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123 Cards in this Set
- Front
- Back
- 3rd side (hint)
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The major types of producers |
- general agents (agents working for general agents normally interact with the public in the sale of insurance)
- independent agents - captive agents - career agents - producing general agents - brokers - surplus-line or excess-line brokers or agents - solicitors |
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Insurance
General Agents |
- Independent businesspeople (subject to the terms of their general agency contracts) who are empowered by the life insurance company they represent to sell the products of the company in specified territories and to appoint agents to do business under them.
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Insurance
Independent Agents |
- Agents generally represent several insurance companies doing business under the American or Independent agency insurance system.
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Insurance
Producer groups |
- Independent agents (and brokers) may affiliate with a producer group.
- Producer groups generally are made up of high-end independent agents. These groups negotiate special commission schedules with insurers and have minimum production requirements for affiliated agents. |
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Insurance
Captive Agents |
- Sell property and liability insurance for companies that are known as direct writers.
- Represents only one company or one group of companies under common ownership. - |
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Insurance
Career Agents |
- Generally life insurance agents in a general agency or a company-owned office under the agency management or the branch office systems.
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Insurance
Producing General Agents |
Producing general agents (PGAs) are also called personal producing general agents (PPGAs).
Like General Agents but differ in the following ways: - generally produce the majority of their income by selling insurance personally, - do not have specified territories, - frequently do not hire agents to work for them, although they have authority to do so if they wish. |
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Insurance
Brokers |
- Individuals who are licensed with and can work with many
insurers. - An agent of an insurance buyer. Once an insurer is selected, the broker or state law make the broker an agent of the insurer. |
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Surplus-Line, Excess-Line Brokers, or Agents
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- Has the authority to go outside the state and place the business with a surplus-line (unadmitted) insurer if the necessary coverage cannot be obtained from an insurer admitted in the state.
-These are found almost exclusively in the property and casualty field. |
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Solicitors
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- Generally cannot bind the insurer or issue policies.
- They find insurance prospects and then handle the business through an independent agent, a broker, a company branch, or a service office. - Not every state allows solicitors to operate. |
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Legal Relationships -
Brokers and Agents |
Agent:
- Representative of the insurer - A principal (an insurer) gives an agent the authority to solicit, create, modify, or terminate insurance contracts, subject to the limitations of the agency agreement between the two as modified by the law of the jurisdiction. Broker: - Representative of the prospective insured when acting in his or her capacity as a broker. Note, as previously stated, that once an insurer is agreed upon, either the insurer or state law can effectively make the broker the insurer’s agent— this is so that the insurer can issue and place the insurance contract. |
Recent changes in a number of states have made the agent/broker distinction less obvious. Rather than issue agent or broker licenses, these states are licensing people as producers.
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Broker vs. Agent
Which can bind the insured to an insurance contract. |
- Broker generally cannot bind a prospective insured or the insurer to an insurance contract.
- An agent can bind the insurer to an insurance contract |
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What field have brokers traditionally worked?
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- Property and Casualty
- There have been an increasing number of life and health insurance brokers |
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When giving a premium payment to a broker...
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- Is not considered a payment to the insurer
- However in some states the broker is made an agent of the insurer for the purposes of collecting premiums. |
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An agent’s authority to legally
bind a principal (insurer, in this case) stems from three sources: |
1. Express authority,
2. Implied authority 3. Apparent authority. |
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Express Authority
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- Is specifically conferred on the agent.
- Stated in the agent's contract with the insurer - The insurer may specify the types of insureds, coverage and amount the agent can write. |
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Implied Authority
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- Not expressly granted, but which the agent is assumed to have in order to transact the insurer’s business
- The difference between implied and apparent authority is intent. - Normally considered positively. |
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Apparent Authority
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- Which is a doctrine of ostensible authority
- the appearance of, or assumption of, authority based on the actions, words, or deeds of the agent/insurer; or, because of circumstances the insurer created, a third party (insured) is led to believe that the agent is acting within the scope of reasonable and appropriate authority. - The insurer can be liable for the acts of the agent. - Acts of the agent are binding - even if the agent is terminated - unless the insurer notifies clients directly that the agent was terminated. |
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Producer
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- A number of states have replaced agent and broker licenses with producer licenses.
- Takes the position that all producers are agents. - In most cases a producer must pay a fee for every insurance company with which he wants to writes business. - |
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Loss Adjustment Process
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- The steps that are taken when an insured loss occurs
- Every insurance policy describes the steps that must be taken in order for a payment to be made. |
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An Adjuster
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- A person who investigates insurance claims and determines the amount of payment to be made.
- Agents also serve as adjusters - Most categories of adjusters support the insurance company (except for a public adjuster). |
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Public Adjusters
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- Hired by an insured to help navigate the claim process.
- Provides guidance to an insured who does not feel comfortable handling his or her claim. - Typically receives a contingency fee based on the amount of the settlement. |
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Insured's Duties Pertaining to a Loss Settlement
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1. Notice of Loss
2. Protection of property 3. Inventory 4. Evidence 5. Proof of loss 6. Assistance and cooperation 7. Appraisal |
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4 Steps followed by a claim's adjuster during the loss adjustment process.
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1. Notice of Loss
2. Investigation 3. Proof of Loss 4. Payment or Denial |
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Notice of loss
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- The insured is required to give immediate notice of a loss
- (generally) "Immediate notice" means as soon as possible. - Until notice is given the insurance company has no obligation. - A phone call is typically adequate. |
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Protection of Property
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- Provision in most policies that requires the insured to protect the damaged property after a loss.
- Insurers will typically reimburse any costs associated with this - This provision typically helps to minimize losses to the insurer. |
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Inventory
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- Insured's are required to conduct an inventory of the damaged property.
- The report must be itemized and include: - Quantity, - Description - Actual cash value or replacement value - the amount of the loss of the damaged property - Receipts, bills and other proof supporting amounts should be attached. - If proof is lost insurer would only require reasonable compliance. |
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Evidence
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- The insured may be required to show the damaged property to the insurer as often as reasonably asked.
- Helps the insurer to determine if the claim is valid. - If evidence is intentionally destroyed the contract may be void. - For injury claims medical reports may be required. - The insurer determines what evidence is required. |
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Proof of Loss
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- Most insurers provided proof of loss forms that should be filled out
- Provides information regarding the time, cause of loss, the interest of the insured, other insurance covering the loss, all encumbrances on the property and other information. |
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Assistance and cooperation
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- The insured must cooperate and provide assistance to the insurer.
- This includes: attending hearings, presenting evidence and supplying medical reports. |
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Appraisal
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- May be requested by either the insured or insurer is they cannot agree on the value of a loss.
- This provision reduces litigation and provides an equitable and fair procedure for disputes pertaining to the amount of loss. |
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Appraisal process
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- The insured and insurer select impartial appraisers.
- Appraisers select an umpire. - Together they determine the amount of loss. |
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Settlement Options of the Insurer
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1) Replacement option
2) Abandonment and salvage option 3) Pair or set option |
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Settlement Options of the Insurer
Replacement Option |
- The insurer may repair or replace damaged property
- Generally insurer's must give the insured notice within 30 days after the date that the proof of loss was provided. - Generally not used by insurers |
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Settlement Options of the Insurer
Abandonment and Salvage |
- Involves surrendering ownership of lost or damaged property tot he insurance company so that a total loss can be claimed.
- An insured does not have the right to choose this option - The insured may choose to keep damaged property and accept a lower payment |
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Settlement Options of the Insurer
Pair or Set |
- Option gives the insurer the right to:
a) repair or replace any part b) restore a pair or set to its value before the loss c) pay the difference between the actual cash value of the property before and after the loss If the insured has a personal property endorsement or floater policy this option can not be selected. |
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Actual Cash Value
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The replacement cost less depreciation
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For a covered loss under a typical commercial property contract the insurer will pay:
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The greater of:
1) The actual cash value of the damaged part of the building 2) the amount determined by the use of one of the following formulas: A) replacement cost X coinsurance percentage B) ( (insurance carried / Insurance required) X Loss) - Deductible |
- The deductible is subtracted from the loss after the coinsurance penalty percentage is applied.
- The total payment cannot exceed the amount of the loss or the amount to insurance coverage except in cases where adequate insurance is owned with a guaranteed replacement cost policy. |
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Commercial Property Insurance
Coinsurance Penalty |
The coinsurance rate is usually 70%-90% (often 80%).
If the insured does not have at least that much coverage there is a penalty. |
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Health Care Insurance
Stop-Loss Limit |
- The amount of covered expenses, following payment of the deductible, that is shared by the insured and the insurance company.
- The insurer pays 100% of any amount beyond the stop-loss limit |
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Deductible
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- 100% of the deductible is paid by the insurer
- The amount of the deductible is paid first - Covered expenses less than or equal to the deductible is paid by the insurer |
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Per-cause deductible
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- Deductible is paid for each claim
- Policies with this clause pay less in benefits and typically have a higher premium |
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- Seven factors that limit an insurer’s liability covering losses:
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1. Insurable Interest
2. Actual Cash Value of the loss 3. Policy limits or face value 4. Other Insurance 5. Co insurance 6. Deductibles 7. Subrogation |
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Insurable interest
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- Exists when the interested party will suffer a financial loss if the insured loss occurs.
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Actual cash value of the loss.
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- Used with property losses, is the replacement cost minus depreciation.
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Policy limits or face value.
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- The maximum amount that will be paid when the insured loss occurs.
- The majority of policies have face amount limits and include several internal limits applying to certain types of property, losses, locations, perils, or hazards. |
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Other insurance Provision
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- Provision states that when a loss occurs, and there is more than one insurance policy covering the same loss, the insured will not profit from the loss.
- Either one policy is considered the primary with the other paying for any uncovered loss, or the policies pay prorated shares of the loss. |
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Coinsurance
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Either the:
- Splitting of costs or - A minimum percentage of insurance that is required to avoid being penalized for inadequate insurance when there are partial losses. |
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Deductibles
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- A retained risk.
- The portion of insured losses that the insured is expected to pay before the insurance company pays anything. |
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Subrogation
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- The right of an insurance company that has paid for a loss to recover its payments if it is determined that a different insurance company or person is responsible for the loss and is required to pay for it.
- Prevents the insured from collecting twice for the same loss. |
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Important Factors When Selecting an Agent (8):
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1) Competence
2) Inclination to Service 3) Experience 4) Training 5) Education 6) Specialization 7) Designations 8) Reputation |
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Draft Authority
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- The authority to handle minor claims in the office, without having to go through a long adjustment process.
- Consideration when selecting a property and liability agent |
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CPCU
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Chartered Property and Casualty Underwriter
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CLU
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Chartered Life Underwriter
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ChFC
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Chartered Financial Consultant
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5 Steps to Avoid Misunderstanding
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1) Put crucial points in writing
2) Read and understand the insurance contract 3) Understand the insurance company's internal procedures 4) Realize the marketplace has an impact on the services the agent is able to deliver. 5) Maintain a professional working relationship with an agent |
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Usual and Customary Rate (UCR)
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- Tables that determine the maximum amount an insurer will pay for a medical procedure under a major medical policy are not a part of the policy, but directly impact potential claims.
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Who are the insurance rating companies (6):
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1) A.M. Best Company
2) Demotech 3) Fitch Ratings 4) Moody's Investor Service 5) Standard & Poor's Corporation 6) TheStreet.com Ratings (formerly Weiss Research) |
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A.M. Best
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- The oldest of the insurance rating services
- The only rating service that specializes in rating insurance companies - Rates over 4,500 insurance companies - Ratings based on comprehensive analysis o fa company’s financial records as well as interviews with key employees. |
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Demotech
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- Provides financial stability ratings for property and casualty companies and title insurers.
- Available information includes: - Assets - Policyholder surplus - Premiums written by year - States where insurer is liscenced |
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Fitch Ratings
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- Provides ratings on over 800 insurance entities along with fixed income security ratings
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Moody's
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- Generally rates a company at its request, but will rate some companies with public information.
- Publishes a "financial strength rating" |
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Standard & Poor's
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- Publishes two ratings:
1) "Claims-paying ability rating" - Done by request and public as well as non public information is used. 2) "Qualified Solvency Rating" - - Done with public records only at no charge to the companies being rated. |
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TheStreet.com Ratings
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- Publishes "safety ratings"
- Uses public information only - No meetings with the company officers are held. - The only rating service that does not charge companies for their ratings |
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State Insurer Insolvency Funds
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- State funds established to protect policyholders from losses int he even of insurer insolvency.
- Generally, remaining solvent insurers are assessed to cover a proportionate share of losses. - New York State operates on a pre-loss assessment basis. |
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NAIC Watchlist
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If 4 of the 12 ratios are outside of the "usual ranges" for an insurance company it is put on this list.
- Depending on the problem ratios the companies on this list are selected for one of the following : A) Immediate regulatory Attention B) Targeted regulatory Action C) No Regulatory Action |
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12 ratios used in the NAIC Watchlist:
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1. Net Change in Capital and Surplus: Greater than –10% and less than 50%
2. Gross Change in Capital and Surplus: Greater than –10% and less than 50% 3. Net Gain to Total Income: Greater than 0% 4. Commissions and Expenses to Premiums and Deposits: Less than 60% 5. Adequacy of Investment Income: Greater than 100% 6. Nonadmitted to Admitted Assets: Less than 10% 7. Real Estate to Capital and Surplus: Less than 200% for companies with capital and surplus greater than $5 million; less than 100% for companies with capital and surplus equal to or less than $5 million 8. Investments in Affiliates to Capital and Surplus: Less than 100% 9. Surplus Relief: Greater than –99% and less than 39% for companies with capital and surplus greater than $5 million; greater than –10% and less than 10% for companies with capital and surplus equal to or less than $5 million 10. Change in Premium: Greater than –10% and less than 50% 11. Change in Product Mix: Less than 5% 12. Change in Asset Mix: Less than 5% |
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Risk-Based Capital Ratios
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- A method developed by the NAIC to measure the minimum amount of capital that an insurance company needs to support its overall business operations.
- Used to set capital requirements considering the size and degree of risk taken by the insurer. |
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Four major categories of risk that must be measured to arrive at an overall risk-based capital amount.
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1) Asset Risk
2) Credit Risk 3) Underwriting Risk 4) Off-Balance Sheet Risk |
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Asset risk
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- The measure of an asset’s default of principal or interest or fluctuations in market value as a result of changes in the market.
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Credit risk
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- A measure of the default risk on amounts that are due from policyholders, reinsurers, or creditors.
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Underwriting risk
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- A measure of the risk that arises from underestimating the liabilities from business already written, or inadequately pricing current or prospective business.
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Off-balance sheet risk
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- A measure of risk due to excessive growth rates, contingent liabilities, or items not reflected on the balance sheet.
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NAIC created the Risk-Based Capital
(RBC) Model Act |
- An insurer’s capital base is adjusted to reflect risk.
- RBC instructions require insurers to submit an annual RBC report that takes into consideration: A) The risk with respect to the insurer's assets B) The risk of adverse insurance experience with respect to the insurer's liabilities and obligations c) The interest rate risk with respect to the insurer's business, d) All other business risks and such other relevant risks as are set forth in the RBC instructions |
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RBC Rations are intended to be used by :
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- State insurance commissioners only
- Insurers are prohibited from using their RBC ratios in any type of company publication. |
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RBC
Company Action Level |
- First Level
- At this level: 1) the company must submit a plan showing how it will improve its RBC numbers. 2) No intervention from the state |
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RBC
Regulatory Action Level |
- Second level
- At this level the commissioner generally will: - evaluate the submitted plan - carry out an analysis or examination of the insurer's assets - prescribe what corrective actions are to be taken |
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RBC
Authorized Control Level |
- Third Level
- At this level the commissioner may choose to put the company under the regulatory control of the commissioner's office |
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RBC
Mandatory Control Level |
- Fourth (last level)
- The state insurance commissioner is required to take control of the insurance company - The commissioner then makes a determination if the company can be rehabilitated or is insolvent |
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Other characteristics for evaluation of an insurance company (beyond RBC)
(8) |
1) Size and Age
2) History 3) Operating Ratios 4) Average Policy Size 5) Lines of business 6) Investment Returns 7) Direct Recognition 8) Forms of ownership |
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Size and Age of an insurance company Considerations
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- Long track record
- Assets that significantly exceeds the amount insured. |
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History of an insurance company considerations
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- Past financial problems
- Dividend or earnings history |
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Operating ratios of an insurance company considerations
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The various rating companies provide a number of financial operating ratios for each of the companies they rate.
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Lapse Ratio of an insurance company considerations
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- The percentage of policies that are terminated each year out of all policies in force.
- Lapse ratios may be found in Best’s Agents Guide, available from the A.M. Best Company. |
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Average policy size of an insurance company considerations
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- Avg policy size may give some indication of the type of business a company is writing
- It is important to know the amount of insurance in force relative to the assets backing it up. |
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Lines of business of an insurance company considerations
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- Specialization
- Consider current and future needs of the client and whether the company provides that type of insurance |
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Investment return of an insurance company considerations
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- If one company seems to be earning much more than the rest, It may be taking on substantially more risk in its investments.
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Direct recognition of an insurance company considerations
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- This is a procedure where dividends or interest are adjusted to reflect the actual cost of lending money to the policyholder.
- A company that does not use direct recognition essentially has nonborrowers subsidizing borrowers. |
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Direct recognition
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- This is a procedure where dividends or interest are adjusted to reflect the actual cost of lending money to the policyholder.
- If the policy loan rate is lower than the rate the insurance company can earn, the dividends or interest on that policy are decreased. |
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Forms of Ownership for insurance copmanies - considerations
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- Mutual companies pay profits to policy holders
- Stock companies have shareholders to answer to leading to better management |
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Two Primary Forms of Insurance Company Ownership
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1) Mutual Companies - owned by policy holders
2) Stock companies - owned by the stockholders |
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Fraternal benefit societies
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- Nonprofit social organizations that often sell life insurance products.
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Insurance Companies
Mutual Companies |
Owned by policy holders
- Typically only sell to members of the group - Relatively small part of the insurance industry - Pay profits to policy holders - Generally policyowners get a better product at a lower net cost. |
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Insurance Companies
Stock Companies |
- Owned by stockholders
- Trend is more companies are stock companies |
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Risk Retention Groups
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- A variation on the method of operation used by mutual insurance companies.
- A number of similar companies join together and establish a separate insurance company that insures only members of that group. |
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The Life Insurance Policy Illustration Model Regulation
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- Established by NAIC
- Adopted in many states - Defines and limits how an insurance company may illustrate life insurance policy values. - They may have policies that are not sold with illustrations - Requires: 1) All guaranteed and non-guaranteed values to be clearly identified 2) All pages of the illustration must be provided to the client 3) The insured must sign a copy of the illustration and it must be included with the application when submitted 4) If there is a variation between the application and policy a new illustration must be prepared and signed |
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Insurance Marketplace Standards Association (IMSA)
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- Created by the insurance industry
- Voluntary membership trade association - To be a member the company must show it adheres to the standards of ethical market conduct. |
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Insurance Marketplace Standards Association (IMSA)
Standards (6) |
1) To conduct business according to high standards of honesty and fairness and to render that service to its customers which, in the same circumstances, it would apply to or demand for itself.
2) To provide competent and customer-focused sales and service. 3) To engage in active and fair competition 4) To provide advertising and sales materials that are clear as to purpose and honest and fair as to content. 5) To provide for fair and expeditious handling of customer complaints and disputes 6) To maintain a system of supervision and review that is reasonably designed to achieve compliance with these Principles of Ethical Market Conduct |
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12 Key Factors in Insurance Company
Selection |
1) Rating companies
2) IMSA membership 3) NAIC Watchlist 4) RBC ratios (if available) 5) Size and age 6) History 7) Operating ratios 8) Persistency 9) Average policy size 10 ) Lines of business 11) Investment return 12) Direct recognition |
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State Insurance Company Guarantee
Programs |
- States have funds established to protect policyholders from losses in the event of insurer insolvency.
- Generally, remaining solvent companies in the state are assessed to cover a proportionate share of losses. - Several states have a fund that provides for payment to people injured in an auto accident when the negligent driver cannot pay for damages. |
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Who passes laws that govern the conduct of insurance business ?
What do the laws cover? |
- State legislature
- Laws cover: - Requirements involved in organizing an insurance company - Standards of solvency - Regulation of rates and investments - Licensing of agents |
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What is the state insurance department (administrative/executive) responsible for?
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- Sets regulation implementing legislation and administers compliance.
- Exercises judicial power in interpreting and enforcing the state insurance code. |
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What are the areas of insurer operations regulated by the insurance commissioner (12 areas):
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1) Examination of companies
2) Rates 3) Guarantee Funds 4) Competence of Agents 5) Unfair Practices 5) Company Insolvencies 6) Policy Forms 7) Access to Insurance 8) Social Pricing 9) Investments 10) Licensing of Companies 11) Reserves |
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McCarran Ferguson Act
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- Left direct regulation of the insurance industry largely up to the states
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Examples of federal regulation include the following in the insurance industry:
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- IRS provision dealing with insurance and investments
- The SEC - ERISA/PBGC/DOL/IRS - COBRA and the Family Medical Leave Act of 1993 - The Civil Rights Act of 1964, The Age Discrimination in Employment Act, Americans with Disabilities Act - The Health Insurance Portability and Accountability Act of 1996 (HIPPA) |
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Impact to the insurance industry:
Internal Revenue Code |
- Provisions of the code:
1) Define life insurance 2) Specify the income and estate tax treatment of life insurance death benefits, cash value buildup, interest on loans and disability premiums and benefits. |
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Impact to the insurance industry:
The SEC |
- Regulatory authority extends to securities packaged in products sold by broker/dealer subsidiaries of some life insurance companies.
- Includes: variable life insurance, variable universal life insurance and variable annuities - regulations involve contract language and product design |
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Impact to the insurance industry:
ERISA /PBGC/DOL/IRS |
- ERISA established comprehensive and massive regulation of pension and other employee benefit plans.
- impacts the insurance industry because their products are typically sold to pensions and other employer sponsored plans - describe the limits and benefits of life insurance as part of the assets used to fund qualified plans. |
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PBGC
Pension Benefit Guaranty Corporation |
- Established by ERISA to insure pension benefits for participants
- Requires annual filing of the pension plan |
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Impact to the Insurance Industry
COBRA and the Family and Medical Leave Act of 1993 |
- Requires employers with 20 or more employees to make continuation of health insurance coverage available for group insurance participants in the event of termination of employment or other “qualifying events.”
- The primary effect of the law provides job security, and especially continued health insurance coverage to individuals who need the leave. |
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Impact to the Insurance Industry
The Civil Rights Act of 1964 |
-Has been interpreted to require provisions of pension plans not to discriminate based on sex.
- The 1978 amendments to the Civil Rights Act require employers of 15 or more employees to cover costs of pregnancy on the same basis that nonmaternity health costs are covered under their group medical insurance. Benefits must also be extended to the spouses of these employees. |
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Impact to the Insurance Industry
The Age Discrimination in Employment Act |
- Requires employers with 20 or more employees to make the same health benefits available to all employees and their spouses, regardless of age or eligibility for Medicare.
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Impact to the Insurance Industry
The Americans with Disabilities Act |
- Impacts employers with 25 or more employees.
- They may not refuse employment to disabled persons because of concerns about possible effects on group health insurance premiums, nor can they discriminate against disabled employees in the area of health benefits once the person has been hired |
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Impact to the Insurance Industry
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) 7 Impacts |
Many impacts:
1) Preexisting conditions. 2) Nondiscrimination 3) Special Enrollment Rights 4) Guaranteed Coverage 5) Long-term Care 6) Accelerated death benefits 7) Privacy and access to records |
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HIPPA
Preexisting conditions |
- Preexisting conditions may be excluded from a health care plan for a maximum of 12 months.
- Late enrollee's exclusion period can be up to 18 months. - Pregnancy cannot be excluded as a pre-existing condition. - If an individual was covered for at least 12 months under one plan and changes jobs which requires changing to a new plan the new plan cannot impose a new pre-existing conditions period. |
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HIPPA
Nondiscrimination |
Group health care plans cannot exclude individuals or charge extra because of existing health conditions.
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HIPPA
Special enrollment rights |
When an individual declines coverage because other coverage exists, and then his or her status changes, a group plan must allow that individual to enroll without penalty or having to wait until the next regular enrollment period.
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HIPPA
Guaranteed coverage |
A person who has been covered under a group plan for at least 18 months must be allowed to purchase an individual plan if no group plan is available.
This purchase would follow full use of COBRA coverage and include the months provided for under COBRA. |
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HIPPA
Long-term care |
- Allow the policyholder to take an income tax deduction for all or a portion of the premiums as well as make the benefits income tax free.
- This law directly affects the design and benefits of LTC policies |
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HIPPA
Accelerated death benefits |
- If a person qualifies under HIPAA as terminally ill or chronically ill, benefits paid from a life insurance policy may be fully or partially income tax free.
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HIPPA
Privacy and access to records |
- Key privacy requirements for
all medical-related activities (e.g., physicians, pharmacists, etc.) - Asserted and affirmed an individual’s right to have access to his or her medical records |
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Patient Protection and Affordable Care Act of 2010
(PPACA) |
- Federal regulations and laws directly impacting the regulatory environment of the insurance industry
- Enacted on 3/23/2010 - Contains tax provisions that become effective in 2010. 1) lifetime coverage limits are disallowed 2) cost of over-the-counter medicines cannot be paid by a cannot be paid by a Flexible Spending Arrangement (FSA), health reimbursement arrangement (HRA), Health Savings Account (HAS), or Archer Medical Savings Account (MSA), unless a prescription is obtained 3) Health coverage for older children under 27 years of age is now generally tax-free to the employee. 4) Beginning in 2011 - employers must report the value health insurance coverage provided to to employees on their w-2 5) New requirements for group health plans. 6) Coverage regarding preexisting condition exclusions, lifetime and annual dollar limits on benefits, and rescissions were all eliminated; patient protections were strengthened. 7) There are additional requirements for tax-exempt hospitals. 8) There is an annual fee on branded prescription pharmaceutical manufacturers and importers. 9) Small business health care tax credit is included. |
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The National Association of Insurance Commissioners (NAIC) State Accreditation
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- (NAIC) began a process of introducing a series of model laws which, if enacted by a state, would give that state accreditation by the NAIC.
- Purpose is to increase the reliability of the oversight of insurance companies by various states. |
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