Insurance Consumer Affairs Exchange Marian Drape Information Systems Division

1. NAIC Complaint Data What Comes In What Goes Out Insurance Consumer Affairs Exchange Marian Drape Information Systems Division Market Information Systems Team September 30, 2008

2. Closed Consumer Complaints CMS I-SITE CIS

3. 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?

4. A Complaint Is… 074 097 165 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.

5. What Comes In

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

7. When do we get data? • Monthly - 2nd business day • Daily

8. What data do we get? • Closed • Consumer • Confirmed/Unconfirmed • Firm/Individual • Medicare • Types of Insurance

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

11. Complaint Identification • State • State complaint number • Date opened • Date closed

12. Complaint Against • Name • Address • NAIC company code • FEIN • National producer number • Date of birth

13. Complainant/Insured • Zip code • Age group • Complainant type • Insured, beneficiary, military personnel

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

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

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

17. Dispositions • 45 disposition codes • Determines confirmed complaint • At least one disposition is confirmed

18. 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

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

20. Validate • Form and format • Entity • Error resolution • NAIC Transmission Viewer • Internal NAIC applications

21. Load • All valid data • CDS – Complaints Database System

22. 1991 1998 2008 CDS operational Expansion of coverage types, reasons, dispositions MAP (D) Working Group review of complaint handling and reporting Complaints Database System

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

24. Quality • Frequency • Monthly • Currency • Within last month • Accuracy • Completeness

25. Quality • Firm/Individual • Life, Health & Annuity/Property & Casualty • Confirmed/Unconfirmed • Medicare • Use of ‘other’ • Error rate

26. Quality • Market State Audit System • Compare state data to data in CDS • Identify discrepancies • Suggest resolutions

27. Quality • MIS Metrics • Counts • Timeliness • Error rates • Types of complaints

28. Metrics

29. Quality • Participating state reports • Counts • Earliest/most recent submission dates • Earliest/most recent closed complaint dates

30. What Goes Out

32. Complaints in CMS • Centers for Medicare & Medicaid Services • State’s compliance with OBRA 1990 • Quarterly • Data sent from NAIC’s Government Relations Office

33. Complaints in CIS http://www.naic.org/cis/index.do

34. 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

35. Complaints in CIS • Complaints against a selected risk bearing entity • 4 reports • Aggregate consumer complaints reports • 3 reports

36. Complaints in CIS • Complaints against a selected risk bearing entity • Counts by state • Counts by code • Trend • Ratio

37. For selected company By state Filters By year By complainant Counts by State Report

38. For selected company By code Coverage Reason Disposition Filters By year By complainant Counts by Code Report

39. Change in complaint counts Total Percent Three year trend Filters By complainant Trend Report

40. Company’s complaint index National median complaint index Filters By year By insurance type Ratio Report

41. Complaints in CIS • Aggregate reports • By type of insurance • By reason • By disposition • Updated monthly

42. Summary Seven primary coverage types By year Detail All secondary coverage types By year Complaints by Type of Insurance

43. Summary Top ten reasons By year Detail All reasons By year Complaints by Reason

44. Counts By year Complaints by Disposition

45. Complaints in I-SITE • All • 10 years • Voluntarily reported by states • Regulator only

46. Complaints in I-SITE • Complaints against a selected entity • Counts by state • Counts by code • Trend • Index • Summary • Market analysis

47. Count, State, Trend Reports More selection criteria • States/regions • Complainant • Role code • Medicare supplement policy • Date range

48. Selection criteria States/regions Policy type Premium year Complaint year Results for confirmed and total (complete) complaints Complaint Index Report

49. 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 Complaint Summary Report

50. 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