separator
Skip to Contentseparator HomeseparatorCheck License StatussepartorContact UssepartorRequest for Assistance
Welcome to the California Department of Insurance
Site tools
Decrease font size Increase font size Site map Help Print-friendly version
California Plain Language Spreadsheet

This spreadsheet is available in Excel format.  Insurance companies should submit the spreadsheet in Excel format when submitting rate filings.

California Plain Language Spreadsheet, v. 1
Company Name:
Company ID number for this filing:
SERFF ID number for this filing:

Text of form cells:
Column A: Policy Form Number
Column B: Marketing Name

For all subsequent columns, the following instruction applies: for the expense period on which the rates are based, premium attributed to:

Column C: Medical Costs prior to rate increase
Column D: Medical Costs after rate increase
Column E: Administrative costs prior to rate increase
Column F: Administrative costs after rate increase
Column G: Profit/margin projected prior to rate increase
Column H: Profit/margin projected after rate increase
Column I: Comments
End of text of form cells.

separator