Topic 11 State Reg. Of Gi

Front 1

Points of Regulation for Insurance companies vs. Benefit plans.

Back 1

• Insurance- so they don't go insolvent
  

• Benefit plans- ER gets tax deduction- make sure EE well being is maintained

Front 2

Roles of regulation

Back 2

• State gov- regulates insurers

• Federal gov. regulates ER when they offer EE benefit plans

Front 3

McCarrian- Fergson Act 1945

Back 3

• Exempts Insurers from Federal regulation.
  
• States Regulate

• Fed gov. can only regulate business aspects of insurance not insurance aspects

Front 4

NAIC

Back 4

• National Association of Insurance Commissioner
  

• At least 50(1 for each state plus territories)

Front 5

What does the NAIC do?

Back 5

• Has no regulatory authority
  

• Promotes uniformity in regulation among states
  
• Model Acts or Model Laws- suggestive templates to make all the same

Front 6

Example of Uniform

Back 6

GTLI

Front 7

GTLI- Areas of Regulation Impacting GTLI and EE benefits

Back 7

1. Eligible Group for GI purpose
2. Contractual Provisions
3. Taxation

Front 8

1.) Eligible Group for GI purpose

Back 8

• Min # to be considered GI?
• Types of groups eligible?

Front 9

Types of Groups considered eligible

Back 9

• ER/EE groups- need to define definition ER, EE, Dependent

• Taff-Hartly plans- unions

• Affinity groups- student groups, alumni associations, professional associations

• Trade Associations- local chamber of comm.

• MEWA

Front 10

MEWA

Back 10

• Multiple ER welfare arrangements

• problem- Sole purpose of group is free underwriting- A.S problem

Front 11

2.) Contractual provision

Back 11

• Def. of key terms

• State mandates- HI, state mandate benefit laws

• e.g- mandatory coverage for certain items- contraception, in vitro fertilization

• Min level of benefits

Front 12

Problem with Mandates

Back 12

• Raise the cost of HC

Front 13

ERISA Preemption

Back 13

Overrides state attempts to regulation ER

Front 14

3.) Taxation

Back 14

• - Premium taxes
  

• Taxes on revenue

• 3-4% of premium written