📌 Table of Contents

• A–Z Glossary of Compliance Terms

• Why This Glossary Matters

• Related Internal Resources

• Frequently Asked Questions (FAQ)

📘 A–Z Glossary of US Insurance Compliance Terms

A – Compliance Foundations

• Admitted vs. Non‑Admitted Insurer – Refers to whether the insurer is licensed in the state (admitted) or operating under surplus lines laws (non‑admitted).

• Actuarial Opinion – Statement by an actuary regarding adequacy of reserves and solvency.

• Ad Review Compliance – State-required review process for insurance marketing and advertising.

• Annual Statement – Yearly financial report filed with state DOIs.

B – Broker Rules & Bulletins

• Broker Licensing – Regulatory requirement for selling insurance in a given state.

• Bulletin – Official communication from a state DOI, outlining new requirements.

• Blued-Sky Laws – State securities laws potentially affecting indexed products.

• Business Continuity Plan (BCP) – Disaster recovery and compliance operations framework.

C – Core Compliance Concepts

• Complaint Ratio – NAIC-reported metric showing consumer complaints relative to market size.

• Compliance Calendar – Tool for tracking deadlines across states.

• Continuing Education (CE) – Required training for license renewal.

• Corporate Governance – Internal control and board oversight structure.

• Consumer Privacy Laws – State and federal mandates to protect PII.

D – DOI & Data Governance

• DOI (Department of Insurance) – State authority regulating insurance operations.

• Data Call – Request for market or financial data by regulators.

• Debt to Surplus Ratio – Solvency indicator.

• Depreciation & Reserve Discounting – Financial reporting standards.

E – Ethics & Enterprise Risk

• EFT (Electronic Funds Transfer) – Secure payment processing method.

• Ethics Training – Required CE course in most states.

• Enterprise Risk Management (ERM) – Holistic approach to risk oversight.

• Errors & Omissions (E&O) – Liability coverage for agents and brokers.

F – Filings, Fraud, and FOIA

• Filing Objection – Regulatory feedback indicating a deficiency in a filing.

• Filing360 – [Internal link placeholder: software page] Filing management system.

• Fraud Prevention – Regulatory requirement to detect and report suspicious activities.

• Freedom of Information Act (FOIA) – Public access to regulatory filings.

G – General Agents & Governance

• GA (General Agent) – Broker-dealer or wholesale rep supervising agents.

• Guideline (NAIC) – Non-binding recommendations for compliance best practices.

• General Account vs. Separate Account – Accounting distinction for product types.

• Guaranteed Renewable Policy – Contractual right to renew without cancelation.

H – Health Laws & Holding Companies

• HIPAA – Federal privacy and health data protection law.

• Human-in-the-Loop (HITL) – [Internal link: AI compliance article] AI validation process.

• Holding Company Regulation – Oversight of insurer groups per Model #440.

• Home State Regulation – Licensing reciprocity for producers or carriers.

I – Insolvency & Innovations

• IRFS (Insurance Regulation Filing System) – [Internal link: IRFS overview] Centralized filing system.

• InsurTech – Technology-driven innovation in insurance compliance.

• Insurer Insolvency – Process handled by state DOIs under receivership laws.

• Insurance Regulatory Information System (IRIS) – Solvency screening tool.

J – Joint Underwriting

• JUA (Joint Underwriting Association) – State-backed risk pools for hard-to-insure markets.

K – Key-Person and Licensing

• Key-Person Coverage – Life policies on essential individuals; may trigger compliance flags.

L – Licensing and Legal Standards

• Lapse & Nonforfeiture – Rules around grace periods and value retention.

• Legal Entity Identifier (LEI) – Financial ID used in filings.

• Licensing (Producer/TPA) – State-based authorization process.

M – Market Conduct & Model Acts

• Market Conduct Exam – State investigation into business practices.

• Model Law – NAIC-proposed regulation adopted by states.

• Model Audit Rule (MAR 205) – Financial audit governance framework.

• Mergers & Acquisitions Review – Regulatory pre-approval for insurer consolidations.

N – NAIC and Non-Admitted

• NAIC – National organization that sets regulatory standards.

• NIPR – [Internal link: NIPR tutorial] Tool for multi-state producer licensing.

• NRRA (Non-Admitted and Reinsurance Reform Act) – Federal preemption law for surplus lines.

O – Offerings & Oversight

• Offerings & Disclosures – State-mandated consumer disclosures.

• Out-of-Pocket Maximum – Regulatory cap on consumer medical spending.

P – Privacy & Policyholder Protections

• PII (Personally Identifiable Information) – Consumer data subject to security regulations.

• Policy Form – Requires DOI approval before use.

• Producer Appointments – Insurer/producer relationship filed with DOI.

• Policyholder Surplus – Key capital buffer metric.

Q – Qualified Plans

• Qualified Trusts – Legal structure for deferred compensation products.

R – Reinsurance & Risk Management

• Reinsurance Credit Rules – Standards for financial risk transfer recognition.

• Rate Filing – Regulator-reviewed premium pricing process.

• RBC (Risk-Based Capital) – NAIC solvency requirement based on company risk profile.

• Regulatory Bulletin – DOI-issued updates or clarifications.

S – Suitability & Surplus

• SERFF – [Internal link: SERFF platform guide] Electronic rate/form filing system.

• Suitability Review – Ensures recommendations match client needs.

• State Guaranty Associations – Protects consumers in event of insolvency.

• Surplus Lines Compliance – Extra-state oversight for non-admitted carriers.

T – Third-Party Oversight

• Third-Party Administrator (TPA) – Firms performing claims/admin work for insurers.

• Trend Testing – Actuarial projection technique used in rate filings.

U – Unclaimed & Utilization Rules

• UCAA – Uniform application for carrier licensing across states.

• Unclaimed Property Laws – State mandates on returning dormant funds.

• Utilization Review – Review of medical necessity and authorization compliance.

V – Variable Products

• Variable Life & Annuities – SEC-regulated products requiring dual compliance.

W – Workers’ Comp & Whistleblower

• Workers' Compensation Compliance – State-specific regulatory obligations.

• Whistleblower Policy – Protects employees reporting violations.

X/Y/Z – Zoning & Zero Premium

• Zero-Premium Plans – Policies with $0 premium after subsidies; requires specific disclosures.

• Z-Factor / Zoning Modifiers – Geographic rate adjustments in property filings.

📈 Why This Glossary Matters

• Speeds up onboarding for new compliance staff.

• Reduces regulatory risk through clear definitions.

• Supports AI-powered compliance systems and audits.

• Improves communication with regulators and internal teams.

🔗 Related Internal Resources

• What is SERFF?

• Understanding NAIC Model Laws

• AI in Insurance Oversight

❓FAQ: US Insurance Compliance Glossary

Q1. What is the NAIC in insurance compliance?
The NAIC (National Association of Insurance Commissioners) is a regulatory organization that develops model laws and standards for U.S. insurance regulation.

Q2. What is SERFF and why does it matter?
SERFF (System for Electronic Rate and Form Filing) allows insurers to submit policy forms and rate filings for regulatory approval.

Q3. How is a TPA regulated?
Third-Party Administrators (TPAs) must be licensed in many states and follow DOI rules on claims, privacy, and reporting.

Q4. What is a market conduct exam?
A regulator-led review of an insurer’s marketing, claims, and business practices to ensure fair treatment of consumers.

Q5. What's the difference between admitted and non-admitted insurers?
Admitted insurers are licensed by the state and contribute to guarant