- July 5, 2020
is a US based organization which is created and managed by insuranceregulators from all the fifty states, the US territories and Districtof Columbia. When uniformity is needed in the insurance industry, main role is to provide a forum for the establishment of similarinsurance policies that meet the needs of all stakeholders. wasformed in 1871 by state insurance regulators with the main objectiveof coordinating the regulations adopted by multi-state insurers(David,2011).Since its creation, the organization has attained a high level ofsuccess due to new legislative concepts, improved technology, andexpertise in the delivery of services. key mission is to helpinsurance regulators serve the public interest and achieve theirgoals in an efficient and effective way as per the requirements oftheir members. Other objectives of include promoting competitivemarkets, facilitate equal treatment of members’ customers, ensuringthe financial reliability of financial institutions, and supportingthe regulation of insurance companies.
2016 officers include John Huff who is the president, Ted Nickel,Julie Mix McPeak, Eric Cioppa, and Andrew Beal. Through the supportof members, the officials are responsible for ensuring insuranceregulations are followed and all operations of the organization areeffectively undertaken.
Themajority of employees perform their duties at the main officesituated in Kansas City. The office is the destination for eightdivisions. The first one in media relations, which focus on releasingnews and promoting education of the insurance consumers through,insure U. The executive division provides support to the organizationand insurance regulators from all the states. Major sections of theexecutive division include finance department, risk management,compliance department and business strategy department(, 2016).The section of financial regulatory services provides support toregulators in the areas of solvency, finance, financial reporting,reinsurance, statutory accounting, examinations, and investments.Human resources and internal services are focused on contributing tointernal operations which include providing mail services, humanresources activities, and record management.
Informationtechnology group (ITG), which is one of the major sections, has quitea number of roles. The group assists the organization to use astate-based system that utilizes market regulation systems, financialdata repository, automated valuation services, securities valuationsystems and online premium tax. In this way, ITG is able to providecompetitive technology to insurance companies in addition toproviding world-class services to the members. Member servicesdepartment is responsible for providing education and training toinsurance customers as well as library services. Regulatory servicessection provides statistical services, financial services, and marketregulation. The last section is the technical services. Technicalservices unit provides technology assistance through StateNet andI-Site.
budget is prepared through contributions of stakeholders of insurancecompanies in collaboration with state members. Before the budget isadopted, it must be grilled by the public as per the bylaws. The2017 budget proposed six fiscals which include regulatory datacollection, online content system, job scheduler, systemfor electronic rate and form filing, recalibration of database filingfee structure and information technology infrastructure librarysystem.
Model Laws and Regulations
Accidentand Health Insurance
Thisregulation covers various aspects such as individual healthinsurance, small employer insurance, and insurance market. Thesection below discusses notable laws covered by health insurancelaws.
HealthInsurance Reserves Model Regulation
Healthinsurance reserves model regulation covers issues which include claimreserves, premium reserves, contract reserves reinsurance andeffective date. The standard covers individual as well as grouphealth insurance and in particular single premium credit for disabledindividuals. The regulation also creates three divisions of healthinsurance premiums which include contract reserves, claim reserves,and premium reserves. The claim reserves must be paid on all healthinsurance covers. Premium reserves cover all contracts relating to aperiod of coverage when other premiums have been paid after the dateof valuation (,2016).On the other hand, contract reserves are required for individuals andgroups that are also covered by level premiums.
HealthCarrier Prescription Drug Benefit Management Model Act
Thisregulation covers key drug issues. These include prescription drugformularies, prospective covered persons, medical exceptionsapproval, record keeping, contracting responsibilities, disclosurerequirements, penalties, effective date and separability. Theregulation main objective is to provide laws that cover prescriptionof drugs, and processes applied by health carriers in providing drugbenefits.
IndividualMarket Health Insurance Coverage Law
Thisregulation is used by NIAC during the implementation of individualmarket health insurance coverage Act. Notable aspects covered includerestrictions on premium rates, important health benefits package,single risk pool, prescription drug benefit, enrollment incatastrophic plans, cost-sharing requirements, rules touching of fairmarketing, severability, Prohibitionon Preexisting Condition Exclusions, and disclosure of creditablecoverage. The purpose of this regulation is to ensure that membersprovide insurance services as per the individual market healthinsurance coverage model Act. According to section 4 of this Act, theregulation applies to health benefit plans that offer individualmarket insurance coverage.
StandardizedHealth Claim Form Model Regulation
Thisregulation, which is responsible for ensuring members use standardforms during reimbursement of health care as well as billing, coversissues such as requirements for the use of HCFA Forms 1500, 1450 andJ512. This regulation is applied by health care practitioners,issuers, and institutional care practitioners. HCRA Form 1500 is usedby health care practitioners, apart from dentist when clients aremaking a claim (,2016).In addition to billing the client, the law requires that the formshould be clearly completed and given to the client. Further, theregulation specifies that HCP CS Codes and ICD-9 CM Codes can only beused by health care practitioners during the first filling of claimswhen providing health care services. When issuing form HCFA Form 1450institutional care practitioners can use three codes which areICD-9-CM Codes, HCP CS Codes and Revenue Codes. Other accident andhealth insurance regulations include heath carrier claim auditregulations, individual health insurance model Act, and smallemployer insurance model Act.
Accidentand Health Insurance Consumer Protection
Thislaw deals with accidents and health insurance. Three major lawswithin this regulation include advertisement of accident and sicknessinsurance model regulation, health information model Act andprohibition on the application of discretionary clauses model Act.
Advertisementof Accident and Sickness Insurance Model Regulation
Thisregulation aims at establishing proper standards that protect buyersin relation to advertising sickness as well as accident insurance.Additionally, the law maintains that insurance companies mustdisclose true information on the benefits, exclusions and limitationsof sickness insurance in order to avoid misleading advertisement.
HealthInformation Privacy Act
HealthInformation Privacy Act key purpose is to set criteria for protectinghealth information from being accessed by third parties. Othernotable issues covered by this regulation includes the right toaccess health information kept by healthcare providers, right toamend protected information, the disclosure of protected information,the collection of information and right to limit disclosure (,2016).Section 5 of this Act provides the policies, procedures, andstandards that are adopted in the management of health information.For example, the Act limits the access to health information toindividuals who require it to undertake their responsibilities. Otherissues covered by section 5 include appropriate training,disciplinary actions in case of violating information policies,methods of disposing health information, titles of individualsrequired to avail protected information and ways storing protectedhealth information.
Prohibitionon The Application of Discretionary Clauses Model Act
Thisregulation aims at guaranteeing that disability and health insurancebenefits are covered by contracts. In this way, it helps to avoidconflict of interest among the providers of the insurance servicesand clients.
Accidentand health insurance delivery systems
HealthCarrier Grievance Procedure Model Act
Theobjective of this regulation is to provide standards for creatingprocedures that are applied by healthcare organizations inguaranteeing collect resolution of grievances to covered parties. encourages all members to adopt this act as well as theUtilization Review and Benefit Determination Model Act.
QualityAssessment and Improvement Model Act
ThisAct creates the standards that health carriers should follow whileperforming quality assessment processes. In this way, the healthcarriers are able to evaluate the quality of their services ascompared to their counterparts in other states. Key requirements thathealth carriers should follow include identifying a system that isable to effectively assess the health care as per the plans ofcarriers, communicating their findings in a timely manner and providea written description of quality assessment to .
HealthCare Professional Credentialing Verification Law
Thisregulation demands health carriers to create a reliable verificationprogram. The criteria set by this regulation must be effectivelyfollowed during original credentialing verification and futureprocesses. Other examples of Acts established by to improvehealth insurance delivery systems include Health Career ExternalReview Model,Prepaid Limited Health Service Organization Model, Single Health CareVoluntary Purchasing Alliance and Stop-Loss Insurance Model amongothers (, 2016).
Accidentand Health Insurance Group Regulations
SmallGroup Market Health Insurance Act
Thisregulation aims at establishing the requirements for guaranteedpremium rating within small group market and other benefits.According to this act, an eligible employer is the one who isplanning to participate in a small group market health insurance inany of the states. This act also gives examples of essential healthbenefit as laboratory services, ambulatory patient services,hospitalization, prescription drugs and rehabilitative services.
Coordinationof Benefits Model Regulation
Coordinationof benefits model regulation has three major purposes. First, itestablishes an identical order of benefits which are followed bymembers. Secondly, it emphasizes that efficiency should be followedby members. Thirdly, it mitigates duplication of benefits that arefollowed by states (,2016).
AnnualFinancial Reporting Model Law
Themain objective of this goal is to improve the financial systems ofinsurance departments by advocating for annual audit, creatinginternal control and management report that covers financialreporting. Major accounting records include a report of CPA, cashflow statement, and balance sheet.
Theseregulations are focused on improving the financial strength ofcompanies. They include Derivative Instruments Model Regulation,Protected Cell Company Model Act, UniformDeposit Law, Risk-Based Capital (RBC) Model Act and Model IndemnityContracts Act among others.
ConsumerCredit Insurance Model Act
ThisAct is focused on establishing regulations related to creditinsurance without prohibiting competition among insurance companies.The regulation touches on types of consumer credit, provisions of thecertificate of insurance, issuing of policies, penalties, and dutiesof an insurer.
CreditPersonal Property Insurance Model Act
Thisregulation, which has 17 sections, has five major purposes. Theseinclude creating public welfare by ensuring insurance companies areregulated when providing personal credit insurance. Secondly, itseparates between insurers and creditors. Thirdly, it established alegal framework which monitors credit personal property insurance inall states. Fourthly, it deals with challenges arising fromcompetition among insurance companies. Lastly, it mitigates thelikelihood of unfair competition among the insurance companies.
aims at coordinating the performance of state-based insurers byproviding various regulations that are accessible through itslibrary. Under the leadership of JohnHuff, the organization has established a strong workforce that islocated in Kansas City. has eight divisions including mediarelations, executive division, financial regulatory services, humanresources and internal services, information technology, memberservices department, regulatory services and technical services. Asnoted in the paper, the organization has established quite a numberof regulations which should be followed by the members to ensure theyprovide quality services. Examples of such regulations includeAccident and Health Insurance laws, Health Carrier GrievanceProcedure Model Act, Accidentand Health Insurance Group regulations and accountingregulations such as Annual Financial Reporting Model Law, CompanyManagement Securities, and CreditInsurance.
David,R. (2011). IF1 – Insurance, Legal & Regulatory. CharteredInsurance Institute.
(2016). Model Laws and Regulations.Retrieved from http://www.naic.org/prod_serv_model_laws.htm