California Plain Language Spreadsheet v.1

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.