TIA Section H Flashcards
Reasons for Government Participation in Insurance
- Filling insurance needs unmet by private insurance
-Provide insurance where market is underserved by private insurance (unavailability or affordability)
-Government has the capacity to subsidize losses by directly taxing taxpayer or indirectly by using a government-provided fund to subsidize any losses - Compulsory Purchase of Insurance (individuals may be forced to buy insurance to meet social responsibilities, so the government may feel obliged to provide insurance)
- Convenience
-It may be easier for the government to quickly establish a program - Greater Efficiency
-Based on the assumption that the government can provide insurance at a lower cost than the private market - Social Purposes
Government can be involved in insurance in three levels:
Exclusive Insurer
Partner with Private Insurer
Competitor to Private Insurer
Examples of Exclusive Insurer
Social Security (Federal)
Government-run workers compensation program (State)
Examples of Partner with Private Insurer
Offers reinsurance coverage to private market
-NFIP, TRIA, Federal Crop Insurance (Federal)
-FAIR, WC, Windstorm Plans, Residual Auto Plan (State)
Examples of Competitor to Private Insurer
WC
Crop Insurance Overview
-Provides protection to farmers against losses to crops from natural disasters (drought, heat, cold, fire, wind, flood)
-Farmers can choose which crop they are buying insurance for. If the farmer chooses to insure a field, he must insure all fields in the country to avoid risk of adverse selection.
-Operated by the Federal Crop Insurance Corporation (FCIC) which is owned by the US Department of Agriculture (USDA). USDA created the Risk Management Agency (RMA) to operate and manage FCIC
-In 1980, congress authorized a subsidy of the premium (In 2014, farmers paid roughly 38% of the premium)
Structure of crop insurance
-Public-private partnership
-Private insurer markets, writes & services policies (must sells coverage to any farmer)
-RMA sets rates, and determines which crops can be insured in different areas
-RMA acts as reinsurer
-Premiums are subsidized by the federal government
-Federal government reimburses insurers for operating & administrative costs
Supporters of federally backed crop insurance believe
It is necessary to bring stability to a volatile sector of the economy.
-Private crop insurance may be much more expensive or unavailable due to the risk of catastrophic losses
Opponents of federally backed crop insurance believe
It may encourage agricultural overproduction and encourage farming in disaster prone areas, harming the environment, and increasing disaster relief costs.
(If the farmer is not bearing risk, they will have the incentive to plant in areas that may be cheaper to get the reward of higher profits even though losses are more likely in these disaster prone areas).
Federal Workers Compensation Programs
FECA - Benefits to non-military federal employees for employment related injuries and disease
Black Lung Benefits Act (BLBA) - Benefits for wage loss and medical provided to miners totally disabled from black lung disease, and eligible survivors. Established because state WC often didn’t provide coverage
Conditional Payment
Many people begin incurring medical costs before eligibility to collect insurance is determined. During this time, Medicare will make conditional payments. If the insurer is determined to be primary, it will need to reimburse Medicare.
Medical Set-Aside
Calls for all parties to a settlement to agree to set aside money to be primary over Medicare, for the period where the individual is eligible for Medicare
In 2001, the Center for Medicare and Medicaid Services (CMS) established guidelines for the review and approval of MSA’s
-CMS can reject or revise the MSA proposals
-Many insurers use specialists to review their MSA proposals and guide them through the process, increasing administrative costs
After the MSA is approved, claimants must agree to:
-pay the workers compensation related medical bills using the MSA
-complete the reporting of payments
Two Main Areas of Concern:
Pharmacy Costs:
-The MSAs originally priced the drugs at retail value, ignoring the negotiated price agreements of the insurer
-Many common pain management drugs are not covered by Medicare. Medicare issued language to indicate that the provision does not need to be made in the MSA for drugs not covered by Medicare.
Life Expectancy:
-MSAs were based on the claimant’s actual age, instead of the “rated age” (impaired age). (Not accounting for decreased life expectancy due to individual’s injury)
New Reporting Requirements since 2007
Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) requires claim payers to report data to the CMS.
-Must determine the Medicare-enrollment status of all claimants and report certain information about those claims
P&C Actuarial Implications of Recent Changes
-Between 2008 and 2010, in advance of the reporting deadline, there may have been an increase in:
-Claim Closings (to avoid new reporting deadlines)
-Lump sum payments
-The jump will distort paid and reported losses
-Since then, there may have been a slowdown in settlement rates due to the change in MSA procedures
-CMS approval of MSAs usually takes 60 to 90 days
-A portion of the increasing WC medical trends may be due to the new MSA requirements
-Historically, settlements may have been attributed fully to indemnity, instead of being separated into medical vs indemnity. MSAs will require a correct division into the two pieces.
-Insurers may have increased settlements to account for future medical considerations, due to the new MSA rules
Nonstandard Insurance programs
Some insurers in the voluntary market insure high risk drivers in specialized risk programs called nonstandard insurance programs
Insurers usually impose certain restrictions to reduce the level of risk:
-Insurers will often limit coverage so it is just enough to comply with state’s compulsory insurance requirement. Some insurers may offer optional higher limits for more premium.
-Coverage for medical payments for the insured may be limited
-Collision insurance may have a higher deductible
-Premium would be significantly higher than it is for average drivers
-
Safe Driver Insurance Plans (SDIPs)
Many insurers with nonstandard insurance programs have SDIPs which encourage insureds to drive safely by offering discounts to insureds who have no accidents or traffic convictions during a period (those that do have accidents/violations must pay a higher premium)
Three groups of programs for insureds in the residual market:
-Automobile insurance plans (Assigned risk plans)
-Joint underwriting associations (JUA)
-Other programs (Reinsurance Facility and Maryland State Fund)
Automobile Insurance Plan (AIP)
All auto insurers in the state are assigned a portion of the high risk drivers based on their market share of the auto insurance written in the state
Characteristics of AIP
-Applicants need to demonstrate that they have been unable to obtain auto insurance within a certain number of days (usually 60)
-The minimum limits offered are at least equal to the compulsory insurance requirement
-Certain people may be ineligible for coverage, including those with no valid drivers’ license, convicted of a felony within the preceding 36 months, and that habitually violate the laws
-Premiums are usually higher than in the voluntary market
Joint Underwriting Associations (JUAs)
A JUA is an organization that provides insurance to the residual market. There are also servicing insurers that perform services such as:
-Receive applications
-Issue policies
-Collect premiums
-Settle claims
-Other necessary services
Agents/brokers submit the applications of the high risk drivers to the JUA or the servicing insurer.
The JUA sets the rate and approves the policy form.
The auto insurers in the state will pay a share of the underwriting losses and expenses based on their share of the voluntary auto premium in the state. Some of this money will go toward compensating the servicing insurers.
Difference between AIP and JUA
For AIP’s, insurers are assigned policyholders proportional to their market share, and are therefore responsible for receiving the premiums and paying the losses of these assigned policyholders. The losses may be significantly more or less than their market share based on the performance of these assigned policyholders.
For JUAs, the auto insurers in the state pay a share of the underwriting losses and expenses based on their share of the voluntary auto premium in the state.
Reinsurance Facility
Insurers accept all applicants who have a valid driver’s license, issue policies, collect premium and settle claims. If the insurer does not wish to retain the policy, the insurer can assign the policy to the reinsurance facility while continuing to service it. All of the auto insurers in the state share the underwriting losses and expense in proportion to the auto insurance premium in the state.
(Insureds apply to the insurance companies like usual, the company then cedes the premium and losses to the facility. Company that ceded the risk still services the claims but it is reimbursed the loss amount by the facility).
Maryland State Fund
Insures high risk drivers. The private insurers need to subsidize the losses. They will in turn charge a surcharge to their own insureds.
(Requires insurers in the state to subsidize the cost of insurance for those in the fund and then can surcharge their own insureds to make up the difference)
Similarity between JUA and Reinsurance Facility
For both, the sharing of profit or loss is done based on the voluntary market share of insurers.
Government rate regulation of auto insurance helps resolve this conflict…
Since it is mandatory for drivers to have auto insurance, the public perceives purchasing insurance to be a right, as opposed to a privilege. The desire of insurers to make a profit could conflict with this perceived right of the public to purchase insurance.
FAIR Plans
Lenders require that property owners obtain property insurance in order to obtain a mortgage. FAIR (Fair Access to Insurance Requirements) plans provide coverage when insurers in the voluntary market can not offer coverage at a reasonable rate.