§ 27-71-3 - Definitions. - Rhode Island Statutes

SECTION 27-71-3

   § 27-71-3  Definitions. – (a) "Commissioner" means the "director of the department of businessregulation" or his or her designee.

   (b) "Complaint" means a written or documented oralcommunication to the commissioner primarily expressing a grievance, meaning anexpression of dissatisfaction. For healthcare companies, a grievance is awritten complaint submitted by or on behalf of a covered person.

   (c) "Comprehensive market conduct examination" means a reviewof one or more lines of business of an insurer domiciled in this state that isnot conducted for cause. The term includes a review of rating, tierclassification, underwriting, policyholder service, claims, marketing andsales, producer licensing, complaint handling practices, or complianceprocedures and policies.

   (d) "Market conduct action" means any of the full range ofactivities that the commissioner may initiate to assess the market andpractices of individual insurers, beginning with market analysis and extendingto targeted examinations. The commissioner's activities to resolve anindividual consumer complaint or other reports of a specific instance ofmisconduct are not market conduct actions for purposes of this chapter.

   (e) "Market analysis" means a process whereby market conductsurveillance personnel collect and analyze information from filed schedules,surveys, required reports and other sources in order to develop a baseline andto identify patterns or practices of insurers licensed to do business in thisstate that deviate significantly from the norm or that may pose a potentialrisk to the insurance consumer.

   (f) "Market conduct examination" means the examination of theinsurance operations of an insurer licensed to do business in this state inorder to evaluate compliance with the applicable laws and regulations of thisstate. A market conduct examination may be either a comprehensive examinationor a targeted examination. A market conduct examination is separate anddistinct from a financial examination of an insurer performed pursuant to theRhode Island general laws, but may be conducted at the same time.

   (g) "Market conduct surveillance personnel" means thoseindividuals employed or contracted by the commissioner to collect, analyze,review or act on information on the insurance marketplace, which identifiespatterns or practices of insurers.

   (h) "National Association of Insurance Commissioners" (NAIC)means the organization of insurance regulators from the fifty (50) states, theDistrict of Columbia, and the four U.S. territories.

   (i) "NAIC" market regulation handbook" means a handbook,developed and adopted by the NAIC, or successor product, which:

   (A) outlines elements and objectives of market analysis andthe process by which states can establish and implement market analysisprograms; and

   (B) sets up guidelines that document established practices tobe used by market conduct surveillance personnel in developing and executing anexamination.

   (j) "NAIC market conduct uniform examination procedures"means the set of guidelines developed and adopted by the NAIC designed to beused by market conduct surveillance personnel in conducting an examination.

   (k) "NAIC" standard data request" means the set of fieldnames and descriptions developed and adopted by the NAIC for use by marketconduct surveillance personnel in an examination.

   (l) "Qualified contract examiner" means a person undercontract to the commissioner, who is qualified by education, experience and,where applicable, professional designations, to perform market conduct actions.

   (m) "Targeted examination" means a focused exam conducted forcause, based on the results of market analysis indicating the need to revieweither a specific line of business or specific business practices, includingbut not limited to, underwriting and rating, marketing and sales, complainthandling operations/management, advertising materials, licensing, policyholderservices, non-forfeitures, claims handling, or policy forms and filings. Atargeted examination may be conducted by desk examination of by an on-siteexamination:

   (1) "Desk examination" means a targeted examination that isconducted by an examiner at a location other than the insurer's premises. Adesk examination is usually performed at the department of businessregulation's offices with the insurer providing requested documents by hardcopy, microfiche, discs, or other electronic media, for review; and

   (2) "On-site examination" means a targeted examinationconducted at the insurer's home office or the location where the records underreview are stored.

   (n) "Third-party model or product" means a model or productprovided by an entity separate from and not under directed or indirectcorporate control of the insurer using the model or product.