Liability $10,000 Property Damage Liability $10,000 Personal Injury Protection $20,000/$40,000 Uninsured Motorist Coverage, Stacked $20,000/$40,000 Underinsured Motorist Coverage, Stacked $100 Deductible Comprehensive $500 Deductible Collision Automobile: 2009 Honda Accord LX, 4-door sedan, VIN 1HGCP263&9 (I.S.O., VSR=09-12; OCN=09-14) Note: Premiums are to be provided for a new applicant who is the sole owner of one vehicle. Any discounts/surcharges afforded to new applicants must be separately identified on the worksheet. Rates must be based on a stand-alone policy and not tied to a package policy. 3. Each insurer shall provide representative annual premium quotations no later than October 4, 2010. 4. Be advised of the following requirements: a. If, within the next 90 days, your company is proposing to implement a rate revision, an additional set of worksheets must be completed reflecting your proposed rates. Change the policy effective date on these worksheets from November 1, 2010 to the proposed effective date of the rate revision. Questions may be directed to the Insurance Division’s Rate & Policy Branch. b. Insurers providing motor vehicle policies in accordance with §431-12, Hawaii Revised Statutes, Mass Merchandising of Insurance, shall provide the address, telephone number and name of a contact person at the insurer’s office in the State designated to conduct the administration of its business and handle claims. Insurers may request an additional listing to be labeled as a mass merchandising premium. Worksheets submitted with mass merchandising premiums should be appropriately labeled as mass merchandising. c. Any insurer desiring special annotations or exclusion from this publication listing may provide a written request for such consideration by the Commissioner in addition to the insurers’ premium quotations. (Insurers declaring that no new applicants are being accepted must complete worksheets for renewal business). d. A motor vehicle insurer that does not transact private passenger auto business in Hawaii shall submit a letter stating such exemption. 5. Copies of the pdf-fillable worksheets are available at our website: Go to: www.hawaii.gov/dcca/areas/ins/commissioners_memo Select: Commissioner’s Memorandum 2010-3R Written requests for printed copies may be submitted to us by sending us a self-addressed 9x6 envelope 6. All insurers authorized to write motor vehicle insurance in the State of Hawaii must respond to this memorandum no later than October 4, 2010 or they may be subject to penalties: a. Mail paper copies of completed worksheets to the Rate & Policy Analysis Branch: Attention: Rate & Policy Analysis Branch Insurance Division Mailing Address: Street/Express Mailing Address: P.O. Box 3614 335 Merchant Street, 2nd Floor, Room 213 Honolulu, HI 96811-3614 Honolulu, HI 96813 To comply with the reporting deadline, completed worksheets may be e-mailed to RPAdatacall@dcca.hawaii.gov with hard copies to follow. b. NOTHING TO REPORT Each Insurer who does not transact private passenger auto business in Hawaii must state such exemption in writing and mail to the Rate & Policy Analysis Branch. Do not e-mail these letters. Insurers who fail to respond may be subject to penalties. If your rating factors for pleasure use, clear driving record, and single vehicle are other than 1.00, you must complete Worksheet A-Supplement in addition to the physical damage portion of this worksheet. Insurance Company Company's latest rate level adjustment effective as of: HAWAII PREMIUM QUOTATIONS Policy Effective Date: November 1, 2010 Automobile: 2009 Honda Accord, LX, 4-Dr Sedan (I.S.O., V.S.R. = 09-12) Symbol Age/Model Year Classification: Pleasure Use, Clear Driving Record Primary Rating Factor Secondary Rating Factor (1) Base Premium (2) Primary + Secondary Rating Factor (3) *Other Rating Factor (4) *Other Rating Factor (5) ANNUAL PREMIUM Territory 01 – Oahu $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Territory 03 – Maui $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: Territory 04 – Kauai $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: Territory 05 – Hawaii $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: (S) = stacked Total: *Other Rating Factors - Explain: Responsible Officer: (Name/Title) WORKSHEET A Insurance Company Company's latest rate level adjustment effective as of: HAWAII PREMIUM QUOTATIONS Policy Effective Date: November 1, 2010 Automobile: 2009 Honda Accord, LX, 4-Dr Sedan (I.S.O., V.S.R. = 09-12) Symbol Age/Model Year Classification: Pleasure Use, One (1) Accident, $1,000 Property Loss Only Primary Rating Factor Secondary Rating Factor No Surcharge On At-Fault Accidents Under $ (1) Base Premium (2) Primary + Secondary Rating Factor (3) *Other Rating Factor (4) *Other Rating Factor (5) ANNUAL PREMIUM Territory 01 – Oahu $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Territory 03 – Maui $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: Territory 04 – Kauai $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: Territory 05 – Hawaii $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) Total: SUB TOTAL: (S) = stacked Total: *Other Rating Factors - Explain: Responsible Officer: (Name/Title) WORKSHEET B Insurance Company Company's latest rate level adjustment effective as of: HAWAII PREMIUM QUOTATIONS Policy Effective Date: November 1, 2010 Automobile: 2009 Honda Accord, LX, 4-Dr Sedan (I.S.O., V.S.R. = 09-12) Symbol Age/Model Year Classification: Pleasure Use, One (1) Speeding Conviction Primary Rating Factor Secondary Rating Factor (1) Base Premium (2) Primary + Secondary Rating Factor (3) *Other Rating Factor (4) *Other Rating Factor (5) ANNUAL PREMIUM Territory 01 – Oahu $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 03 – Maui $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 04 – Kauai $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 05 – Hawaii $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: (S) = stacked *Other Rating Factors - Explain: Responsible Officer: (Name/Title) (Address) (Phone) WORKSHEET C Insurance Company Company's latest rate level adjustment effective as of: HAWAII PREMIUM QUOTATIONS Policy Effective Date: November 1, 2010 Automobile: 2009 Honda Accord, LX, 4-Dr Sedan (I.S.O., V.S.R. = 09-12) Symbol Age/Model Year Classification: Pleasure Use, One (1) Driving Under Influence With Proof of Financial Responsibility (SR-22) Primary Rating Factor Secondary Rating Factor SR-22 Rating Factor [ [ ] Insurer does not accept NEW applicants with DUI conviction ] Insurer does not accept NEW applicants with Administrative License Revocations (1) Base Premium (2) Primary + Secondary Rating Factor (3) *Other Rating Factor (4) *Other Rating Factor (5) ANNUAL PREMIUM Territory 01 – Oahu $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 03 – Maui $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 04 – Kauai $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: Territory 05 – Hawaii $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) $100 Ded Comp $500 Ded Coll (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Total: (S) = stacked *Other Rating Factors - Explain: Responsible Officer: (Name/Title) WORKSHEET D Insurance Company Company's latest rate level adjustment effective as of: HAWAII PREMIUM QUOTATIONS Policy Effective Date: November 1, 2010 Automobile: 2009 Honda Accord, LX, 4-Dr Sedan (I.S.O., V.S.R. = 09-12) Symbol Age/Model Year Other Territory (describe): (1) (2) (3) (4) (5) Primary + Secondary *Other *Other Rating Rating Rating ANNUAL Base Premium Factor Factor Factor PREMIUM Worksheet A Profile: Pleasure, Clear Driving Record $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: $100 Ded Comp $500 Ded Coll Total: Worksheet B Profile: Pleasure, 1 Accident Under $1,000 Property Loss $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: $100 Ded Comp $500 Ded Coll Total: Worksheet C Profile: Pleasure, 1 Speeding Conviction $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: $100 Ded Comp $500 Ded Coll Total: Worksheet D Profile: Pleasure, 1 DUI Conviction With SR-22 $20,000/40,000 BI $10,000 PD $10,000 Basic PIP $20,000/40,000 UM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: $100 Ded Comp $500 Ded Coll Total: (S) = stacked *Other Rating Factors - Explain: Responsible Officer: (Name/Title) WORKSHEET OT (file only if applicable) If your rating factors for pleasure use, clear driving record, and single vehicle are other than 1.00, you must complete Worksheet A-Supplement in addition to the physical damage portion of Worksheet A. Insurance Company Company's latest rate level adjustment effective as of: DETERMINATION OF RATES AT BASE LIMITS Policy Effective Date: November 1, 2010 Classification: Pleasure Use Clear Driving Record Automobile: 2009 Honda Accord, LX, 4-Dr Sedan Symbol Single Vehicle (I.S.O., V.S.R. = 09-12) Age/Model Year One Registered Owner One Driver/One Vehicle As Reflected in Manual Disclose all rating relativities used in deriving annual base rates to adjust to: (9) (1) (2) (3) (4) (5) (6) (7) (8) ANNUAL BASE RATES AT MINIMUM Limits Rates Min Required Pleasure Clean Single *Other REQUIRED STATUTORY LIMITS FOR SINGLE *Other Statutory Use Driving Vehicle Adjustment Adjustment VEHICLE ONE REGISTERED OWNER Territory 01 – Oahu Limits Record BI $20,000/40,000 BI PD $10,000 PD PIP $10,000 Basic PIP UM (S) $20,000/40,000 UM (S) UIM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Territory 03 – Maui BI $20,000/40,000 BI PD $10,000 PD PIP $10,000 Basic PIP UM (S) $20,000/40,000 UM (S) UIM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Territory 04 – Kauai BI $20,000/40,000 BI PD $10,000 PD PIP $10,000 Basic PIP UM (S) $20,000/40,000 UM (S) UIM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: Territory 05 – Hawaii BI $20,000/40,000 BI PD $10,000 PD PIP $10,000 Basic PIP UM (S) $20,000/40,000 UM (S) UIM (S) $20,000/40,000 UIM (S) (TO BE REPORTED ON SUMMARY SHEET) SUB TOTAL: (S) = stacked *Other Rating Factors - Explain: Responsible Officer: (Name/Title) WORKSHEET A-Supplement (file only if applicable) Insurance Company Personal Auto Program SUMMARY SHEET RATES IN EFFECT November 1, 2010 Regular, Mass Merchandising, Pending Rate Filing or Other (please clarify) Record the subtotals from worksheets A (or A-Supplement), B, C, and D below: Subtotals = $20,000/40,000 BI $10,000 PD $10,000 PIP $20,000/40,000 UM, STACKED $20,000/40,000 UIM, STACKED ANNUAL PREMIUM SUB TOTALS Worksheet A (or A-Supplement) (Pleasure, Clear record) Worksheet B (Pleasure, 1 accident, $1,000 property loss) Worksheet C (Pleasure, 1 speeding conviction) Worksheet D (Pleasure, 1 DUI conviction w/SR-22) Oahu (01) Maui (03) Kauai (04) Hawaii (05) Other Territory* * Insurers with other territories must complete worksheet OT Responsible Officer: (Name/Title) (Address) (E-Mail) (Phone)