The Market Regulation Division is responsible for monitoring market conduct activity of domestic and foreign Property and Casualty (P&C) insurance companies, Life and Health (L&H) insurance companies, Premium Finance companies, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) etc…as required by North Carolina General Statute, Chapter 58. The purpose of the examination is to monitor compliance with statutes and regulations in the following areas: Policyholder Treatment, Sales, Marketing, Underwriting and Rating, Agent Appointments and Terminations, Nonforfeitures General Administration, Provider Relations and Delivery Systems, Utilization Management, Quality Management, Provider Credentialing, Delegated Oversight, and Claims.
In order to execute these responsibilities, staff members perform a combination of in-house reviews of various documents submitted by the regulated entities and on-site target examinations of company records and operations.
The Market Analysis team performs market conduct analysis by collecting and analyzing data on domestic insurance entities and, as appropriate and/or required, insurance entities that are licensed to do business in the State of North Carolina but are not domestic to this state in order to proactively identify general market disruptions early and to eliminate or limit harm to consumers, policyholders and/or claimants.
Find information on Medical Loss Ratio (MLR) and MLR Examinations.