Form Ins7218 – Fill Out and Use This PDF

Risk Assessment

Ohio Department of Insurance

50 W. Town St., 3rd Fl.

John R. Kasich – Governor

Suite 300

Mary Taylor – Lt. Governor/Director

Columbus, OH 43215

(614) 644-2647

Fax (614) 644-3256

Reinsurance Agreement Review Form D

www.insurance.ohio.gov

Company Name:

NAIC #

Control #

Date Submitted:

Deemer Date:

Analyst Review:

Date:

Supervisor Review:

Date:

STEP 1 - REVIEW THE FILING IN ITS ENTIRETY AND COMPLETE THE ITEMS BELOW. DOCUMENT ALL NEGATIVE RESPONSES AND RELEVANT FACTS OR ISSUES WITH THE FILING IN THE REMARKS SECTION.

2) Are the following terms and conditions provided in the Agreement?

			Remarks
Reinsurer:	Yes	No
Reinsured:	Yes	No
Business covered:	Yes	No
Effective Date:	Yes	No
Limits of Liability:	Yes	No
Net Retention:	Yes	No
Loss occurrence:	Yes	No
Loss & Loss adjustment expense:	Yes	No
Ceded premium:	Yes	No
Reports and Remittances:	Yes	No
Cancellation/Termination provision:	Yes	No
Access to records:	Yes	No
Offset:	Yes	No
Insolvency:	Yes	No
Cut-through language:	Yes	No
Unauthorized reinsurer:	Yes	No
Recapture:	Yes	No
Experience refunds:	Yes	No
Arbitration:	Yes	No

Additional Remarks:

3) Is the Agreement only between affiliated parties?		Yes	No
Remarks:

	Accredited by the National Association of Insurance Commissioners (NAIC)
INS7218 (Rev. 01/2011)	Page 1 of 2

Ohio Department of Insurance	Reinsurance Agreement Review Form D

7) Are there any terms in the Agreement that are unclear or need clarification?		Yes	No
Remarks:

8)What is the estimated amount of liability to be ceded and/or assumed each year by the Domestic insurer? Remarks:

9)What is the estimated period of time the Agreement is to be in effect? Remarks:

10)What is the type and dollar amount of consideration (premiums ceded/assumed, reserves transferred, etc.)? Remarks:

11)What is the effect of the reinsurance agreement on the Domestic company regarding the following (note if there is a polling agreement in place)?

Remarks

Surplus:

Risk-Based Capital:

Financial Strength Ratings:

B/S and I/S items:

12)Does the Form D contain the required signature and certification? Remarks:

13)Are there any other issues or concerns with the filing that may require follow up with the company? Remarks:

14)Recommendation (include revisions to the agreement): Remarks:

STEP 2 - IF THERE ARE NO MATERIAL CONCERNS, PREPARE RECOMMENDATION FOR SUPERVISOR REVIEW. IF ADDITIONAL INFORMATION IS NEEDED, CONTACT COMPANY. INDICATE TO THE COMPANY IF FILING WILL BE DENIED AND NEEDS TO BE REFILED.

	Accredited by the National Association of Insurance Commissioners (NAIC)
INS7218 (Rev. 01/2011)	Page 2 of 2