insurance consumer affairs exchange marian drape information systems division

Insurance Consumer Affairs ExchangeMarian Drape

Information Systems DivisionMarket Information Systems Team

September 30, 2008

NAIC Complaint DataWhat Comes InWhat Goes Out

CMSCIS

I-SITE

Closed Consumer Complaints

Agenda• What Comes In

– Where do we get complaint data?– When do we get complaint data?– What data do we get?– What do we do with complaint data?

• What Goes Out– CMS– CIS– I-SITE

• Questions?

074097165

A Complaint Is…

Any *written communication that expresses dissatisfaction

with a specific person or entitysubject to regulation

under the state's insurance laws.

Market Regulation and Consumer Affairs (D) Committee, June 13, 2006

*Note: An oral communication, which is subsequently converted to a written form, will meet the definition of a complaint for this purpose.

What Comes In

Where do we get complaint data?• State insurance departments• Voluntary• Electronic transmission

When do we get data?

• Monthly - 2nd business day• Daily

What data do we get?

• Closed• Consumer • Confirmed/Unconfirmed• Firm/Individual• Medicare• Types of Insurance

NAIC Standard Complaint Data• Complaint identification• Complaint against• Complainant/Insured information• Type of coverage• Reason for complaint• Disposition

Complaint Identification

• State• State complaint number• Date opened• Date closed

Complaint Against

• Name• Address• NAIC company code• FEIN• National producer number• Date of birth

Complainant/Insured

• Zip code• Age group• Complainant type

– Insured, beneficiary, military personnel

First Level Coverage

• Auto (8)• Fire, Allied Lines, CMP (7)• Homeowners (7)• Accident & Health (4)• Life & Annuity (7)• Liability (6)• Miscellaneous (18)

Second Level Coverage

• Auto (17) • Fire, Allied Lines, & CMP (7)• Homeowners (13)• Accident & Health (24)• Life & Annuity (11)• Liability (24)• Miscellaneous

Reasons

• Underwriting (29)• Policyholder Service (22)• Claim Handling (36)• Marketing & Sales (30)

Dispositions

• 45 disposition codes• Determines confirmed complaint

– At least one disposition is confirmed

Dispositions

• Unconfirmed dispositions– Unable to assist– Cancellation upheld– Non-renewal upheld– No action requested/required– Referred to proper agency/section– Company in compliance– Company position upheld– No jurisdiction– Insufficient information

What do we do with the data?• Validate • Load• Quality• Present

Validate

• Form and format • Entity• Error resolution

– NAIC Transmission Viewer– Internal NAIC applications

• All valid data• CDS – Complaints Database System

Complaints Database System• 199

1• 199

• 2008

– CDS operational– Expansion of coverage types,

reasons, dispositions– MAP (D) Working Group review

of complaint handling and reporting

Complaints Database System• 10 year retention• 2,000,000+ complaints• 22,000+ Medicare complaints

Quality

• Frequency– Monthly

• Currency– Within last month

• Accuracy• Completeness

Quality

• Firm/Individual• Life, Health & Annuity/Property &

Casualty• Confirmed/Unconfirmed• Medicare• Use of ‘other’• Error rate

Quality

• Market State Audit System– Compare state data to data in CDS– Identify discrepancies– Suggest resolutions

Quality

• MIS Metrics– Counts– Timeliness– Error rates– Types of complaints

Metrics

Quality

• Participating state reports– Counts– Earliest/most recent submission dates– Earliest/most recent closed complaint

What Goes Out

CMS CIS I-SITE

Who has access?

Federal governmen

tPublic

State insurance regulators

Types? Medicare

Confirmedonly

AllRisk bearing entities

Retention?

3 years plus

current10 years

Complaints in CMS

• Centers for Medicare & Medicaid Services

• State’s compliance with OBRA 1990• Quarterly• Data sent from NAIC’s Government

Relations Office

Complaints in CIShttp://www.naic.org/cis/index.do

Complaints in CIS

• Closed• Consumer• Risk bearing entities• Confirmed

– At least one disposition is confirmed• Three years (plus current, if

applicable)• Voluntarily reported by states• Public data

Complaints in CIS

• Complaints against a selected risk bearing entity– 4 reports

• Aggregate consumer complaints reports– 3 reports

Complaints in CIS

• Complaints against a selected risk bearing entity– Counts by state– Counts by code– Trend– Ratio

Counts by State Report• For selected company• By state• Filters

– By year– By complainant

Counts by Code Report• For selected company• By code

– Coverage– Reason– Disposition

• Filters– By year– By complainant

Trend Report

• Change in complaint counts– Total– Percent

• Three year trend• Filters

– By complainant

Ratio Report

• Company’s complaint index

• National median complaint index

• Filters– By year– By insurance type

Complaints in CIS

• Aggregate reports– By type of insurance– By reason– By disposition

• Updated monthly

Complaints by Type of Insurance• Summary

– Seven primary coverage types

– By year

• Detail– All secondary

coverage types– By year

Complaints by Reason

• Summary– Top ten reasons – By year

• Detail– All reasons– By year

Complaints by Disposition

• Counts• By year

Complaints in I-SITE

• All• 10 years• Voluntarily reported by states• Regulator only

Complaints in I-SITE

• Complaints against a selected entity– Counts by state– Counts by code– Trend– Index

• Summary • Market analysis

Count, State, Trend Reports

• States/regions• Complainant• Role code

• Medicare supplement policy

• Date range

More selection criteria

Complaint Index Report

• Selection criteria– States/regions– Policy type– Premium year– Complaint year

• Results for confirmed and total (complete) complaints

Complaint Summary Report

• List of risk bearing entities

• Complaint and market share statistics

• Selection criteria– Policy types– By state or region– Comparison to other

states or regions– All or confirmed

Using Complaints in I-SITE• Market analysis• Coordination with other states• Target insurance company exams• Compare complaints with premium

volume• Compare complaints with other entities • Trending of business practices• Identify need for regulatory action• Public disclosure of complaints data

CMSCIS

I-SITE

Closed Consumer Complaints

Marian Drape

816.783.8602

mdrape@naic.org

insurance consumer affairs exchange marian drape information systems division

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