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White Papers

All of the below publications are free, and are only available in PDF file format.

Antifraud

Auto Insurance

Health Insurance

Life Insurance and Annuities

Market Regulation

Regulatory Issues

Reinsurance

Solvency

Workers’ Compensation

 

 

Adverse Selection Issues and Health Insurance Exchanges Under the Affordable Care Act
Assists state policymakers with the implementation of health insurance exchanges. Identifies and discusses the tools health insurers typically use today to minimize adverse selection, the tools included in the federal Patient Protection and Affordable Care Act (PPACA) and the additional tools available to the states when exchanges become operational in 2014. Copyright 2011.

ASE-OP Adverse Selection White Paper Download Free PDF

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Alternative Mechanisms for Troubled Insurance Companies
This white paper provides guidance to state insurance regulators and is intended to be an advisory resource. It discusses approaches and concepts that are available within and outside the United States to assist regulators with assessing possible alternatives for handling troubled insurers. It includes discussions on various types of alternative mechanisms for troubled companies; observations and considerations before using alternative mechanisms; advantages and disadvantages of the various types of alternative mechanisms; case studies; and sample documents. Copyright 2010.

AMT-OP Alternative Mechanisms for Troubled Insurance Companies Download Free PDF

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Application and Use of Insurance Fraud-Related Databases and Sources of Information: A Guide for State Insurance Departments
This white paper identifies sources of antifraud information, including financial regulators, law enforcement and other fraud-related entities. Membership applications for several antifraud organizations are also included. Copyright 2002.

FRD-OP Insurance Fraud-Related Databases and Sources of Information Download Free PDF

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Applying Managed Care Techniques to Auto Insurance
This white paper presents the findings of an NAIC committee charged with examining the possible regulatory approval of managed care systems for auto insurance medical benefits as a means to lower auto insurance costs. The paper includes the results of a survey conducted by the NAIC Research Division of 26 states with "no-fault" or "add-on" statutes to assess the impact of managed care on personal injury protection coverage. Copyright 1998.

MCA-PB Applying Managed Care Techniques to Auto Insurance Download Free PDF

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Best Practices Organizations White Paper
This white paper analyzes the standards established by best practices organizations. This information is intended to help state insurance departments determine what recognition, if any, such best practices organizations should be given in the development of regulatory requirements for life insurance and annuity products. The white paper presents attributes of best practices organizations and contains a chart showing how states have used the evaluations. Copyright 2004.

BPO-OP Best Practices Organizations White Paper Download Free PDF

Bulletin Regarding Health Care Providers: January 22, 1998, Memo from Special Committee on Health Insurance
The purpose of this memo was to reaffirm the NAIC's position on state regulation of provider sponsored organizations (PSOs), including its belief that all health risk-bearing entities performing same or similar functions should be licensed and regulated in the same way. Copyright 1998.

HCP-OB Bulletin Regarding Health Care Providers Download Free PDF

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Communication and Coordination Among Regulators, Receivers, and Guaranty Associations: An Approach to a National State Based System
This white paper addresses the various issues relating to communication and coordination among regulators, receivers and guaranty associations — each of which is separately responsible for providing a national state-based safety net for policyholders and claimants using different tools. This paper discusses how these groups might better work together to protect consumers and create a seamless transition for troubled companies. Copyright 2005.

CAC-OP Guaranty Association Coordination: An Approach to a National State Based System Download Free PDF

The Comparative Roles of Navigators and Producers in an Exchange: What are the Issues?
Assists state policymakers with the implementation of health insurance exchanges. Identifies and discusses issues concerning the roles of producers and navigators in the operation of an exchange, in relation to the requirements established by the federal Patient Protection and Affordable Care Act (PPACA). Copyright 2011.

RNP-OP Navigator/Producer White Paper Download Free PDF

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Consumer Complaints White Paper
This white paper provides an overview of concepts, principles and procedures for the resolution of consumer complaints. The procedures in place reflect budgetary and legal constraints within each state. By identifying "best practices" for complaint resolution, the paper provides state insurance departments with options for effective complaint handling. Copyright 2000.

CCW-OP Consumer Complaints Download Free PDF

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Credit Reports and Insurance Underwriting
This white paper addresses regulatory concerns about the use of credit reports in insurance underwriting. It details sources for consumer credit history and how companies use credit reports for underwriting purposes in life, health and property/casualty lines. It also includes information on recourse for consumers with poor credit histories, as well as where to find low-cost help for credit problems. State and federal legislative and regulatory action is also discussed. Copyright 1997.

CRU-OM Credit Reports and Insurance Underwriting Download Free PDF

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Definition of Insurance
The purpose of this white paper is to provide guidance to state insurance regulators on the commonly recognized elements of an insurance product. It focuses on the areas of the Gramm Leach-Bliley Act (GLBA) that help delineate the boundaries of functional regulation relating to insurance. This white paper is divided into three areas: 1) definition of insurance; 2) distinguishing the business of insurance; and 3) resolution of disputes under Section 304 of GLBA. Copyright 2000.

DOI-OP Definition of Insurance Download Free PDF

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Electronic Commerce and Regulation Issue Paper
This paper is the culmination of study by an NAIC working group appointed to 1) evaluate how the Internet and other methods of electronic commerce could increase efficiencies in the regulation of insurance; and 2) develop specific recommendations to help facilitate the beneficial use of electronic commerce by insurers. Copyright 2000.

ECR-OP Electronic Commerce and Regulation Issue Paper Download Free PDF

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ERISA: Barrier to Health Care Consumers' Rights
This publication includes sections on the history of ERISA and its preemption of state law and state consumer protections, as well as various attachments on ERISA provisions, relative insurance pools and states that have enacted the Stop Loss Insurance Model Act. For the millions of Americans enrolled in self-funded health plans, ERISA provides the only recourse for those wronged by their plan. Because ERISA may preempt state laws, it is also the most significant obstacle to state insurance regulators’ efforts to expand or enforce provisions governing consumer rights. Copyright 2000.

ERI-HC99 ERISA: Barrier to Health Care Consumers' Rights Download Free PDF

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An Exploration of Potential Regulatory Measures Intended to Prevent Individuals at Later Durations of Non-Group Major Medical Products from Receiving Higher Rate Increases than Those at Early Durations White Paper
This white paper outlines six approaches states may take to prevent individuals at later durations of non-group major medical insurance products from receiving higher rate increases than those at early durations (known as the “closed block problem”). For each approach, it provides a basic explanation for appropriate use, benefits and drawbacks, and considerations policymakers must keep in mind when attempting to adopt or implement the approach. Copyright 2008.

ERM-OP An Exploration of Potential Regulatory Measures Intended to Prevent Individuals at Later Durations of Non-Group Major Medical Products from Receiving Higher Rate Increases than Those at Early Durations White Paper Download Free PDF

Guidelines to be Used between CMS and State Insurance Departments for the Medicare+Choice Program
This memorandum provides general guidelines to the states and those areas of the Centers for Medicare & Medicaid Services (CMS) responsible for administering the Medicare+Choice program. It includes federally waived provider sponsored organizations, and provides for the mutual sharing of information between CMS and states to facilitate each party's role. Copyright 2001.

GMP-OP Guidelines to be Used between CMS and State Insurance Departments for the
Medicare+Choice Program
Download Free PDF

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Guidelines for Industry for Reporting Suspicious Claims or Activity to State Fraud Bureaus
This publication provides uniform direction to the insurance industry for the reporting of suspicious claims or activity. Specific attention is paid to the submission process, including the minimum amount of information that should appear on the reporting form and the basic types of evidence that may be used to support a report of suspicious behavior. Copyright 2003.

GIR-OP Guidelines for Industry for Reporting Suspicious Claims or Activity to State Fraud Bureaus Download Free PDF

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Health Insurance Exchanges Under the Affordable Care Act: Governance Options and Issues
Assists state policymakers with the implementation of health insurance exchanges. Identifies and discusses issues concerning governance of the exchange, in relation to the requirements established by the federal Patient Protection and Affordable Care Act (PPACA). Copyright 2011.

HIE-OP Governance White Paper Download Free PDF

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Inter-Affiliate Pooling Arrangements
This white paper discusses issues and possible solutions associated with inter-affiliate pooling arrangements, which are reinsurance agreements among two or more affiliated companies whereby each participating company shares in the underwriting results of the participating insurers on a predetermined basis. The NAIC working group that drafted this white paper was charged with considering whether to amend the model Holding Company Act or the Rehabilitation and Liquidation Model Act in order to prevent unfair treatment of policyholders of insolvent affiliated pooling companies. Copyright 2000.

IPA-OP Inter-Affiliate Pooling Arrangements Download Free PDF

Investigation and Prosecution of Insider Misconduct in the Insurance Industry: A Guide for State Insurance Departments
This guide seeks to define an antifraud strategy for state insurance departments to facilitate the investigation and prevention of insurance industry insider fraud. It also seeks to establish guidelines on the investigative and prosecutorial resources necessary to investigate insider
insurance industry fraud based on such parameters as volume of insurance premiums written, the nature of the industry activity, population and other objective measures. Copyright 2002.

IMP-OP Investigation and Prosecution of Insider Misconduct in the Insurance Industry Download Free PDF

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Issues Involving External Grievance Review Procedures
Outlines major issues regarding external grievance review procedures for health carriers and highlights state responses to these issues. Provides information about the 39 states that have chosen to institute a formal process for resolving consumer complaints about health care and health plans. Copyright 2000.

EGR-OP Issues Involving External Grievance Review Procedures Download Free PDF

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Marketing Insurance Over the Internet
This paper includes a detailed review and recommendations regarding the sale, marketing and regulation of insurance through the Internet. Specifically, it addresses such technology issues as digital and electronic signatures, electronic fund transfers, electronic applications, privacy and confidentiality issues, contracted policy forms and producer/company licensing issues. Copyright 1998.

MOI-OP Marketing Insurance Over the Internet Download Free PDF

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Medicaid Managed Care: Perspectives of the NAIC
This white paper addresses issues that policymakers should consider when designing and implementing a Medicaid managed care program, while balancing the goals of protecting consumers and ensuring the financial solvency of insurers. Managed care arrangements have become a viable alternative to states seeking innovative strategies to provide medical assistance beneficiaries with quality health care in a cost-effective manner. Copyright 1996.

MMC-OP Medicaid Managed Care: Perspectives of the NAIC Download Free PDF

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Medical Savings Accounts: Background Information and Regulatory Concerns of the NAIC
This white paper provides background information on key issues related to medical savings accounts (MSAs): Strengths and weaknesses of the use of MSAs to control costs; design elements of MSAs; impact of MSAs on the insured marketplace; and regulatory concerns. Copyright 1996.

MSA-OP Medical Savings Accounts: Background Information and Regulatory Concerns Download Free PDF

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Medicare Managed Care: A Regulatory Overview
This white paper provides information regarding the state regulation of plans participating in Medicare managed care. Information in the paper was gathered from some of the relevant laws, as well as discussions with state regulators and federal officials. The appendix contains a sample Medicare managed care HMO/CMP contract. Copyright 1997.

MMR-OP Medicare Managed Care: A Regulatory Overview Download Free PDF

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White Paper on Regulation of Medicare Private Plans
This white paper outlines the problems in the Medicare private plan market and their underlying causes, and suggests solutions that will help protect the Medicare-eligible population. It is not a position paper. It is a collection of the viewpoints of various participants—including state regulators, industry, consumer groups and the Centers for Medicare and Medicaid Services—that can help policymakers make informed decisions in dealing with these programs in the future. Copyright 2008.

MPP-OP White Paper on Regulation of Medicare Private Plans Download Free PDF

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Medicare Supplement Insurance Issues Paper
This white paper was developed in response to NAIC members’ concerns regarding the impact on consumers of rate increases for Medicare supplement insurance. This paper incorporates a report by the American Academy of Actuaries that examines the factors affecting the cost of Medicare supplement insurance. Copyright 2002.

MSI-OP Medicare Supplement Insurance Issues Paper Download Free PDF

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Multi-State Examination of the National Council on Compensation
Insurance, Inc.

Presents the approach, findings and recommendations of the examination and evaluation of statistical reporting data quality and timeliness and experience ratings produced and released by the NCCI. This multi-state examination was performed in August 2001 on behalf of the Oregon Department of Consumer and Business Services’ Insurance Division and twelve other NAIC-member jurisdictions. Copyright 2002.

NCI-OP Multi-State Examination of NCCI Download Free PDF

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Multi-State Examination of the National Council on Compensation
Insurance, Inc. - Executive Summary

This executive summary was written to provide an overview of the August 2001 multi-state examination of the NCCI and to explain the action plans agreed upon between the NCCI and the NAIC to resolve each of 48 exam recommendations identified pertaining to either data quality, unit reporting or experience-rating issues. Copyright 2005.

NCC-ES Multi-State Examination of NCCI - Executive Summary Download Free PDF

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Mutual Insurance Holding Company Reorganizations
Analyzes mutual insurance holding company reorganizations in the context of states' regulatory framework. Discusses principal drivers behind this form of corporate structure, treatment of policyholders under a reorganization and standards for reviewing a mutual insurer's plan of reorganization. Copyright 1998.

MIH-OP Mutual Insurance Holding Company Reorganizations Download Free PDF

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"Other States" Coverage in Workers' Compensation Policies
This white paper addresses “other states” coverage specifically related to the temporary and incidental activities of a company’s employees in states other than the state of hire. It outlines recommendations for a legislative remedy that would help protect employers and their employees in these types of situations. Copyright 1998.

OSC-OP Other State Coverage in Workers' Compensation Download Free PDF

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An Overview of Workers' Compensation Independent Contractor Regulatory Approaches
This paper discusses the ramifications of different laws and procedures on establishing criteria for an independent contractor vs. an employee. The authors stress the impact of different screening systems on the administration of the workers’ compensation system, and offer several recommendations for improving the smooth and fair application of exemptions for independent contractors. Copyright 2009.

OWC-OP An Overview of Workers' Compensation Independent Contractor Regulatory Approaches Download Free PDF

The Potential Impact of Climate Change on Insurance Regulation
Written under the assumption that global warming is occurring, this white paper provides an overview of climate change concerns related to insurance and insurance regulation. It presents issues faced by the various lines of business and ways regulators can mitigate these potential problems. Investment implications and opportunities, the government's role, and the importance of enhanced disclosure also are covered. Copyright 2008.

CCI-OP The Potential Impact of Climate Change on Insurance Regulation Download Free PDF

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Public Hearing on the Use of Credit Information in the Underwriting and Rating Process
This paper includes the minutes and written testimony from a public hearing held by the NAIC to address how the use of credit scores should be regulated. Testimony was received from insurance regulators, consumer groups, credit scoring companies and insurance trade associations. The testimony primarily focused on the use of credit scores in personal lines auto insurance. Copyright 2002.

URP-OP Public Hearing on the Use of Credit Information in the Underwriting and Rating Process Download Free PDF

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Regulation of Health Risk-Bearing Entities
This white paper reviews the changing nature of the health insurance market and the states’ regulatory response. Underlying the overview of this issue are two central premises: 1) all entities that assume health insurance risk should be subject to the same solvency standards and other consumer-protection standards; and 2) the regulatory framework should foster a level playing field among risk-bearing entities. Copyright 1997.

RBE-OP Regulation of Health Risk-Bearing Entities Download Free PDF

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Regulation of Voluntary Underwriting and Reinsurance Pools White
Paper
This report provides an in-depth query into how the financial condition of underwriting pools is monitored and determines whether changes to the accounting guidance (for pools) within the Accounting Practices and Procedures Manual are needed. It includes a comprehensive examination of pool management, including underwriting agreements, pool membership, fee structures, retrocessions and actuarial support. Copyright 2003.

RVU-OP Regulation of Voluntary Underwriting
and Reinsurance Pools White Paper
Download Free PDF

Regulatory Access to Insurer Information: The Issues of Confidentiality and Privilege
This white paper analyzes the issue of regulatory access to documents that insurers maintain are protected or are otherwise confidential. A fundamental concern is the interplay between regulatory access and third-party access through public records laws, litigation discovery and other means. It includes the following sections: How Existing NAIC Model Laws Address Confidentiality; Basis for Assertions of Confidentiality and Privilege; Confidentiality Issues with Regulatory Examinations/Investigations; and Distinguishing Access by Regulators from Access by Third Parties. Copyright 2000.

ICP-OP Regulatory Access to Insurer Information Download Free PDF

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Regulatory Re-engineering of Commercial Lines Insurance
This white paper describes the environment in which commercial lines insurers are operating and problems that certain regulatory practices cause for insurers, agents and brokers attempting to service businesses operating in more than one state. Proposed solutions also presented. Copyright 1998.

CDR-OP Regulatory Re-engineering of Commercial Lines Insurance Download Free PDF

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Report of the Multiple Rating Organizations Study Group to the Workers' Compensation Task Force
This white paper is intended to help public policymakers identify the ramifications of having more than one advisory rating or statistical organization for workers' compensation. The goal of this publication is to provide a thorough analysis of the issues presented by this type of situation, as well as help insurance regulators craft solutions to fit their jurisdictions’ particular circumstances. Copyright 2000.

MRO-OP Report of the Multiple Rating Organizations Study Group to the Workers' Compensation Task Force Download Free PDF

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Report of the NAIC Genetic Testing Working Group
This white paper analyzes the appropriateness of the use of genetic testing in applications for insurance coverage. This paper provides a brief, easily understood primer on genetic testing, its status and issues raised by its use; an overview of actions taken by the various states; suggestions regarding possible regulatory options; and a compilation of statutes enacted by the states. Copyright 1996.

GTR-OP Report of the NAIC Genetic Testing Working Group Download Free PDF

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Report on Employee Leasing and Professional Employer Organizations
This report weighs the advantages and disadvantages of the master policy approach and the multiple coordinated policy approach in workers’ compensation insurance for employment services outsourcing. It also discusses the use of new terms to represent language previously associated with these types of operations and provides a listing of various issues for state regulators and legislators to ponder when addressing this topic in their state. Copyright 2002.

ELP-OP Report on Employee Leasing and Professional Employer Organizations Download Free PDF

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The Sales and Marketing Practices, Auditing and Accounting Procedures and Products of Insurers Utilizing the Home Service System
This white paper was developed in response to issues regarding the sale and marketing of property/casualty insurance products to low- and moderate-income persons and concerns over availability in underserved areas. Includes findings of a survey of life and property/casualty insurers using the home service system of marketing and recommendations to address areas of concern. Copyright 1998.

HSR-PB The Sales and Marketing Practices, Auditing and Accounting Procedures and Products of Insurers Utilizing the Home Service System Download Free PDF

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Suitability of Sales of Life Insurance and Annuities
This white paper examines the creation and enforcement of suitability standards for the sale of life insurance and annuities. It provides an overview of requirements established by the SEC and the NASD and the effectiveness of those requirements, including applicable court decisions. Also included is information about standards established by various states and their experiences in enforcing those standards. Copyright 2000.

SOS-LI Suitability of Sales of Life Insurance and Annuities Download Free PDF

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Uninsured Motorists: A Growing Problem for Consumers
The goal of this white paper is to help the NAIC consider a uniform cost-effective approach to minimizing the number of motorists that are operating without the insurance that is required by state law in most jurisdictions. Prepared by the NAIC Property and Casualty Insurance Committee, this white paper explores the extent of the problem and identifies solutions that the states have implemented to address this issue. Copyright 2006.

UMC-OP
Uninsured Motorists: A Growing Problem for Consumers Download Free PDF

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US Reinsurance Collateral White Paper
The purpose of this white paper is to provide a balanced synopsis of the historical arguments in favor of and against amending U.S. reinsurance collateral requirements. This report was written to help NAIC members make public policy recommendations concerning this issue. The study is based on a review of historical data collected and compiled by various interested parties, as well as the NAIC financial reporting database. Copyright 2006.

URC-OP US Reinsurance Collateral White Paper Download Free PDF

The Use of Social Media in Insurance
This white paper focuses on insurance company and producer uses of social media; regulatory and compliance issues associated with the use of social media; and guidance for addressing identified regulatory and compliance issues. Copyright 2012.

USM-OP The Use of Social Media in Insurance Download Free PDF

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Workers' Compensation Carve-Out Business-Underwriting and Reinsurance Pools Working Group
This white paper includes a comprehensive analysis and evaluation of workers'
compensation carve-out business and the operations of underwriting pools and associations,
their impact on the insurance and reinsurance marketplace and the extent that statutory
authority may have to be revised to ensure adequate and effective oversight. Copyright 2001.

WCC-OP Workers' Compensation Carve-Out Business-Underwriting and Reinsurance Pools Working Group

Download Free PDF

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Workers' Compensation Large Deductible Study
Today, large deductible policies are a major factor in the workers’ compensation marketplace. This study was written to inform about current workers’ compensation large deductible issues and to provide findings and recommendations in regard to those issues. Adequate attention to the recommendations provided is anticipated to resolve many of the concerns and demonstrated problems that states have experienced with this alternative product. Copyright 2006.

WCD-OP Workers' Compensation Large Deductible Study Download Free PDF