This reporting form is for use by captive insurers.
Captive insurers that wrote TRIP-eligible lines of insurance in 2021 but did not provide any terrorism risk insurance subject to TRIP under any policy, are not required to report. This is the case even if the captive insurer provided terrorism risk insurance in years prior to 2021.
Captive Insurers that are part of a larger group that is subject to reporting on either the Small Insurer template or the Insurer (Non-Small) Groups or Companies template should report on the appropriate template and not use this reporting form.
Offshore captive insurers that are licensed to write insurance in any U.S. jurisdiction, and which write terrorism risk insurance subject to TRIP are required to report and should identify themselves using their OLC Code.
All information should be reported on a consolidated insurer group basis, unless reporting for a single insurer.
When providing premium on a jurisdictional basis, premium should be allocated in the same fashion that it is for state reporting and premium tax purposes. Accordingly, coverage written by captive insurers may be allocated in full to their state of domicile or licensure.
Note: This allocation method should not be applied on the Geographic Exposures worksheet, which seeks information based upon the location of the exposure, regardless of the manner in which the premium may have been allocated.
When providing premium on a jurisdictional basis, for premium which is otherwise not allocable to a particular jurisdiction (e.g.: certain Ocean Marine, Inland Marine, and Aviation coverages; or coverages based upon foreign operations with a U.S. nexus), report this premium under “Other/Not Subject to Allocation in a Particular Jurisdiction.”
DEP should be included in this calculation to the extent that commercial property and casualty coverage is issued for losses occurring at the following locations: (1) Within the United States; (2) With respect to an air carrier (as defined in section 40102 of title 49, United States Code), or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States); and (3) At the premises of any U.S. mission.
TRIP-eligible lines to be included in DEP calculations generally correspond to NAIC lines (as reported on the NAIC Exhibit of Premiums and Losses, commonly known as Statutory Page 14). The information reported on this worksheet should only include TRIP-eligible DEP. Any amounts reported on Statutory Page 14 that are not within the scope of TRIP-eligible lines as defined by the Program regulations should not be reported here [see 31 CFR 50.4(w)]. Specifically:
The property line Allied Lines (NAIC Line 2.1) should not include federal crop insurance or any other type of crop insurance privately issued or reinsured.
Workers’ Compensation (NAIC Line 16) data should only include primary workers’ compensation coverage written on an admitted basis. Do not include premium associated with workers’ compensation deductible reimbursement (reported in Row 13) or excess workers’ compensation (reported in Row 14 and identified as sub-type of insurance 16.003 on the NAIC’s Uniform Property & Casualty Product Coding Matrix and otherwise reported under 17.3 as indicated).
The liability line of Other Liability (NAIC Line 17) should not include Professional Errors and Omissions Liability Insurance [see 31 CFR 50.4(t)] or Excess Workers’ Compensation Premium (which is entered separately as noted above).
Deductible reimbursement policies (other than workers’ compensation) that fall within a TRIP-eligible line should be reported under that line on the Direct Earned Premium by Jurisdiction Worksheet, the Exposures by Jurisdiction Worksheet, and/or the Geographic Exposures (Nationwide) Worksheets
Information is sought concerning policies that will or would have responded to “certified acts of terrorism” during the reporting period. The fact that the policy did not in fact make payments for claims associated with any certified acts of terrorism is not relevant to the obligation to report information.
For purposes of this data collection, reporting insurers do not need to make the premium adjustments in connection with residual market mechanisms provided for under 31 CFR 50.33.
Policy count should be calculated based on the number of policies incepting in 2021 (or otherwise in effect for the entire year). For reporting other elements apart from DEP, where the reporting of information (e.g., exposures) under policies in effect during 2021 would result in double counting for the year as a whole, utilize a reporting date of December 31, 2021.
Information subject to reporting under the Standalone Terrorism (Nationwide) Worksheet and Cyber (Nationwide) Worksheet should be considered a subset of an insurer’s TRIP-eligible policies, and should also be reported on additional worksheets, as appropriate.
All exposure information should be reported gross of any private reinsurance, except where otherwise indicated.
Questions on the Reinsurance (Nationwide) Worksheet are limited to reinsurance purchased from unaffiliated third-party companies, and do not include reinsurance transactions within a group of affiliated insurers.
Blacked out cells indicate that no data will be reportable for that particular cell.
Hypothetical policy situations demonstrating proper data completion are available on the TRIP website (https://home.treasury.gov/policy-issues/financial-markets-financial-institutions-and-fiscal-service/federal-insurance-office/terrorism-risk-insurance-program/annual-data-collection).
Affiliations Worksheet:
For Type of Insurer on the Affiliations Worksheet, an option on the dropdown menu for Alien Surplus Lines Insurer has been included.
Premium (Jurisdiction) Worksheet:
The TRIP-Eligible Lines of Insurance have now been divided in all cases (excepting Excess Worker’ Compensation) between deductible reimbursement policies and other policies within the specified line of insurance.
A separate reporting cell for Total Non-TRIP-Eligible Lines Premium (Cell D30) has been added.
Cyber (Nationwide) Worksheet:
The 2021 Cyber (Nationwide) Worksheet has been replaced with an expanded worksheet which, in addition to the information previously requested, now also requests certain information for cyber policies written in non-TRIP-Eligible lines of insurance, cyber policy numbers and DEP as divided between small, medium, and large policyholders, and specific policy information and loss information in connection with cyber extortion (including ransom payment) coverage under cyber policies.
Exposure Bases (Jurisdiction) Worksheet:
The TRIP-Eligible Lines of Insurance have now been divided in all cases (excepting Excess Worker’ Compensation) between deductible reimbursement policies and other policies within the specified line of insurance.
Column F, requiring the disclosure of Total 2021 TRIP-Eligible Property Exposures where Terrorism Risk Coverage is provided only for NBCR Risks in each Line of Insurance, has been added.
Column L, requiring the disclosure of Total 2021 TRIP-Eligible Liability Lines where Terrorism Risk Coverage is provided only for NBCR Risks in each Line of Insurance, has been added.
Reinsurance (Nationwide) Worksheet:
Replaced modeled loss scenario.
Affiliations Worksheet:
The Type of Insurer (D9-D27) dropdown menu has been modified to identify Alien Surplus Lines Insurer as a reporting option.
Premium (Jurisdiction) Worksheet:
The instructions have been modified to confirm the reporting division as between deductible reimbursement policies and other policies in each TRIP-Eligible Line of Insurance except Excess Workers’ Compensation.
The instructions have been modified to explain the reporting expected for Total Non-TRIP-Eligible Lines Premium in Cell D30.
Cyber (Nationwide) Worksheet:
The instructions have been expanded to explain the nature of the reporting now expected in connection with the expanded Cyber (Nationwide) Worksheet.
Exposure Bases (Jurisdiction) Worksheet:
The instructions have been modified to confirm the reporting division as between deductible reimbursement policies and other policies in each TRIP-Eligible Line of Insurance except Excess Workers’ Compensation.
Further instructions have been provided in connection with the questions posed in Columns F and L where coverage is provided solely for NBCR risks.
The changes to Cyber (Nationwide) Worksheet include the collection of certain data elements not previously requested by Treasury:
Lines 12-17: Premium and Number of Policies allocated by size of policyholder, measured by its Number of Employees;
Lines 21-24; Limits specific to Cyber Extortion and Ransom Payments; and
Lines 25-30; Loss information specific to Cyber Extortion and Ransom Payments.
To the extent an insurer has not been collecting this information in connection with its operations and thus cannot capture this information, it is not required to provide this information in the 2022 TRIP Data Call. The determination not to report this information because of existing capabilities is subject to the same verification that an insurer provides that it is providing information “as a full and true statement of the information provided to the best of its knowledge, information and belief.” See 31 CFR 50.50(c)(1). Insurers that have been collecting the information should report the information, subject to the more detailed instructions below. Insurers may contact Treasury directly as to any issues prosed by this expanded data collection.
Insurer Group Affiliations |
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Section |
Field Name |
Comments |
B4 |
NAIC Group Code |
Provide the NAIC Group Code used for state regulatory reporting purposes. If the insurer is not part of a group, leave blank and report the individual company’s NAIC Company Code in Cell B9. Groups that have no such number will be assigned a number by the aggregator. |
C4 |
Insurer Group Name |
Provide name as used by reporting insurance group. If the insurer is not part of a group, leave blank and report the individual company’s name in Cell C9. |
B9-B27 |
NAIC Company Code |
Provide the NAIC Company Code used for state regulatory reporting purposes. Enter information for each company within an affiliated group of insurers (as reported in Cells B4 and C4) or enter information for individual company if not part of a group. Companies that have no such number will be assigned a number by the aggregator. |
C9-C27 |
Insurance Company Name |
Provide name as used by reporting insurance company. Enter information for each company within an affiliated group of insurers (as reported in Cells B4 and C4), or report for individual company if not part of a group. |
D9-D27 |
Type of Insurer |
Select from drop-down list the item that best describes the operations of the reporting insurer with respect to the Terrorism Risk Insurance Program (Captive, Offshore Licensed Captive, Risk Retention Group, or Alien Surplus Lines Insurer). |
E9-E27 |
Domicile |
Select the jurisdiction in which the insurer is domiciled. |
H3 |
Total 2020 Policyholder Surplus |
Enter total 2020 policyholder surplus as reported by the insurance group or company for state regulatory purposes on its Annual Statement for 2020 at Page 3, Line 37, Column 1. To the extent the insurer does not report this figure for state regulatory purposes, report a policyholder surplus figure for 2020 based upon an equivalent methodology. |
H4 |
Total 2020 TRIP-Eligible DEP (all lines) |
Provide the insurance group or company’s total 2020 TRIP-Eligible Direct Earned Premium (DEP), for all lines and all jurisdictions. If the insurer reported in the 2021 TRIP Data Call, this field has already been populated with the information that was previously provided. |
Direct Earned Premium (DEP) (Jurisdiction) |
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Section |
Field Name |
Comments |
B2 |
Jurisdiction |
Provide DEP information by jurisdiction (U.S. state, the District of Columbia, or U.S. territory) on separate worksheets.
|
B6-B28 |
TRIP-Eligible Line of Coverage |
Cells B6-B28 list the TRIP-eligible lines of coverage presently included in the Program, which are divided for all lines except Excess Workers’ Compensation between deductible reimbursement policies and other policies within the identified line of insurance. Cells C6-C28 list the NAIC lines (as reported on the NAIC Exhibit of Premiums and Losses, commonly known as Statutory Page 14) which generally correspond to these TRIP-eligible lines. |
C6-C28 |
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D6-D28 |
Total 2021 TRIP-Eligible DEP (all policies) |
The figures in Column D will show the total 2021 DEP charged for the corresponding TRIP-eligible line of insurance listed in Cells B6-B18. The figures reported in this column will equal the sum of the respective figures reported in Columns E-G. Cell D29 will show the insurance group or company’s total 2021 TRIP-eligible DEP for all lines of insurance. |
E6-E28 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total 2010 DEP of policies, where terrorism risk coverage was not provided to the policyholder.
|
F6-F28 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided for Disclosed $0 Charge) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total 2021 DEP of policies, where terrorism risk coverage was provided by the insurer to the policyholder for a disclosed charge of $0. |
G6-G28 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided with a Premium Charged) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total DEP for 2021 of policies, where terrorism risk coverage was provided by the insurer to the policyholder for a disclosed charge of more than $0. |
H6-H28 |
Total 2021 DEP Charged for Terrorism Risk Coverage |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide the amount of DEP charged for terrorism risk.
|
D30 |
Total Non-TRIP Eligible Lines DEP |
Report the total 2021 non-TRIP Eligible Lines DEP of the Captive Insurer (that is, all DEP of the Captive Insurer for any other insurance that is not subject to TRIP). |
Standalone Terrorism (Nationwide) |
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Section |
Field Name |
Comments |
C3 |
2021 DEP for Standalone Terrorism Policies |
Provide 2021 DEP for standalone terrorism policies for the United States as a whole.
The figure entered in Cell C3 must equal the sum of the figures entered in Cells C4 and C5. |
C4 |
Portion of 2021 DEP Providing Coverage for Losses for Certified Acts of Terrorism under TRIP |
Identify the portion of the 2021 standalone terrorism DEP provided in Cell C3 which was subject to TRIP (if any). |
C5 |
Portion of 2021 DEP Providing Coverage for Losses Arising from Other (Non-Certified) Acts of Terrorism |
Identify the portion of the 2021 standalone terrorism DEP provided in Cell C3 which was not subject to TRIP (if any). |
C6 |
2021 Number of Standalone Terrorism Policies Issued |
Provide the 2021 policy count for the DEP provided in Cell C3. |
C7 |
2021 Number of Standalone Terrorism Policies Issued Providing Coverage for Losses for Certified Acts of Terrorism under TRIP |
Provide the 2021 policy count for the DEP provided in Cell C4. |
C8 |
2021 Property Insurance Exposure for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism under TRIP |
Provide the insurer’s total 2021 property insurance exposure for all property coverage provided in connection with the amount reported in Cell C3.
|
C9 |
Total 2021 Limits of Liability for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism under TRIP |
Provide the insurer’s total 2021 liability exposure for all liability coverage provided in connection with the amount reported in Cell C3.
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Cyber (Nationwide) |
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Section |
Field Name |
Comments |
C3-E3 |
Total 2021 TRIP-Eligible DEP (All Cyber Policies) |
Provide the amount of DEP charged for cyber coverage in TRIP-eligible lines. Enter totals for the United States as a whole. Enter 2021 TRIP-eligible DEP for “standalone” cyber policies in Cell C3. Enter 2021 TRIP-eligible DEP for package policies in Cell D3. Only include premium associated with the cyber coverage in the policy. If the policy does not specify the cyber premium, provide an estimate of the cyber component of the package policy. Policies that may respond to a cyber loss but do not explicitly provide coverage for cyber risks (sometimes characterized as non-affirmative cyber or “silent cyber”) should not be included in this worksheet. Policies that provide cyber coverage outside of TRIP-eligible lines should not be included. Cell E3 must show the sum of the values entered in Cells C3 and D3. Cells C3-E3 must show the sum of the values respectively entered in Cells C4-E4 and C5-E5. |
C4-E4 |
Total 2021 TRIP-Eligible DEP for Cyber Policies (Terrorism Risk Coverage Declined) |
Provide total 2021 DEP of cyber policies in TRIP-eligible lines, where terrorism risk coverage was not provided to the policyholder. Include premium in this row only if a cyber policy did not provide any coverage subject to TRIP. Enter 2021 TRIP-eligible DEP for “standalone” cyber policies in Cell C4. Enter 2021 TRIP-eligible DEP for package policies containing cyber coverage in Cell D4. Only include premium associated with the cyber coverage in the policy. If the policy does not specify the cyber premium, provide an estimate of the cyber component of the package policy. Policies that may respond to a cyber loss but do not explicitly provide coverage for cyber risks (sometimes characterized as non-affirmative cyber or “silent cyber”) should not be included in this worksheet. Policies that provide cyber coverage outside of TRIP-eligible lines should not be included in these fields. See C7-E7. Cell E4 must show the sum of the values entered in Cells C4 and D4. |
C5-E5 |
Total 2021 TRIP-Eligible DEP for Cyber Policies (Terrorism Risk Coverage Provided) |
Provide total 2021 DEP of cyber policies in TRIP-eligible lines, where terrorism risk coverage was provided to the policyholder. Include premium in this row only if a cyber policy provided coverage subject to TRIP. Enter 2021 TRIP-eligible DEP for “standalone” cyber policies in Cell C5. Enter 2021 TRIP-eligible DEP for package policies containing cyber coverage in Cell D5. Only provide premium associated with the cyber coverage. If the policy does not specify the cyber premium, provide an estimate of the cyber component of the package policy. Policies that may respond to a cyber loss but do not explicitly provide coverage for cyber risks (sometimes characterized as non-affirmative cyber or “silent cyber”) should not be included in this worksheet. Policies that provide cyber coverage outside of TRIP-eligible lines should not be included. Cell E5 must show the sum of the values entered in Cells C5 and D5. |
C6-E6 |
Total 2021 DEP Charged for Terrorism Risk Coverage Under Cyber Policies |
Provide the amount of DEP charged for terrorism risk in cyber policies providing terrorism risk coverage. Enter 2021 DEP charged for terrorism risk in “standalone” cyber policies in Cell C6. Enter 2021 DEP charged for terrorism risk in package policies containing cyber coverage in Cell D6. These figures, representing premium charged for terrorism risk, should be a component of the amounts provided in C5 and D5, respectively. For purposes of cyber coverage provided as part of a package policy, do not provide as the terrorism risk coverage DEP the total amount of terrorism risk coverage DEP provided under the policy as a whole. Provide only the amount associated with the cyber portion of the coverage or estimate an appropriate amount from the amount charged under the policy as a whole. Policies that may respond to a cyber loss but do not explicitly provide coverage for cyber risks (sometimes characterized as non-affirmative cyber or “silent cyber”) should not be included in this worksheet. Do not include premiums for terrorism coverage that is not subject to TRIP (“non-certified” coverage). Cell E6 must show the sum of the values entered in Cells C6 and D6. |
C7-E7 |
Total 2021 Non-TRIP-Eligible DEP (All Cyber Policies) |
Provide the amount of DEP charged for cyber coverage in the lines of insurance not subject to TRIP. Enter totals for the United States as a whole. Enter 2021 non-TRIP-eligible DEP for “standalone” cyber policies in Cell C7. Enter 2021 non-TRIP-eligible DEP for package policies in Cell D7. Only include premium associated with the cyber coverage in the policy. If the policy does not specify the cyber premium, provide an estimate of the cyber component of the package policy. Policies that may respond to a cyber loss but do not explicitly provide coverage for cyber risks (sometimes characterized as non-affirmative cyber or “silent cyber”) should not be included in this worksheet. Cell E7 must show the sum of the values entered in Cells C7 and D7. |
C8-E8 |
Total 2021 Number of Cyber Policies Issued in TRIP-Eligible Lines of Insurance |
Provide the corresponding 2021 policy count for the DEP provided in Cells C3-D3. Cell E8 must show the sum of the values entered in Cells C8 and D8. |
C9-E9 |
Total 2021 Number of Cyber Policies Issued (Terrorism Risk Coverage Provided) |
Provide the corresponding 2021 policy count for the DEP provided in Cells C5-D5. Cell E9 must show the sum of the values entered in Cells C9 and D9. |
C10-E10 |
Total 2021 Number of Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance |
Provide the corresponding 2021 policy count for the DEP provided in Cells C7-D7.
Cell E10 must show the sum of the values entered in Cells C10 and D10. |
C11-E11 |
Total 2021 Number of all Cyber Policies Issued |
Provide the corresponding 2021 policy count for all cyber policies issued in TRIP-Eligible and Non-Trip-Eligible Lines of insurance combined. Cell C11 must show the sum of the values entered in Cells C8 and C10, and Cell D11 must show the sum of the values entered in Cells C8 and D10. |
C12-E12 |
Total 2021 Number of all Cyber Policies Issued to Small Policyholders (100 or fewer employees) |
Taking the figures reported in Line 11, identify the number of policies where the policyholder reported 100 or fewer employees. |
C13-E13 |
Total 2021 Number of all Cyber Policies Issued to Medium Policyholders (101-500 employees) |
Taking the figures reported in Line 11, identify the number of policies where the policyholder reported between 101 and 500 employees. |
C14-E14 |
Total 2021 Number of all Cyber Policies Issued to Large Policyholders (501 or more employees) |
Taking the figures reported in Line 11, identify the number of policies where the policyholder reported more than 500 employees. |
C15-E15 |
Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (100 or fewer employees) |
Provide the DEP associated with the number of policies reported in Line 12. |
C16-E16 |
Total 2021 DEP of all Cyber Policies Issued to Medium Policyholders (101-500 employees) |
Provide the DEP associated with the number of policies reported in Line 13. |
C17-E17 |
Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (501 or more employees) |
Provide the DEP associated with the number of policies reported in Line 14. |
C18-E18 |
Total 2021 Limits of Liability for Cyber Policies Issued in TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for all cyber liability coverage provided in connection with the corresponding amounts reported in Cells C3 and D3. Include the total amount of the reporting insurer's liability exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the liability insurance to calculate the insurer’s exposure. For cyber coverage provided as part of a package policy, provide the limits associated with the cyber coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C19-E19 |
Total 2021 Limits of Liability for Cyber Policies Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP |
Provide the insurer’s total 2021 liability exposure for all cyber liability coverage provided in connection with the corresponding amounts reported in Cells C5 and D5. Include the total amount of the reporting insurer's liability exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the liability insurance to calculate the insurer’s exposure. For cyber coverage provided as part of a package policy, provide the limits associated with the cyber coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C20-E20 |
Total 2021 Limits of Liability for Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for all cyber liability coverage provided in connection with the corresponding amounts reported in Cells C7 and D7. Include the total amount of the reporting insurer's liability exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the liability insurance to calculate the insurer’s exposure. For cyber coverage provided as part of a package policy, provide the limits associated with the cyber coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C21-E21 |
Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for cyber extortion coverage only that is provided in connection with the corresponding amounts reported in Cells C3 and D3. Include the total amount of the reporting insurer's cyber extortion exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the cyber extortion insurance to calculate the insurer’s exposure. For cyber extortion coverage provided as part of a package policy, provide the limits associated with the cyber extortion coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C22-E22 |
Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for ransom payments for cyber extortion that is provided in connection with the corresponding amounts reported in Cells C3 and D3. Include the total amount of the reporting insurer's ransom payment exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the ransom payment insurance to calculate the insurer’s exposure. For ransom payment coverage provided as part of a package policy, provide the limits associated with the ransom payment coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C23-E23 |
Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for cyber extortion coverage only that is provided in connection with the corresponding amounts reported in Cells C7 and D7. Include the total amount of the reporting insurer's cyber extortion exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the cyber extortion insurance to calculate the insurer’s exposure. For cyber extortion coverage provided as part of a package policy, provide the limits associated with the cyber extortion coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C24-E24 |
Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance |
Provide the insurer’s total 2021 liability exposure for ransom payments for cyber extortion that is provided in connection with the corresponding amounts reported in Cells C7 and D7. Include the total amount of the reporting insurer's ransom payment exposure (and thus do not include amounts within a policyholder’s deductible, etc.). Use the limits of the ransom payment insurance to calculate the insurer’s exposure. For ransom payment coverage provided as part of a package policy, provide the limits associated with the ransom payment coverage provided. If the policy has an aggregate limit, use the aggregate limit. If the policy is subject to a per occurrence limit and not an aggregate limit, use the single occurrence limit. Where a policy is not subject to defined limit of liability, estimate exposure using a maximum probable loss model. |
C25-E25 |
Total 2021 Direct Losses Paid for Cyber Extortion under all Cyber Policies Issued |
Provide the insurer’s total 2021 payments for direct losses paid for cyber extortion. Amounts reported should be in connection with the policies associated with the amounts reported in Cells C3 and Cy, and D3 and D7, as well as any other cyber policy issued if the payments were made in 2021. |
C26-E26 |
Total 2021 Direct Losses Incurred for Cyber Extortion under all Cyber Policies Issued |
Provide the insurer’s total 2021 amounts incurred, but not paid, for direct losses for cyber extortion. Amounts reported should be in connection with the policies associated with the amounts reported in Cells C3 and C7, and D3 and D7, as well as any other cyber policy issued if the amounts were incurred in 2021. |
C27-E27 |
Total 2021 Direct Losses Paid for Cyber Extortion (Ransom Payment or Reimbursement Only) under all Cyber Policies Issued |
Provide the insurer’s total 2021 payments for ransom payments only, as part of cyber extortion coverage. Amounts reported should be in connection with the policies associated with the amounts reported in Cells C3 and C7, and D3 and D7, as well as any other cyber policy issued if the ransom payment was made in 2021. |
C28-E28 |
Total 2021 Number of Claims Associated with Payments reported in Line 27 |
Provide the number of claims associated with the payments identified in Line 27. |
C29-E29 |
Total 2021 Direct Defense and Loss Containment Amounts Paid for Cyber Extortion under all Cyber Policies Issued |
Provide the insurer’s total 2021 payments for direct defense and loss containment amounts paid for cyber extortion. Amounts reported should be in connection with the policies associated with the amounts reported in Cells C3 and D7, and D3 and D7, as well as any other cyber policy issued if the payments were made in 2021. |
C30-E30 |
Total 2021 Direct Defense and Loss Containment Amounts Incurred for Cyber Extortion under all Cyber Policies Issued |
Provide the insurer’s total 2021 amounts incurred, but not paid, for direct defense and loss containment for cyber extortion. Amounts reported should be in connection with the policies associated with the amounts reported in Cells C3 and C7, and D3 and D7, as well as any other cyber policy issued if the amounts were incurred in 2021. |
Exposure Bases by Jurisdiction |
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Section |
Field Name |
Comments |
B2 |
Jurisdiction |
Provide information by jurisdiction (U.S. state, the District of Columbia, or U.S. territory) on separate worksheets.
|
B6-B28 |
TRIP-Eligible Line of Coverage |
Cells B6-B28 list the TRIP-eligible lines of coverage presently included in the Program, which are divided for all lines except Excess Workers’ Compensation between deductible reimbursement policies and other policies within the identified line of insurance. Cells C6-C28 list the NAIC lines (as reported on the NAIC Exhibit of Premiums and Losses, commonly known as Statutory Page 14) which generally correspond to these TRIP-eligible lines. |
C6-C28 |
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D6-D28 |
Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total property exposure under all 2020 policies where terrorism risk coverage was provided in connection with property coverage.
|
E6-E28 |
Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total property exposure under all 2021 policies where terrorism risk coverage was obtained and where the policy does not exclude coverage for nuclear, biological, chemical, and radiological (NBCR) risks.
|
F6-F28 |
Total 2021 TRIP-Eligible Property Exposures (Terrorism Risk Coverage Provided Only for NBCR Risks) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total property exposure under all 2021 policies where terrorism risk coverage was obtained and where the policy only provides coverage for nuclear, biological, chemical, and radiological (NBCR) risks.
To the extent the insurer’s policies provide coverage for some, but not all, risks within the NBCR category, assume that policies provide coverage for NBCR Risk only so long as that is the only coverage provided by the policy. |
G6-G28 |
Total 2021 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Provided) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total deductible or retention exposure retained by policyholders under the policies reported in Cells D6-D28.
|
H6-H28 |
Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Declined) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total 2021 property insurance exposure, where terrorism risk coverage was not obtained by the policyholder.
|
I6-I28 |
Total 2021 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Declined) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total deductible or retention exposure retained by policyholders under the policies reported in Cells H6-H28.
|
J6-J28 |
Total 2021 Limits of Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Provided) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide the insurer’s total 2021 liability exposure in TRIP-eligible lines, where terrorism risk coverage was provided to the policyholder.
|
K6-K28 |
Total 2021 TRIP-Eligible Limits of Liability (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide the insurer’s total 2021 liability exposure under all 2021 policies where terrorism risk coverage was provided in connection with liability coverage and where the policy does not exclude coverage for nuclear, biological, chemical, and radiological (NBCR) risks.
|
L6-L28 |
Total 2021 TRIP-Eligible Limits of Liability (Terrorism Risk Coverage Provided Only for NBCR Risks) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide the insurer’s total 2021 liability exposure under all 2021 policies where terrorism risk coverage was obtained and where the policy only provides coverage for nuclear, biological, chemical, and radiological (NBCR) risks.
To the extent the insurer’s policies provide coverage for some, but not all, risks within the NBCR category, assume that policies provide coverage for NBCR risk only so long as that is the only coverage provided by the policy. |
M6-M28 |
Total 2021 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Provided) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total deductible or retention exposure retained by policyholders under the policies reported in Cells J6-J28.
|
N6-N228 |
Total 2021 Limits of Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Declined) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide the insurer’s total 2021 liability exposure in TRIP-eligible lines, where terrorism risk coverage was not obtained by the policyholder.
|
O6-O28 |
Total 2021 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Declined) |
For each corresponding TRIP-eligible line of insurance listed in Cells B6-B28, provide total deductible or retention exposure retained by policyholders under the policies reported in Cells N6-N28.
|
P6-P28 |
Total 2021 Payroll for TRIP-Eligible Policies (Terrorism Risk Coverage Provided) |
Provide total 2021 payroll for workers’ compensation policies, workers’ compensation deductible policies, and and excess workers’ compensation policies (Lines 18-20).
|
Q6-Q28 |
Total 2021 Payroll Not Subject to Terrorism Risk Coverage |
Provide total 2021 payroll for workers’ compensation policies, workers’ compensation deductible policies, and excess workers’ compensation policies (Lines 18-20) where terrorism risk coverage is not assumed by the captive insurer. |
Policyholder Industry Code (Nationwide) |
||
Section |
Field Name |
Comments |
B2 |
NAICS Code Number Most Applicable to the Business(es) Insured by the Captive Insurer: |
From the dropdown list, select the North American Industrial Classification System (NAICS) industry code number which is most applicable to the business(es) insured by the captive insurer. |
Places of Worship (Nationwide) |
||
Section |
Field Name |
Comments |
C4 |
NAICS Code 813110 |
Reporting insurers should categorize information under: (1) NAICS Codes, (2) SIC Codes, (3) ISO Class Codes, or (4) Other to allocate premium on this worksheet.
|
D4 |
||
C5 |
SIC Code 8661 |
|
D5 |
||
C6 |
ISO Class Codes 0900 (Property) or 41650 (Liability) |
|
D6 |
||
C7 |
Other |
|
D7 |
||
E4 |
Total 2021 DEP Charged for Terrorism Risk Coverage (Property) |
For each corresponding industry code, provide the amount of 2021 DEP charged for terrorism risk under property policies issued to Places of Worship. Only utilize one of the reporting methods (NAICS, SIC, ISO, or Other) identified.
|
E5 |
||
E6 |
||
E7 |
||
F4 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) (Property) |
For each corresponding industry code, or utilizing the Other category for some other calculation, provide the total 2021 DEP of property policies, where terrorism risk coverage was not provided to the policyholder.
|
F5 |
||
F6 |
||
F7 |
||
G4 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided) (Property) |
For each corresponding industry code, or utilizing the Other category for some other calculation, provide the total 2021 DEP of property policies, where terrorism risk coverage was provided to the policyholder.
|
G5 |
||
G6 |
||
G7 |
||
I4 |
Total 2021 DEP Charged for Terrorism Risk Coverage (Liability) |
For each corresponding industry code, or utilizing the Other category for some other calculation, provide the amount of 2021 DEP charged for terrorism risk under liability policies.
|
I5 |
||
I6 |
||
I7 |
||
J4 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) (Liability) |
For each corresponding industry code, or utilizing the Other category for some other calculation, provide the total 2021 DEP of liability policies, where terrorism risk coverage was not provided to the policyholder.
|
J5 |
||
J6 |
||
J7 |
||
K4 |
Total 2021 TRIP-Eligible DEP (Terrorism Risk Coverage Provided) (Liability) |
For each corresponding industry code, or utilizing the Other category for some other calculation, provide the total 2021 DEP of liability policies, where terrorism risk coverage was provided to the policyholder.
|
K5 |
||
K6 |
||
K7 |
||
M4 |
Total 2021 DEP Charged for Terrorism Risk Coverage (Workers’ Compensation) |
No entry required. This information will be reported on the insurer’s behalf by NCCI, the California WCIRB, and/or the New York CIRB.
|
M5 |
||
M6 |
||
M7 |
||
N4 |
Total 2021 TRIP-Eligible DEP (Workers’ Compensation) |
No entry required. This information will be reported on the insurer’s behalf by NCCI, the California WCIRB, and/or the New York CIRB.
|
N5 |
||
N6 |
||
N7 |
Geographic Exposures (Nationwide) |
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Section |
Field Name |
Comments |
B3-B30 |
Region |
This field shows the specified metropolitan regions of the United States (Cells B3-B28) for which exposure information should be recorded.
|
C3-C30 |
Description |
This field outlines locations (by ZIP code) in the metropolitan regions listed in Cells B3-B28.
|
D3-D30 |
Total 2021 Payroll for TRIP-Eligible Primary WC and Excess WC Policies (Terrorism Risk Coverage Provided) |
For each corresponding region listed in Cells B3-B30, provide total 2021 payroll for both primary and excess workers’ compensation policies, where terrorism risk insurance was provided. |
E3-E30 |
Total 2021 Payroll for TRIP-Eligible Primary WC and Excess WC Policies (Terrorism Risk Coverage Not Provided) |
For each corresponding region listed in Cells B3-B30, provide total 2021 payroll for both primary and excess workers’ compensation policies, where terrorism risk insurance was not provided. |
F3-F30 |
Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided) |
For each corresponding region listed in Cells B3-B30, provide total property insurance exposure under all 2021 policies where terrorism risk coverage was provided in connection with property coverage.
|
G3-G30 |
Total 2021 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Declined) |
For each corresponding region listed in Cells B3-B30, provide total 2021 property insurance exposure, where terrorism risk coverage was not obtained by the policyholder.
|
C35-C39 |
ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll (Metropolitan Areas) |
For each corresponding region, provide the ZIP codes for the top 5 aggregations of payroll exposure within the metropolitan areas included in Rows 3-28.
|
D35-D39 |
Amount of Top 5 Largest Accumulated Exposure Locations by Payroll (Metropolitan Areas) |
For each corresponding ZIP code listed in Cells C35-C39, provide the total accumulated payroll exposure within that ZIP code. |
E35-E39 |
ZIP Code of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure (Terrorism Risk Coverage Provided) (Metropolitan Areas) |
For each corresponding region, provide the ZIP codes for the top 5 aggregations of property insurance exposure within the metropolitan areas included in Rows 3-28.
|
F35-F39 |
Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure (Terrorism Risk Coverage Provided) (Metropolitan Areas) |
For each corresponding ZIP code listed in Cells C35-C39, provide the total accumulated property insurance exposure within that ZIP code. |
C43-C47 |
ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll (Non-Metropolitan Areas) |
For non-metropolitan areas included in Row 29, provide the ZIP codes for the top 5 aggregations of payroll exposure.
|
D43-D47 |
Amount of Top 5 Largest Accumulated Exposure Locations by Payroll (Non-Metropolitan Areas) |
For each corresponding ZIP code listed in Cells C43-C47, provide the total accumulated payroll exposure within that ZIP code. |
E43-E47 |
ZIP Code of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure (Terrorism Risk Coverage Provided) (Non-Metropolitan Areas) |
For non-metropolitan areas included in Row 29, provide the ZIP codes for the top 5 aggregations of property insurance exposure.
|
F43-F47 |
Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure (Terrorism Risk Coverage Provided) (Non-Metropolitan Areas) |
For each corresponding ZIP code listed in Cells C43-C47, provide the total accumulated property insurance exposure within that ZIP code. |
D49 |
ZIP Code Associated with Largest Probable Maximum Loss (PML) |
Provide the ZIP code for the insurer group or company's largest Probable Maximum Loss (for all lines) at a single street level address location.
|
D50 |
Largest PML at a Single Location (Amount) |
Provide the amount of the insurer group or company's largest Probable Maximum Loss (for all lines) at the location identified in Cell D49.
|
Note: This Worksheet is set up as a questionnaire, with certain amounts requested, yes or no answers sought, and associated explanation to the extent necessary. As a result, and unlike the other worksheets, the data sought may be more easily obtainable from an individual with knowledge of the reinsurance arrangements of the reporting entity, as distinguished from the mechanism of data queries to existing systems. The questions are limited to reinsurance purchased from unaffiliated third-party companies, and do not include reinsurance transactions within a group of affiliated insurers.
Reinsurance (Nationwide) |
||
Section |
Field Name |
Comments |
C3-D3 |
Size of TRIP 2021 Deductible (Cell H4 of Insurer Group Affiliations Worksheet x 20%) |
Provide the insurance group or company’s 2021 TRIP deductible.
|
C4-D4 |
Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss |
For reinsurance purchased by the insurance group or company, provide the per loss limit for losses subject to TRIP. |
C5-D5 |
Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering TRIP Loss |
For reinsurance purchased by the insurance group or company, provide the 2021 maximum aggregate reinsurance limit per calendar year for losses subject to TRIP. |
C6-D6 |
2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss |
For treaty reinsurance purchased by the insurance group or company, provide the 2021 attachment point for losses subject to TRIP. |
C7-D7 |
2021 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss |
For treaty reinsurance purchased by the insurance group or company, provide the 2021 co-participation share for losses subject to TRIP exposure. |
C8-D8 |
Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss |
For reinsurance purchased by the insurance group or company, provide the per loss limit for losses subject to TRIP.
|
C9-D9 |
Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss |
For treaty reinsurance purchased by the insurance group or company, provide the 2021 maximum aggregate reinsurance limit per calendar year for natural catastrophe losses.
|
C10-D10 |
2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss |
For treaty reinsurance purchased by the insurance group or company, provide the 2021 attachment point for natural catastrophe losses.
|
C11-D11 |
2021 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophe Loss |
For treaty reinsurance purchased by the insurance group or company, provide the 2021 co-participation share, if any, for natural catastrophe losses. |
C12-D12 |
Any Reinsurance Exclusions for TRIP Certified Foreign Acts of Terrorism? |
Select whether during any reinsurance purchased in 2021 had any exclusions for TRIP-certified acts of terrorism caused by foreign individuals or actors. |
C13-D13 |
Any Reinsurance Exclusions for TRIP Certified Domestic Acts of Terrorism? |
Select whether during any reinsurance purchased in 2021 had any exclusions for TRIP-certified acts of terrorism caused by domestic acts of terrorism. |
C14-D14 |
Reinsurance for NBCR WC Exposures Resulting from Certified Acts of Terrorism? |
Select whether any reinsurance purchased in 2021 provided any coverage for workers' compensation losses involving TRIP-certified acts of terrorism resulting from nuclear, biological, chemical or radiological (NBCR) exposures. |
C15-D15 |
If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss |
If the response in Cell C14 was “yes”, provide the per loss limit for workers' compensation losses involving TRIP-certified acts of terrorism resulting from NBCR exposures.
|
C16-D16 |
If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss |
If the response in Cell C14 was “yes”, provide the 2021 attachment point for workers' compensation losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C17-D17 |
If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance For Certified Acts of Terrorism involving WC Loss |
If the response in Cell C14 was “yes”, provide the 2021 co-participation share any one loss for workers' compensation losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C18-D18 |
Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism? |
Select whether any reinsurance purchased in 2021 provided any coverage for property losses involving TRIP-certified acts of terrorism resulting NBCR exposures. |
C19-D19 |
If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss |
If the response in Cell C18 was “yes”, provide the per loss limit for property losses involving TRIP-certified acts of terrorism resulting from NBCR exposures.
|
C20-D20 |
If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss |
If the response in Cell C18 was “yes”, provide the 2021 attachment point for property losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C21-D21 |
If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss |
If the response in Cell C18 was “yes”, provide the 2021 co-participation share for property losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C22-D22 |
Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism? |
Select whether any reinsurance purchased in 2021 provided any coverage for liability losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C23-D23 |
If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss |
If the response in Cell C22 was “yes”, provide the per loss limit for liability losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. The figure in C23 should be no more than the figure reported in C4 and may be less than the figure reported in C4 if reinsurance purchased for NBCR risk was less than reinsurance purchased for other types of terrorism claims. |
C24-D24 |
If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss |
If the response in Cell C22 was “yes”, provide the 2021 attachment point for liability losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C25-D25 |
If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss |
If the response in Cell C22 was “yes”, provide the 2021 co-participation share for liability losses involving TRIP-certified acts of terrorism resulting from NBCR exposures. |
C26-D26 |
Any Other Reinsurance Exclusions Specifically Applicable to Certified Acts of Terrorism Under TRIP? |
In Cell C26, select whether the insurance group or company’s 2020 reinsurance contracts contained any additional exclusions that could preclude coverage for losses involving TRIP-certified acts of terrorism. In Cell D26, identify the exclusion(s). |
Lines 27-36 |
Loss to Group or Company within TRIP Deductible, Private Reinsurance Recovery, Deductible/Retention of Insureds, Claim under TRIP, Co-Pay Obligation |
The last series of questions seeks information as to how a particular defined loss event (Line 27) would likely affect the responding insurer group or reporting insurer, in terms of the total projected loss it would likely sustain (Line 30), with that amount divided into six categories:
|
OMB No. 1505-0257
Expiration: November 30, 2023
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2022-02-24 |