MEMORANDUM


TO: Members of the Georgia Self-Insurers Guaranty Trust Fund

FROM: John P. Reale, Administrator

DATE: December 1, 2010

RE: Important Changes, Notifications, and Reminders


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2011 will be an important year regarding changes for members of the Fund. Due to new legislative changes, a new fee structure will be implemented on January 1, 2011, which will include minimum assessments increasing from $1,000 to $2,000, and maximum assessments increasing from $4,000 to $8,000.


Also, please note the following changes to the 2011 Member Information Update Form:

1. Regarding question #1 for Active & Cancelled Members:

State the company name in which your self-insurance is registered. State the name of the person who is our primary contact person at the member company, along with his/her address and telephone number.

State the name of the person who is our secondary contact, along with his/her address and telephone number.

2. Regarding question #2 for Active & Cancelled Members:

Revised State Board of Workers’ Compensation contact name, telephone number and e-mail address.

3. Regarding question #2B for Active & Cancelled Members:

Attach a copy of your third-party administrator’s Georgia TPA license. Please note, such license can be obtained by contacting the Office of Insurance and Safety Fire Commissioner at (404) 656-2056. Added language: If your TPA is exempt from licensure, please provide a copy of the signed exemption letter. For an example of the exemption letter, please visit our website at www.gaguaranty.com.

4. Regarding Question #8 for Active Members (N/A for Cancelled Members)

Was there a change in ownership of your company last year, or did you buy or sell subsidiary companies last year? Moved from question #29 on the active member form.

5. Regarding Question #17 for Active Members & Question #13 for Cancelled Members

Submit a loss run, as of 12/31/10, for your company, and a separate loss run for subsidiaries and affiliates, if any.

Submission of the loss run for your company may be made by thumb drive or CD, if preferable.

Please note, once data is submitted, no changes may be made. Please ensure accuracy of data before sending.

6. Regarding Question #18 for Active Members & Question #14 for Cancelled Members

Please attach a written explanation of any variance of 20% or more in the total medical, indemnity, and/or reserve data that you reported on last year’s update form. Moved from question #21 on the active member form, and question #27 on the cancelled member form.

7. Regarding Question #19 for Active Members & Question #15 for Cancelled Members

Please attach a list of all claims designated to be catastrophic along with their respective reserves. Added language: If none, please indicate N/A here: _____________.

8. Regarding Question #19 for Active Members & Question #17 for Cancelled Members

Captive insurance endorsement. Removed language, “per your agreement with this employer”.

Captive endorsement page to be completed by captive insurer, requesting the following information: Endorsement Number, Named Insured, Policy Number, with Authorized Representative signature, and date. Added contact information for Fund and State Board of Workers’ Compensation.

9. Regarding Question #26 for Active Members & Question #25 for Cancelled Members
1.)

Please advise who is responsible for notifying your excess carrier of claims eligible for reimbursement.

2.)

Please advise who is responsible for notifying the SITF of claims eligible for reimbursement.

10. Regarding Question #31 for Active Members & Question #28 for Cancelled Members

For submitting audited financial statements, if preferable, list your company’s website address.

Should you have any questions, please do not hesitate to contact us at the number listed above.

Thank you in advance for your cooperation.