STATUS OF ITEM FILINGS



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National Council on Compensation Insurance Regulatory Services JUNE 3, 2016 STATUS OF ITEM FILINGS IF-2016-06-01 ACTION NEEDED BACKGROUND IMPACT NCCI ACTION PERSON TO CONTACT Review changes in the Status of Item Filings for impact on your company s system. This circular contains national item and state filing approvals, disapprovals, withdrawals, etc., that have been filed with the regulators as of the date of this circular. It is updated on a weekly basis and is labeled so that readers can understand what version of the circular they are reviewing. For example, the first circular released in the month of July 2015 is labeled IF-2015-07-01. The 01 symbolizes the first update for the month of July. The second through fourth weeks of the month are labeled 02 04, respectively. For item filing details, please refer to the announcement circular identified for each item filing. States with statuses that have changed are boldfaced and shaded. See the following chart for a list of changes by state. Arkansas law does not permit NCCI to file rules and rates on its members behalf. Therefore, insurance carriers must make an independent filing with the Arkansas Insurance Department electing to adopt, or not adopt, an item filing filed by NCCI and subsequently approved by the Department. When such a filing is made with the Department, make sure that the NCCI item filing number (not the NCCI circular number) is referenced. NCCI will continue to monitor and issue updates. Additionally, for all item filings that contain a Form that will be published in NCCI s Forms Manual of Workers Compensation and Employers Liability Insurance, NCCI will provide a downloadable link to this Form upon receipt of approval from the regulatory authority. To purchase or request further information regarding the distribution of this circular, state-specific filing/approval circulars, and manual pages, contact the Customer Service Center at 800-NCCI-123. For memorandum and manual page distribution, call 800-NCCI-123. For item-specific content, refer to specific item status for the Technical Contact. 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 1 of 9

Glossary of Terms: Purpose Intent of filing. Impacted Industries in This Item Identifies the impacted industries for national class item filings only. Effective Date The date that the item is proposed to be effective. Announcement The circular number and date of the NCCI circular detailing the content of the indicated item filing. Technical Contact The person to be contacted for information relating to the content of the item filing. Pending The insurance regulatory authority in the jurisdiction shown has not taken formal action to approve or disapprove the item filing. Recommended NCCI provided a copy of the item filing to the independent rating bureau for consideration. Subscribers should contact the independent rating bureau for further details and status. Effective The insurance regulatory authority in the jurisdiction shown has approved the item filing. Not Applicable The change(s) contained in the item filing is not accepted or recognized in the jurisdiction shown below. Not Filed The item filing was not filed with the insurance regulatory authority in the jurisdiction shown because the change(s) contained in the item filing is either already in place or the jurisdiction is a monopolistic state in which NCCI does not submit item filings. This term also applies to all states that are pending committee review or regulator prefiling review. Disapproved The insurance regulatory authority in the jurisdiction shown has taken action to disapprove the item filing. Withdrawn The rating organization has taken action to withdraw the filing made with the insurance regulatory authority in the jurisdiction shown. Form Downloadable, if Applicable Approved endorsements. Manual Publication Anticipated manual(s) publication date(s). 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 2 of 9

ITEM B-1429 ESTABLISHMENT OF AUDIT NONCOMPLIANCE CHARGE PURPOSE This item establishes an Audit Noncompliance Charge (ANC) rule, endorsement, and statistical code to enable a carrier to apply an ANC to employers that do not allow the carrier to examine and audit their records in NCCI s Basic Manual for Workers Compensation and Employers Liability Insurance, Statistical Plan for Workers Compensation and Employers Liability Insurance, Forms Manual of Workers Compensation and Employers Liability Insurance, and Assigned Carrier Performance Standards. EFFECTIVE DATE January 1, 2017 ANNOUNCEMENT CIRCULAR CIF-2015-12 TECHNICAL CONTACT Miriam Jereda 561-893-3192 PENDING RECOMMENDED CA, MA, MI, MN, NJ, NY EFFECTIVE AL(2), AR(1), AZ(4), CO(7), CT(4), DC(4), DE(17), FL(12), GA(2), HI(10), IA(2), ID(1), IL(11), KS(12), KY(1), LA(4), MD(5), ME(1), MN(20), MO(7), MS(6), (16),NC(15), NE(5), NH(9), NM(4), NV(13), OK(3), OR(14), PA(18), RI(12), SC(8), SD(1), TN(4), UT(2), VA(6), VT(5), WI(19), WV(5) TOTAL NUMBER OF STATES 39 APPROVED NOT APPLICABLE IN NOT FILED ND, OH, WA, WY DISAPPROVED AK, WITHDRAWN FORM DOWNLOADABLE, IF WC 00 04 24, WC 24 06 04 B, WC 25 04 01 A APPLICABLE MANUAL PUBLICATION(S) Published by October 2016. (1) Refer to Approval CIF-2015-13. (2) Refer to Approval CIF-2015-14. (3) Refer to Approval CIF-2015-15. (4) Refer to Approval CIF-2015-16. (5) Refer to Approval CIF-2015-18. (6) Refer to Approval CIF-2015-21. (7) Refer to Approval CIF-2015-23. (8) Refer to Approval CIF-2015-26. (9) Refer to Approval CIF-2015-29. (10) Refer to Approval CIF-2015-30. (11) Refer to Approval CIF-2015-34. (12) Refer to Approval CIF-2015-38. (13) Refer to Approval CIF-2015-42. (14) Refer to Approval CIF-2015-49. (15) Refer to the North Carolina Rate Bureau Letter # C-15-21, dated November 5, 2015. (16) Refer to Approval CIF-2015-58. (17) Refer to DCRB #915, dated March 9, 2016. (18) Refer to PCRB #1655, dated March 9, 2016. 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 3 of 9

(19) Refer to WCRB #3134, dated March 18, 2016. (20) Refer to MWCIA Letter # 16-1688, dated May 5, 2016. ITEM B-1430 ELIMINATION OF ANNIVERSARY RATING DATE (ARD) PURPOSE This item eliminates or revises rules and endorsements that reference anniversary rating date (ARD) in NCCI s Basic Manual for Workers Compensation and Employers Liability Insurance, Experience Rating Plan Manual for Workers Compensation and Employers Liability Insurance, Statistical Plan for Workers Compensation and Employers Liability Insurance, and Forms Manual of Workers Compensation and Employers Liability Insurance. EFFECTIVE DATE May 1, 2017 ANNOUNCEMENT CIRCULAR CIF-2015-25 TECHNICAL CONTACT Linda Bello 803-356-8050 PENDING RECOMMENDED CA, MA, MN, NJ, NY, WI EFFECTIVE AK(3), AL(2), AR(1), AZ(1), CO(8), CT(1), DC(2), DE(11), FL(9), GA(1), HI(2), IA(1), ID(1), IL(3), IN(6), KS(6), KY(1), LA(5), MD(3), ME(1), MI(10), MO(4), MS(1), (6), NC(7), NE(4), NH(2), NM(2), NV(1), OK(1), OR(4), PA(12), RI(3), SC(2), SD(2), TN(1), UT(1), VA(6), VT(2), WV(4) TOTAL NUMBER OF STATES 40 APPROVED NOT APPLICABLE NOT FILED ND, OH, WA, WY DISAPPROVED WITHDRAWN FORM DOWNLOADABLE, IF APPLICABLE Form 19-1D, Form 45-3D, Form NC-5000 B, WC 02 03 01 A, WC 09 04 02 A, WC 15 03 03 B, WC 16 03 02 B, WC 17 06 01 G, WC 25 03 01 A, WC 26 03 01 A, WC 26 03 02 A, WC 26 04 01 A, WC 27 03 01 C, WC 36 04 04 A, and WC 43 03 02 A Notes: 1. Information Page Notes (WC 00 00 01 C) includes information related to completing the Information Page; there is no form downloadable for WC 00 00 01 C. 2. State-specific endorsements are provided for states that have approved Item B-1430. MANUAL PUBLICATION(S) Published by February 2017. (1) Refer to Approval CIF-2015-31. (2) Refer to Approval CIF-2015-35. (3) Refer to Approval CIF-2015-39. (4) Refer to Approval CIF-2015-43. (5) Refer to Approval CIF-2015-46. (6) Refer to Approval CIF-2015-47. (7) Refer to the North Carolina Rate Bureau Letter # C-15-15, dated September 28, 2015. (8) Refer to Approval CIF-2015-52. (9) Refer to Approval CIF-2015-53. 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 4 of 9

(10) Refer to Michigan Workers Compensation Placement Facility Center Letter #268, dated March 24, 2016. (11) Refer to Delaware Compensation Rating Bureau No. 916, dated May 25, 2016. (12) Refer to Pennsylvania Compensation Rating Bureau No. 1659, dated May 25, 2016. B-1431 REVISIONS TO BASIC MANUAL CLASSIFICATIONS AND APPENDIX E CLASSIFICATIONS BY HAZARD GROUP PURPOSE IMPACTED INDUSTRIES IN THIS ITEM EFFECTIVE DATE This item revises, establishes, and eliminates certain classifications in NCCI s Basic Manual for Workers Compensation and Employers Liability Insurance (Basic Manual). National Classifications With Low Credibility to Be Eliminated; State Special Classifications With Low Credibility to Be Eliminated; Classifications to Be Reformatted This item will become effective concurrently with each state s approved rate/loss cost filing on and after October 1, 2016. Refer to the filing memorandum, which can be found as an attachment in CIF-2015-56, for state-specific effective dates. CIF-2015-56, OR-2016-05 ANNOUNCEMENT CIRCULAR TECHNICAL CONTACT Veruschka (561) 893-3198 PENDING RECOMMENDED CA, DE, MA, MI, MN, NC, NJ, NY, PA EFFECTIVE TOTAL NUMBER OF STATES 36 APPROVED NOT APPLICABLE NOT FILED DISAPPROVED WITHDRAWN FORM DOWNLOADABLE, IF 45-3C, 09-4D APPLICABLE MANUAL PUBLICATION(S) Published by September 2016. AK(10), AL(2), AR(1), AZ(1), CO(4), CT(5,6), DC(3), FL(8), GA(5), HI(3), IA(1), ID(4), IL(1), IN(3), KS(2), KY(1), LA(2), MD(1), ME(1), MO(4), MS(1), NE(3), NH(2), NM(1), NV(3), OK(2), OR(7), RI(5), SC(6), SD(3), TN(3), UT(1), VA(6), VT(2), WI(9), WV(4) (1) Refer to Approval CIF-2015-57. (2) Refer to Approval CIF-2015-59. (3) Refer to Approval CIF-2015-60. (4) Refer to Approval CIF-2015-63. (5) Refer to Approval CIF-2016-02. (6) Refer to Approval CIF-2016-05. (7) Refer to Approval CIF-2016-06. (8) Refer to Approval CIF-2016-08. (9) Refer to the Wisconsin Compensation Rating Bureau Letter 3139, dated April 21, 2016. (10) Refer to Approval CIF-2016-12. 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 5 of 9

ITEM E-1404 ESTABLISHMENT OF A METHODOLOGY TO CALCULATE EXPERIENCE RATING PREMIUM ELIGIBILITY AMOUNTS PURPOSE This item establishes a methodology for NCCI to calculate and update the experience rating premium eligibility amounts. State-specific premium eligibility amounts will be calculated annually and indexed based on the year-to-year change in a state s Average Weekly Wage, as estimated by the US Bureau of Labor Statistics Quarterly Census of Employment and Wages (QCEW). This item includes the first annual indexed calculation of each state s premium eligibility amounts. Subsequent annual calculations will be included in a state s loss cost/rate filing. EFFECTIVE DATE This item becomes effective for risks with rating effective dates six months and later after a state s loss cost/rate effective date, beginning with loss cost/rate effective dates on and after January 1, 2017. ANNOUNCEMENT CIRCULAR CIF-2015-61 TECHNICAL CONTACT Bill Dodds PENDING MA, NC,, VA RECOMMENDED CA, DE, MI, NJ, NY, PA, WI EFFECTIVE AK(5), AL(2), AR(1), AZ(1), CO(7), CT(1), DC(4), FL(9), GA(5), HI(3), IA(2), ID(2), IL(2), IN(2), KS(4), KY(1), LA(1), MD(5), ME(1), MN(10), MO(6), MS(1), (2), NE(5), NH(2), NM(2), NV(1), OK(3), OR(2), RI(6), SC(2), SD(1), TN(1), UT(8), VT(3), WV(2) TOTAL NUMBER OF STATES 36 APPROVED NOT APPLICABLE NOT FILED ND, OH, WA, WY DISAPPROVED WITHDRAWN MANUAL PUBLICATION(S) Published by January 2017. (1) Refer to Approval CIF-2015-62. (2) Refer to Approval CIF-2015-64. (3) Refer to Approval CIF-2016-01. (4) Refer to Approval CIF-2016-03. (5) Refer to Approval CIF-2016-04. (6) Refer to Approval CIF-2016-07. (7) Refer to Approval CIF-2016-09. (8) Refer to Approval CIF-2016-10. (9) Refer to Approval CIF-2016-11. (10) Refer to Minnesota Compensation Insurers Association No. 16-1682, dated March 10, 2016. 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 6 of 9

State AK FL GA MD Item 01-AK-2016 Establishment of Alaska Exceptions to Rules 2-B-1-P and 2-B-2-H in NCCI s Basic Manual 01-FL-2016 Establishment of the Florida Workers Compensation Insurance Guaranty Association Surcharge Notification Endorsement (WC 09 06 07) 02-GA-2015 Establishment of a Georgia Work-Based Learning Program Premium Credit 01-MD-2016 Establishment of Maryland Special Classification for Governmental Occupations 02-- 2015 Revisions to the Montana Experience Rating Subject Premium Eligibility Amounts 03-- 2015 Revisions to Basic Manual Classifications and Appendix E Classifications by Hazard Group 04-- 2015 Revisions to Montana Cancelation and Nonrenewal Endorsement (WC 25 06 01 A) 01-- 2016 Revisions to Basic Manual Rules and Classifications 02-- 2016 Montana Construction Executive Supervisors Announcement STATUS OF STATE ITEM FILINGS Approval Effective Date Status Form Downloadable, if Applicable Technical Contact AK-2016-03 AK-2016-04 7/1/16 Approved Veruschka FL-2016-02 7/1/16 Pending Pending Veruschka GA-2015-03 GA-2016-01 7/1/16 Approved Veruschka MD-2016-01 MD-2016-02 1/1/17 Approved Bill Dodds N/A -2015-07 7/1/16 Approved Miriam Jereda 561-893-3192 N/A -2015-09 7/1/16 Approved Miriam Jereda 561-893-3192-2015-10-2015-11 4/1/16 Approved WC 25 06 01 B Bill Dodds -2016-01 -2016-04 7/1/16 Approved Bill Dodds -2016-05 -2016-07 7/1/16 Approved Sean Cordell 561-893-3171 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 7 of 9

State NH OR OR OR SC Item 03-- 2016 Montana Occupational Safety and Health Regulatory Assessment Surcharge 01-NH- 2016 Revisions to Basic Manual Classifications and Appendix E Classifications by Hazard Group for Homemaker Service Workers 01-OR- 2016 Revisions to Oregon Premium Algorithms to Clarify the Balance to Minimum Premium Calculation 02-OR-2016 Establishment of Oregon Amendatory Endorsement (WC 36 06 04) 03-OR- 2016 Revisions to Basic Manual Classifications for Solar Panel and Solar Roofing Tile Installation or Repair 01-SC- 2016 Revision to South Carolina Schedule Rating Plan 01--2015 Revisions to Basic Manual, Forms Manual, and Statistical Plan 01-- 2016 Elimination of A-Rating Process for Classification and Statistical Codes in NCCI s Manuals Announcement STATUS OF STATE ITEM FILINGS (Cont'd) Approval Effective Date Status Form Downloadable, if Applicable Technical Contact N/A -2016-08 7/1/16 Approved Linda Bello 803-356-8050 NH-2016-01 NH-2016-02 4/1/16 Approved Linda Bello 803-356-8050 OR-2016-01 OR-2016-03 4/1/16 Approved Bill Dodds OR-2016-06 OR-2016-07 1/1/17 Approved WC 36 06 04 Bill Dodds OR-2016-02 OR-2016-04 7/1/16 Approved Bill Dodds SC-2016-03 SC-2016-04 9/1/16 Approved Linda Bello 803-356-8050-2015-05-2016-02 7/1/16 Approved WC 42 03 01 H Veruschka -2016-01 7/1/17 Pending Veruschka 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 8 of 9

State Item 02-- 2015 Revisions to Basic Manual Rule 3-A-24- c Terrorism and the Texas Workers Compensation Premium Algorithm Announcement STATUS OF STATE ITEM FILINGS (Cont'd) Approval Effective Date Status Form Downloadable, if Applicable Technical Contact -2015-06 -2016-03 7/1/16 Approved Veruschka 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. ncci.com Page 9 of 9