The Delaware Department of Insurance (DDI) is conducting targeted market conduct exams of third-party administrators (TPAs) for compliance with state insurance laws and regulations.
Reviews will cover areas such as claims handling, premium collection, disclosures, audits and operational practices, following National Association of Insurance Commissioners (NAIC) guidelines. The DDI will consider each TPA’s specific business activities – both in Delaware and nationally – when determining examination requirements.
The DDI recently began notifying TPAs based in Delaware that they will be expected to take part in the targeted market conduct examinations.
According to the DDI, the market conduct examinations aim to evaluate TPAs’ practices for compliance with Delaware insurance rules and regulations. These examinations cover all services which involve a TPA directly or indirectly underwriting, collecting charges or premiums, or denying, modifying, adjusting or settling claims on residents of Delaware in connection with health coverage offered or provided by an insurer.
The DDI’s market conduct examination reports will use the format from the NAIC Market Regulation Handbook. The exams will review company operations, complaints, terminated agreements, advertising, audits, notices to individuals, disclosure of charges, written agreement requirements, TPA payments, information maintenance, premium collection, claims payment and material delivery to individuals.