Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 100 - Insurer Conduct › Chapter 8 - Market Conduct Examination › Section 20 CSR 100-8.002 - Scope and Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets out the scope of the rules in
				  this chapter and provides definitions to aid in the interpretation of the rules
				  in this chapter.
(1)
				Applicability of Rules. The rules in this chapter apply to insurers and other
				companies transacting business in the state and examiners, analysts, and other
				staff within the division engaged in market conduct actions, and are to be read
				together with Chapter 536, RSMo, and sections
				374.202
				to
				374.207,
				RSMo.
(2) Definitions. As used in
				this chapter, the following terms mean:
(A)
				"Company," any person as defined by section 374.202.2(1), RSMo;
(B) "Complaint," has the same meaning as in
				section
				375.936(3),
				RSMo;
(C) "Confirmed Complaint," a
				complaint in which the state department of insurance determines:
1. The insurer, licensee, producer, or other
				regulated entity committed any violation of:
A. An applicable state insurance law or
				regulation;
B. A federal
				requirement that the state department of insurance has the authority to
				enforce; or
C. The term/condition of
				an insurance policy or certificate; or
2. The complaint and entity's response,
				considered together, indicate that the entity was in error;
(D) "Comprehensive market
				conduct examination," a full-scope examination that generally involves a review
				of the company's operations/management, complaint handling, marketing and
				sales, advertising materials, licensing, policyholder service, underwriting and
				rating, nonforfeitures, policy forms and filings, claim handling, and other
				state-specific requirements;
(E)
				"Department," the Department of Commerce and Insurance;
(F) "Desk examination," an examination that
				is conducted by an examiner at a location other than the company's premises. A
				desk examination is usually performed at the department's offices with the
				insurer providing requested documents by hard copy, microfiche, discs, or other
				electronic media, for review;
(G)
				"Director," the director of the Department of Commerce and Insurance;
(H) "Division," the Division of Insurance
				Market Regulation;
(I) "Examination
				warrant," a document issued by the director or the director's designee
				appointing one (1) or more examiners to perform a market conduct examination
				and instructing them as to the scope of the examination;
(J) "Examiner," any individual having been
				authorized by the director to conduct a market conduct examination under
				sections
				374.202
				to
				374.207,
				RSMo;
(K) "Insurer," any person as
				defined by section 374.202.2(5), RSMo;
(L) "Market analysis," a process whereby
				market conduct surveillance personnel collect and analyze information from
				filed schedules, surveys, reports, and other sources in order to develop a
				baseline understanding of the marketplace and to identify patterns or practices
				of insurers or companies licensed to do business in this state that deviate
				significantly from the norm or that may pose a potential risk to insurance
				consumers;
(M) "Market conduct
				action," any of the full range of activities that the director may initiate to
				assess and address the market and practices of individual insurers or
				companies, beginning with market analysis and extending to examinations. The
				director's activities to resolve an individual consumer complaint or other
				reports of a specific instance of misconduct are not market conduct actions for
				the purposes of this chapter;
(N)
				"Market conduct examination," the examination of the insurance operations of an
				insurer or company licensed to do business in this state in order to evaluate
				compliance with the applicable laws and regulations of this state. A market
				conduct examination may be either a comprehensive examination or a targeted
				examination. A market conduct examination conducted under sections
				374.202
				to
				374.207,
				RSMo, is separate and distinct from a financial examination of an insurer, but
				may be conducted at the same time;
(O) "Market conduct surveillance personnel,"
				those individuals employed or contracted by the director to collect, analyze,
				review, examine, or act on information on the insurance marketplace, which
				identifies pattern or practices of insurers and other companies;
(P) "National Association of Insurance
				Commissioners" or "NAIC," the organization of insurance regulators from the
				fifty (50) states, the District of Columbia, and the four (4) United States
				territories;
(Q) "NAIC market
				conduct uniform examination procedures," the set of guidelines developed and
				adopted by the NAIC designed to be used by market conduct surveillance
				personnel in conducting an examination;
(R) "NAIC Market Regulation Handbook," a
				handbook, developed and adopted by the NAIC, or successor product, which-
1. Outlines elements and objectives of market
				analysis and the process by which states can establish and implement market
				analysis programs; and
2.
				Establishes guidelines for market conduct surveillance personnel examination
				practices.
(S) "NAIC
				standard data request," the set of field names and descriptions developed and
				adopted by the NAIC for use by market conduct surveillance personnel in an
				examination;
(T) "On-site
				examination," an examination conducted at the company's home office or the
				location where the records under review are stored;
(U) "Qualified contract examiner," a person
				under contract to the department, who is qualified by education, experience,
				and, where applicable, professional designations, to perform market conduct
				actions; and
(V) "Targeted
				examination," a focused exam, based on the results of market analysis
				indicating the need to review either a specific line of business or specific
				business practices, including, but not limited to, underwriting and rating,
				marketing and sales, complaint handling, operations or management, advertising
				materials, licensing, policyholder services, nonforfeitures, claims handling,
				policy forms and filings, or any other area of review in the NAIC Market
				Regulation Handbook. A targeted examination may be conducted by desk
				examination or by an on-site examination.