Journal of Insurance Regulation最新文献

{"title":"Gender X and auto insurance: is gender rating unfairly discriminatory?","authors":"Lorilee A. Medders, Jamie A. Anderson-Parson, Matthew Thomas-reid","doi":"10.52227/25058.2021","DOIUrl":"https://doi.org/10.52227/25058.2021","url":null,"abstract":"There are three goals of insurance rate regulation. Rates must be: 1) adequate; 2) not excessive; and 3) not unfairly discriminatory. Rates that are adequate yet not excessive are overall high enough to pay claims and expenses, yet not so high overall that they result in unreasonable profiteering by insurers. The third regulatory goal—that rates are not unfairly discriminatory—is the topic of interest in our research. The concept of unfair discrimination in an insurance context—determining what constitutes fairness in pricing—can differ substantially from the thinking on fairness in a societal context. As a result, the term “discrimination” may be used quite differently in these two contexts. Discrimination, with negative societal connotations, is endemic in our world broadly and largely unjustifiable, yet in the narrower world of insurance, it is the basis for the entire industry’s viability and sustainability. In the insurance context, we can receive the term “discrimination” in a neutral manner, simply taking it to mean different treatment for different groups having different characteristics, without it necessarily connoting any negative intent or outcome. Indeed, the purpose in insurance for engaging in “fair discrimination” —that is, discrimination that price differentiates between discernibly different levels of risk—is itself rooted in economic fairness. \u0000\u0000An insurance carrier charges differential prices for its products based on differentials in risk. Nevertheless, when risk transfer to an insurer is priced based on uncontrollable and/or immutable classifications such as race and gender, there can be profoundly different views of what constitutes fairness. In many areas of U.S. law, discrimination on either the basis of gender or sexual identity is prohibited in a number of jurisdictions for a number of consumer situations. Yet the broad concept of societal fairness and the much narrower concept of actuarial fairness differ, and so within insurance markets, U.S. law has historically set insurance apart from other products in speaking to issues of fairness and discrimination (West, 2013). Within the last year, several states have enhanced their recognition of nonbinary or genderqueer identities by implementing a Gender X option on driver’s licenses. Insurance carriers are left with minimal direction on how to appropriately price this emerging class within the three goals of rate regulation. \u0000\u0000Additionally, as diversity and inclusion continue to be a strategic initiative within the insurance market, the insurance industry and its regulatory environment have to navigate carefully between the business imperatives for adequate pricing and inclusion efforts. This paper addresses the potential for unfair discrimination in some lines of business—with special focus on auto insurance—should gender-based rating be continued into the future. It also explores an immediate opportunity to enhance the insurance industry’s social compact with its insured","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122492904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Selected Issues Resulting from COVID-19 on Agents and Lessons for the Future October 10, 2020","authors":"David C. Marlett, Jamie A. Anderson-Parson, Joe Stewart","doi":"10.52227/23477.2020","DOIUrl":"https://doi.org/10.52227/23477.2020","url":null,"abstract":"As the COVID-19 virus outbreak rapidly spread across the nation, state and\u0000local governments responded with mitigation efforts designed to slow the spread.\u0000This article focuses on four main areas and describes the impact on insurance agents.\u0000The first area is the designation of “essential employees.” This was the most\u0000immediate issue and required determination of who should stay home and who\u0000should continue to work because their job was essential. Second, we focus on agency\u0000operations and customer support issues. Next, we cover the challenges agents face\u0000complying with licensing and continuing education (CE) requirements. Lastly, we\u0000look at the surprisingly complicated factors surrounding premium adjustment and\u0000possible conflict with rebate laws and regulations. We interview a range of agents and leadership at insurance trade associations to obtain firsthand experience\u0000regarding these issues, and we provide recommendations based on lessons learned\u0000that can be applied in future disasters.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122941666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of Medicaid expansion, diversity and the ACA primary care fee bump on the performance of Medicaid managed care","authors":"Charles C. Yang","doi":"10.52227/26004.2018","DOIUrl":"https://doi.org/10.52227/26004.2018","url":null,"abstract":"In response to the policy changes to Medicaid, this research examines the impact of Medicaid expansion, diversity, and the Medicaid fee bump on Medicaid managed care. It aims to provide insights to health insurers, consumers, regulators and policymakers regarding profitability, better services, reducing expenses and improving efficiency. The results indicate that Medicaid expansion increases the profit efficiency of Medicaid managed care, but it has no significant impact on medical service efficiency or composite efficiency. The diversity of business lines, product types or payment methods does not create economies of scope for Medicaid profitability, medical service efficiency or composite efficiency. However, the diversity of product types is associated with more ambulatory encounters, while the diversity of payment methods reduces medical and administrative expenses. The Medicaid fee bump does not increase medical expenses or the utilization of medical services, and it has no significant impact on profitability or composite efficiency. \"Medicaid lower reimbursement\" should not be a big concern for Medicaid managed care in terms of profitability, medical services, expenses or overall efficiency. Another finding was that offering more preferred provider organization (PPO) plans improves the performance in profits, services and expenses; and managed care organizations (MCOs) also serving Medicare beneficiaries perform better in Medicaid managed care. In addition, capitation and contractual fee payments both enhance composite efficiency. The value-based payments do not have a significant impact on expenses or efficiency, but they are associated with more ambulatory encounters.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131942319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-based pricing of property and liability insurance","authors":"Lars Powell","doi":"10.52227/22106.2020","DOIUrl":"https://doi.org/10.52227/22106.2020","url":null,"abstract":"Policymakers currently show renewed interest in restricting the use of certain accurate ratemaking variables in personal lines (automobile and homeowners) insurance. Policymakers are considering, and in some states enacting, laws that would exclude gender, education, occupation and credit-based insurance scoring (CBIS) as insurance rating variables. The author argues that excluding accurate rating variables from the insurance pricing process has negative consequences. The accuracy of insurance prices decreases, creating cross-subsidies where lower-risk insureds pay higher premiums and higher-risk insureds pay lower premiums. In addition to being objectively unfair, cross-subsidies increase the overall cost of insurance and distort policyholder incentives to take appropriate precautions. The end result is higher prices, more property damage, more injuries and more fatalities. The author also address arguments put forth by opponents of these rating variables and demonstrate the high level of competition in insurance markets.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129660613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of the 'Risk Management and Own Risk and Solvency Assessment Model Act' and Insurer Ratings","authors":"Cassandra R. Cole, Kathleen A. McCullough, E. Sirmans","doi":"10.52227/20983.2017","DOIUrl":"https://doi.org/10.52227/20983.2017","url":null,"abstract":"The Own Risk and Solvency Assessment (ORSA) requires an increase in reporting for insurers. However, it is possible that many insurers already gather a significant amount of this information for other groups such as rating agencies. This study provides a comparison of the ORSA Summary Report requirements given in the NAIC Own Risk and Solvency Assessment (ORSA) Guidance Manual (ORSA Guidance Manual) and the information requested by ratings agencies such as A.M. Best as stated in the Credit Rating Methodology: Global Life and NonLife Insurance Edition to assess the similarities in information needed for ORSA reporting and rating agencies. We find significant similarities between ORSA reporting and the materials needed for credit rating. Given the overlap, the total cost of ORSA compliance may be less, in terms of time and effort, in preparing the ORSA Summary Report compared to firms that have not gathered information for ratings agencies. We analyze the number of insurers subject to ORSA, as well as the percentages that are both subject to ORSA and are rated by A.M. Best. We find that 69% of insurers subject to the ORSA Model Act also are rated by A.M. Best. This is roughly 72% of the insurance market by premium.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131156503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual market underwriting profitability in health insurance","authors":"P. Born, E. Sirmans","doi":"10.52227/26005.2018","DOIUrl":"https://doi.org/10.52227/26005.2018","url":null,"abstract":"We analyze the underwriting performance of insurers operating in the individual health insurance market from 2010-2017. Our sample consists of both life and health insurance companies. First, we offer descriptive sample statistics of key financial performance measures in this market. Then, we study the difference in performance pre- and post-2014, which represents the year that state online marketplace exchanges were implemented as part of significant health care reform, namely the federal Affordable Care Act (ACA). Our analysis allows us to test whether health care reform affected insurers operating in this market and in what ways. Our results suggest that underwriting profitability was worse in the post-ACA period: Generally, loss ratios and losses per enrollee were significantly higher in the post-reform time period. On the other hand, insurer administrative expenses were significantly lower post-2014. Furthermore, we show that these effects are not uniform across all insurers in the market.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126539167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance for Social Media Liability","authors":"Kevin T. Merriman, David M. Knapp, Meghan E. Ruesch, Nicole M. Weir","doi":"10.52227/23931.2021","DOIUrl":"https://doi.org/10.52227/23931.2021","url":null,"abstract":"Whether a claim involves “bodily injury” or “property damage” is a threshold issue for coverage under Coverage A of the standard comprehensive general liability (CGL) policy and homeowners policy. Social media-related claims that allege pure emotional distress, without corresponding physical manifestations, or that allege damage to intangible property, such as intellectual property rights, may not fall within the insuring agreements of these policies. Social media claims often allege intentional conduct, if not intentional harm, which raises the threshold issue of whether the claim alleges an “occurrence” such that coverage is triggered. To the extent a social media claim falls within the policies’ insuring agreements, the next issue is whether the policies contain exclusions that might apply. Exclusions for expected or intended injury, employer’s liability, and electronic data may limit coverage for social media claims. Likewise, exclusions in homeowners policies for “bodily injury” or “property damage” arising from a home business, professional services, or physical or mental abuse may apply to common social media claims.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115248878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}