Get South Carolina Health Insurance Pool Assessment Base Reporting Form

Filling out the South Carolina Health Insurance Pool Assessment Base Reporting Form accurately is crucial for licensed insurers in South Carolina. This guide provides a clear step-by-step approach to assist users in completing the form online.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the total 2016 direct accident and health premiums written in South Carolina. This amount should match the total premiums shown on the State Page or Schedule T of your Annual Statement.
3. Proceed to the section for premiums excluded from the SCHIP assessment. List any specific categories of coverage provided, such as accident or disability income insurance, credit-only A&H insurance, on-site medical clinic coverage, and others, ensuring to deduct only the amounts included in your total on line one.
4. Calculate the total exclusions by adding together the amounts entered from lines 2(a) to 2(k). Enter this total in the designated space.
5. Next, calculate the 2016 SCHIP assessment base by subtracting the total exclusions (line 2(l)) from the total direct premiums written (line 1). Enter this final amount.
6. Indicate whether your company writes individual major medical insurance in South Carolina by toggling 'Yes' or 'No.' If applicable, enter the 2016 S.C. individual major med premium. If the policy is through a group trust or association, check the designated box.
7. Affix the signature of an authorized officer, along with the printed name, date, and company details. Ensure all contact information for the person filling out the form and the person to receive assessment notices is completed accurately.
8. Once all fields are appropriately filled, save any changes made to the form. You may then download, print, or share your completed form as necessary.

Complete your South Carolina Health Insurance Pool Assessment Base Reporting Form online today.