Model Descriptions


Data Reporting by Property and Casualty Companies

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-751) This regulation sets forth the manner of reporting data by insurers to statistical agents; prescribes reports to be submitted by statistical agents; and prescribes certain conduct in connection therewith. This regulation does not apply to data reported directly by insurers to the commissioner. V-751-1

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Determining Reserve Liabilities for Credit Life Insurance Model Regulation

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-818) This model recognizes the 2001 CSO Male Composite Ultimate Mortality Table for use in determining the minimum standard of valuation and specifies the interest rate and method to be used in determining the minimum standard of valuation for credit life insurance. VI-818-1

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Deposit Law

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
III-300-1

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Derivative Instruments Model Regulation

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-282) This model sets standards for the prudent use of derivative instruments in accordance with the Investments of Insurers Model Act (MDL-280). III-282-1

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Disability Income Insurance—Unfair Discrimination

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-897) This model prohibits unfair discrimination by disability income insurers and insurance professionals on the basis of abuse status. VI-897-1

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Disclosure

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Accident and Health Insurance Contracts: see “Minimum Standards” under “Accident and Health Insurance” heading
Advertising: see “Advertising” heading
Annuities:  see “Annuities” heading
Disclosure for Small Face Amount Life Insurance Policies Model Act (MDL-605) This Act helps ensure that meaningful information is provided to the purchasers of small face amount policies. Disclosure requirements are listed and insurer duties explained. IV-605-1
Disclosure of Material Transactions Model Act               III-285-1
Home Service Disclosure Model Act VI-920-1
Life Insurance: see “Life Insurance” heading
Non-statutory Financial Statements: see “Accounting” heading
Replacement of Insurance: see “Replacement” heading

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Discount Medical Plan Organization Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-98) This Act helps promote the public interest by establishing standards for discount medical plan organizations to protect consumers from unfair or deceptive marketing, sales or enrollment practices and to facilitate consumer understanding of the role and function of discount medical plan organizations in providing access to medical or ancillary services. I-98-1

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Discretionary Clauses Prohibited

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-42) This models helps ensure that health insurance benefits and disability-income protection coverage are contractually guaranteed, and helps avoid the conflict of interest that occurs when the carrier responsible for providing benefits has discretionary authority to decide what benefits are due. I-42-1

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Discrimination

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Blindness VI-888-1
Health Insurance in the Group Market II-107-1
Nondiscrimination in Health Insurance Coverage in the Group Market Model Regulation (MDL-107) This model incorporates the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and federal regulations. It prohibits carriers providing health insurance coverage under a health benefit plan in the group market from discriminating against individual participants or beneficiaries in these plans with respect to plan eligibility and in setting premium and contribution rates based on any health factor of the participants or beneficiaries. II-107-1
Physical or Mental Impairment                (MDL-887) This model identifies specific acts or practices in life and health insurance that are prohibited by the NAIC Unfair Trade Practices Act (MDL-880). The main purpose of this model is to make clear that life and health insurers cannot classify individuals without a rational basis for each decision. VI-887-1
Unfair Discrimination Against Subjects of Abuse in Disability Income Insurance Model Act                VI-897-1
Unfair Discrimination Against Subjects of Abuse in Health Benefit Plans Model Act VI-895-1
Unfair Discrimination Against Subjects of Abuse in Life Insurance Model Act VI-896-1
Unfair Discrimination Against Subjects of Abuse in Property and Casualty Insurance               VI-898-1
Unfair Trade Practices Act (MDL-880) This model regulates insurance trade practices by defining, or providing for the determination of, and prohibiting all such practices that constitute unfair methods of competition or unfair or deceptive acts or practices. VI-880-1

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Domestic Insurers: Re-domestication Model Bill

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-350) This model provides a means whereby any insurer organized under the laws of another state may become a domestic insurer; to provide a means for any domestic insurer to transfer its domicile to another state; and to provide a means for the continuation of a certificate of authority and other approvals pertaining to a foreign insurer that transfers its corporate domicile to another state by merger or consolidation or any other lawful method. III-350-1

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Domestic Violence:

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Unfair Discrimination Against Subjects of Abuse in Disability Income Insurance Model Act            VI-897-1
Unfair Discrimination Against Subjects of Abuse in Health Benefit Plans Model Act VI-895-1
Unfair Discrimination Against Subjects of Abuse in Life Insurance Model Act VI-896-1
Unfair Discrimination Against Subjects of Abuse in Property and Casualty Insurance            VI-898-1

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Drug Benefit Management

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-22) This model provides standards for the establishment, maintenance and management of prescription drug formularies and other pharmaceutical benefit management procedures used by health carriers that provide prescription drug benefits. I-22-1

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Drug Use of Off-Label Drugs

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-148) This model sets standards for payments for drugs that have been approved for indications other than those stated in the labeling approved by the FDA. II-148-1

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Electronic Filing of Health Care Claims

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-30) This model standardizes the forms used in the billing and reimbursement of health care, reduces the number of forms utilized, increases efficiency in the reimbursement of health care and encourages the use of and prescribes a timetable for the implementation of electronic data interchange of health care expenses and reimbursement. I-30-1

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Equity Indexed Annuities

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Buyer’s Guide II-245-1
Non-forfeiture Rates VI-806-1

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Examinations Model Law

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-390) This Act helps provide an effective, efficient system for examining the activities, operations, financial condition and affairs of all persons transacting the business of insurance. II-390-1

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Excess Loss—Stop Loss Insurance Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-92) This model establishes criteria for the issuance of stop-loss insurance policies. This model does not impose any requirement or duty on any person other than an insurer or as treating any stop-loss policy as a direct policy of health insurance. I-92-1

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External Review Procedures for Health Carriers

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-75) This model provides standards for the establishment and maintenance of external review procedures to ensure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination, as defined in this Act. (MDL-76) The purpose of this Act is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination. I-75-1, I-76-1

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Filing Requirements

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Guidelines for Filing of Rates for Individual Health Insurance Forms I-134-1

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Financial Data Reporting by Property and Casualty Companies

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-751) This regulation sets forth the manner of reporting data by insurers to statistical agents; prescribes reports to be submitted by statistical agents; and prescribes certain conduct in connection therewith. This regulation does not apply to data reported directly by insurers to the commissioner. V-751-1

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Financial Guaranty Insurance Guideline

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
VI-1626-1

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Financial Planners:  Unfair Trade Practice

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-880) This model regulates insurance trade practices by defining, or providing for the determination of, and prohibiting all such practices that constitute unfair methods of competition or unfair or deceptive acts or practices. VI-880-1

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Financial Regulation

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Investments in Medium Grade and Lower Grade Obligations Model Regulation III-340-1
Model Regulation to Define Standards and Commissioner’s Authority for Companies Deemed to Be in Hazardous Financial Condition III-385-1
Participation in the NAIC Insurance Regulatory Information System (IRIS) Model Act               (MDL-395) This Act sets forth the requirements for participating in the NAIC Insurance Regulatory Information System (IRIS). It requires annual statement filing for each domestic, foreign and alien insurer that is authorized to transact insurance in the respective jurisdiction. III-395-1

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Force-Placed Insurance: Creditor-Placed Insurance Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-375) This Act creates a legal framework within which creditor-placed insurance may be written; helps maintain the separation between creditors and insurers; and minimizes the possibilities of unfair competitive practices in the sale of creditor-placed insurance. III-375-1

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Fraternal Insurance: Uniform Fraternal Code

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-675) This model defines fraternal benefit societies, lodge systems, representative form of government and sets forth an organizational footprint for a fraternal benefit society. It addresses conversion of fraternal benefit societies into mutual life insurance companies, includes qualifications for membership, articles of incorporation, constitution, laws and amendments, as well as a provisions regarding operation of institutions. V-675-1

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Fraud Prevention Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-680) This model helps state insurance regulators investigate and discover fraudulent insurance acts more effectively, halt fraudulent acts, and assist and receive assistance from state, local and federal law enforcement and regulatory agencies in enforcing laws prohibiting fraudulent insurance acts. V-680-1

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Gifts of Life Insurance to Charitable Institutions

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-601) The model contains guidance for states in a question-and-answer format, explaining the main features of gifts of life insurance to charities. V-601-1

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Grievance Procedure Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-72) This model provides standards for the establishment and maintenance of procedures by health carriers to ensure that covered persons have the opportunity for the appropriate resolution of grievances, as defined in this model. VI-72-1

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Group Insurance

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Administrator Statute (trustees of employee group welfare funds) VI-1090-1
Alliances for Purchasing Health Insurance
Private Health Care Voluntary Purchasing Alliance Model Act I-82-1
Regional Health Care Voluntary Purchasing Alliance Model Act I-80-1
Single Health Care Voluntary Purchasing Alliance Model Act I-78-1
Coordination of Benefits Model Regulation II-120-1
Group Coverage Discontinuance and Replacement Model Regulation (MDL-110) This regulation is applicable to all insurance policies and subscriber contracts issued or provided by a carrier on a group or group-type basis covering persons as employees of employers or as members of unions or associations. II-110-1
Group Health Insurance Definition and Group Health Insurance Standard Provisions Model Act (MDL-100) This model establishes the definition of group health insurance and sets forth the requirements of a group health policy. It also delineates group health insurance standard provisions. II-100-1
Group Health Insurance Mandatory Conversion Privilege Model Act II-105-1
Group Life Insurance Definition and Group Life Insurance Standard Provisions Model Act (MDL-565) This Act sets forth group life insurance standard provisions. It defines group life insurance and contains provisions relating to limits of group life insurance, notice of compensation, dependent coverage, standard provisions, and a supplementary provision relating to conversion privileges. IV-565-1
Nondiscrimination in Health Insurance Coverage in the Group Market Model Regulation II-107-1
Personal Lines Property and Casualty Insurance Model Act V-760-1
Property and Casualty Insurance V-760-1
Small Employer Health Insurance Availability Model Act (Prospective Reinsurance With or Without an Opt-Out) II-118-1
Small Employer Health Insurance Availability Model Regulation II-119-1
Stop Loss Insurance Model Act I-92-1
See also:  “Workers’ Compensation” heading

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Guaranteed Investment Contracts

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-695) This regulation prescribes the terms and conditions under which life insurance companies may issue group annuity contracts and other agreements that establish the insurer's obligation by reference to a segregated portfolio of assets that is not owned by the insurer; the essential operational features of the segregated portfolio of assets; and the reserve requirements for these group annuity contracts and agreements. V-695-1

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Guaranteed Minimum Benefits Under Group Contracts

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-200) This model prescribes rules for separate accounts that fund guaranteed minimum benefits under group contracts. It also sets out the procedures for establishing and maintaining these separate accounts and the reserve requirements for these accounts. II-200-1

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Guaranty Associations

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Life and Health Insurance III-520-1
Property and Casualty Insurance III-540-1
Notice of Protection provided by [State] Life and Health Insurance Guaranty Association

(GDL-1525) This guideline is designed to help states proceed with revisions to Section 19: Prohibited Advertisement of Insurance Guaranty Association Act in Insurance Sales; Notice to Policy Owners in the Life and Health Insurance Guaranty Association Model Act – Model # 520. This guideline updates the general notice on guaranty association coverage required to be provided under Section 19 of the Model Act.

VI-1525-1

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Guidelines for the Filing of Workers’ Compensation “Large Deductible” Policies & Programs.

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
VI-1950-1

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Guidelines for Regulation and Legislation on Workers’ Compensation Coverage for Professional Employer Organization Arrangements

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
VI-1950-1

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Handicapped: Model Regulation on Unfair Discrimination

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-887) This model identifies specific acts or practices in life and health insurance that are prohibited by the NAIC Unfair Trade Practices Act (MDL-880). The main purpose of this model is to make clear that life and health insurers cannot classify individuals without a rational basis for each decision. VI-887-1

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Hazardous Condition, Standards for Defining

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-385) This model sets forth standards for identifying insurers found to be in such condition as to render the continuance of their business hazardous to the public or to holders of their policies or certificates of insurance. III-385-1

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Health Care Claim Audit Guidelines Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-32) This model provides for the reasonable standardization of claim audit guidelines of health care bills to determine whether data in a health care record is supported by services listed on the claim for payment of an insured or an institutional provider. I-32-1

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Health Care Professional Credentialing Verification Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-70) This model requires a health carrier to establish a comprehensive health care professional credentialing verification program to ensure that its participating health care professionals meet specific minimum standards of professional qualification. I-70-1

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Health Care Reform

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL

Health Carrier Grievance Procedure Model Act

  VI-72-1

Utilization Review and Benefit Determination Model Act

  VI-73-1
Regulation for Uniform Definitions and Standardized Methodologies for Calculation of the Medical Loss Ratio (MLR) (MDL-190) The purpose of this model is to promulgate uniform definitions and a standardized methodology for calculating the medical loss ratio, as legislated by Section 2718 (b) of the Public Health Service Act and the Patient Protection and Affordable Care Act. This model was incorporated into a federal regulation during 2010. VI-190-1
American Health Benefit Exchange Model Act (MDL-929) This model provides for the establishment of an American Health Benefit Exchange to facilitate the purchase and sale of qualified health plans in the individual market in this State and to provide for the establishment of a Small Business Health Options Program (SHOP Exchange) to assist qualified small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market. VI-929-1
Model Language for Choice of Health Care Professional

(MDL-930-A) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-A-1
Model Language for Dependent Coverage of Individuals to Age of 26

(MDL-930-B) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-B-1
Model Language for Lifetime and Annual Limits

(MDL-930-C) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-C-1
Model Language for Preventive Services

(MDL-930-D) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-D-1

Model Language for Prohibition on Preexisting Condition Exclusions for Individuals under the Age of 19

(MDL-930-E) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-E-1
Model Language for Prohibition on Rescissions of Coverage

(MDL-930-F) This model is intended to be used as a template to help states implement provisions of PPACA.

VI-930-F-1

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Health Carrier External Review Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-75) This model provides standards for the establishment and maintenance of external review procedures to ensure that covered persons have the opportunity for an independent review of an adverse determination or final adverse determination, as defined in this Act. I-75-1

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Health Carrier Prescription Drug Benefit Management Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-22) This model provides standards for the establishment, maintenance and management of prescription drug formularies and other pharmaceutical benefit management procedures used by health carriers that provide prescription drug benefits. I-22-1

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Health Information Privacy Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-55) This model helps protect the interests of insureds, claimants, creditors and the public generally through early detection of a potentially hazardous financial condition of an insurer and enhanced efficiency in liquidation to conserve the assets of the insurer. I-55-1

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Health Insurance Reserves Model Regulation

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-10) This model implements the NAIC Standard Valuation Law (MDL-820). It defines categories of reserves and sets forth the minimum claim, premium and contract reserve requirements. The regulation provides for gross premium valuation to evaluate adequacy of reserves. I-10-1

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Health Maintenance Organizations

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Health Maintenance Organizations Model Act III-430-1
Model Regulation to Implement Rules Regarding Contracts and Services of Health Maintenance Organizations III-432-1
Risk-Based Capital for Health Organizations Model Act III-315-1

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Health Plan Accountability

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Health Care Professional Credentialing Verification Model Act I-70-1
Health Carrier Grievance Procedure Model Act VI-72-1
Managed Care Network Adequacy Model Act I-74-1
Quality Assessment and Improvement Model Act I-71-1
Utilization Review and Benefit Determination Model Act VI-73-1

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High Yield Investments Regulation

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-340) This regulation helps protect the insurance-buying public by establishing limitations on the concentration of medium-grade and lower-grade obligations in which a domestic insurer can invest. III-340-1

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Holding Companies

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
Insurance Holding Company System Model Regulation with Reporting Forms and Instructions III-450-1
Insurance Holding Company System Regulatory Act III-440-1
Re-domestication Model Bill III-350-1

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Home Service Disclosure Model Act

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-920) This model establishes rules that ensure meaningful information is provided to the purchasers of insurance policies distributed through the home service distribution system. VI-920-1

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Homeowner Warranties

TITLE OF MODEL
DESCRIPTION
VOLUME MODEL
(MDL-685) This Act creates a legal framework within which service contracts may be sold; encourages innovation in the marketing and development of more economical and effective means of providing services under service contracts; and encourages fair and effective competition among different systems of providing and paying for these services. V-685-1

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