声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。

"Journal of Insurance Regulation"由美国保险监管协会（NAIC）出版发行，是一个专注于保险监管和相关政策领域的学术期刊。每年发表学术论文12篇左右。该期刊主要发表关于保险监管、法规、政策和相关实践的原创研究论文、评论文章和案例研究。它旨在为保险监管领域的研究人员、政策制定者和行业从业者提供一个交流和分享最新研究成果的平台。

本期目录

● Why Do Small Firms Offer Health Insurance in Spite of the Employer Mandate Exemption

● Separating Life and Health from Property/Casualty Insurance Operations: An Assessment of Solvency in the Egyptian Insurance Market

● COVID-19 and Credit Watch List as an Economic Indicator

● Addressing Low-Value Insurance Products With Improved Consumer Information: The Case of Ancillary Health Products

●Flood Insurance Redesigned: Regulatory Considerations for a Viable and Sustainable Private Market

● Abstracts of Significant Cases Bearing on the Regulation of Insurance

● How's the Recovery? Salvage and Subrogation in the Property Liability Insurance Industry

● Nuclear Verdicts, Tort Liability, and Legislative Responses

Why Do Small Firms Offer Health Insurance in Spite of the Employer Mandate Exemption

在雇主强制豁免政策下

为什么小型企业仍然提供健康保险？

作者

Roger Lee Mendoza（加州州立大学洛杉矶分校）

摘要：The largest source of healthcare coverage in the U.S. for the non-elderly population (age < 65) and their dependents is employer-sponsored health insurance. In light of the exemption of small firms (< 50 full-time employees) from the “pay-or-play” mandate of the federal Affordable Care Act (ACA) and the substantial costs of employee health insurance to any employer, we investigate why most small firms still offer coverage, and how they manage to do so. We used the Kaiser Family Foundation (KFF)/Health Research and Education Trust (HRET) public dataset (2015–2019) for this purpose. Findings suggest that coverage objectives, strategic choices, and human resource practices in small firms initially pass through the lens of the business owner’s comparative advantages. On that basis, a compensating wage differential might be opted. Healthcare coverage, financial risk, and human resource management intertwine, with long-run consequences on employer health plan design and structure, benefit offerings, and insurance costs. This is particularly important considering that both employer and employee typically contribute to health insurance premiums in small firms. And considering that 96% of all U.S. firms are small, the findings of this study have implications on business operational risk.

在美国，非老年人口（年龄小于 65 岁）及其家属最大的健康保险来源是雇主发起的医疗保险。鉴于小型企业（全职雇员小于 50 人）可豁免联邦《平价医疗法案》（ACA）中“要么付费要么参保”的强制规定，并且员工健康保险对于任何雇主都是一笔巨额费用，我们调查研究了为什么大多数小型企业仍在发起员工健康保险，以及它们是如何做到的。为此，我们使用了凯撒家庭基金会（KFF）/健康研究与教育信托基金（HRET）的公共数据集（2015-2019）。研究结果表明，小型企业的保险覆盖目标、战略选择和人力资源实践最初都是从企业主的比较优势这一视角进行考虑的。在此基础上，可能会选择补偿性工资差异。考虑到在小型企业中，雇主和雇员通常共同缴纳健康保险费，健康保险覆盖、财务风险和人力资源管理相互交织，对雇主的健康计划设计和结构、福利提供和保险成本将产生长期影响，这一点尤为重要。与此同时，由于美国企业中96%都是小型企业，因此本研究的结果对公司业务的操作风险具有重要的意义。

https://content.naic.org/sites/default/files/why-do-small-firms-offer-health-insurance-in-spite-of-the-employer-mandate-exemption-jir-2022-06.pdf

Separating Life and Health from Property/Casualty Insurance Operations: An Assessment of Solvency in the Egyptian Insurance Market

将人寿与健康保险业务

从财产/意外保险业务中分离出来：

埃及保险市场偿付能力评估

作者

Ahmed S. Abdelzaher（埃及贝尼苏埃夫大学），Patricia Born（佛罗里达州立大学）

摘要：In this article, we evaluate the effect of a recent change in regulation of insurers operating in the Egyptian insurance market that required all insurance companies to separate their life and health (L&H) and property/casualty (P/C) activities. We examine, specifically, the effect on the solvency of P/C insurers when they are required to form two completely separate companies for their operations (i.e., divest of their L&H business). Separating into separate entities may increase the transparency of the insurer’s operations, especially with respect to how they allocate capital across the company. Using financial data for all insurers in the Egyptian market for the period 2006–2015, we test whether solvency—captured via 13 solvency surveillance ratios—is affected by the decree. For robustness, we run the analysis for the whole market and for private companies only, focusing on P/C insurers only before and after the decree. Our findings indicate that the likelihood of insolvency, based on our evaluation of solvency ratios, increased after the decree.

在本文中，我们将评估埃及保险市场近期对保险公司监管的一项变化所产生的影响，该变化要求所有保险公司将其人寿与健康险（L&H）和财产险/意外险（P/C）业务分开。具体来说，我们研究了当财产/意外险公司被要求成立两家完全独立的公司开展业务（即剥离人寿和健康险业务）时，对其偿付能力的影响。分离为独立实体可以提高保险公司运营的透明度，特别是在公司内部如何分配资本方面。利用 2006-2015 年期间埃及市场上所有保险公司的财务数据，我们检验了公司偿付能力（通过 13 项偿付能力监测比率反映）是否受到该法令的影响。为了确保稳健性，我们只关注法令颁布前后的财产/意外险公司，对整个市场和仅限于私营公司的情况分别进行了分析。研究结果表明，基于对偿付能力比率的评估，偿付能力不足的可能性在法令颁布后有所增加。

https://content.naic.org/sites/default/files/cipr-jir-2022-10.pdf

COVID-19 and Credit Watch List as an Economic Indicator

COVID-19与作为经济指标的信用观察名单

作者

Joe Goebel（波尔州立大学米勒商学院），Kevin Gatzlaff（波尔州立大学米勒商学院），Kris Kemper（波尔州立大学米勒商学院）

摘要：A global pandemic interrupted a decade-long US expansionary cycle. While governments intervened in an attempt to manage a health crisis, the economy stalled, and equity markets crashed. However, equity markets quickly recovered and moved to positive territory a few months later. We examine the actions of Credit Rating Agencies (CRAs) and the signals that are sent through S&P Watch List activity. After creating a significant indicator based on Credit Watch activity, reflecting private firm information, we find that the swift recovery may have been foreseeable for non-insurance firms. The indicator provides less potential predictive power for insurance firms, either because the greater regulatory activity surrounding insurance firms yields less private information to be discovered by CRAs, or possibly because the insurance industry is more resilient to economic shock than other sectors of the economy.

全球大流行的新冠肺炎疫情中断了美国长达十年的扩张周期。政府在试图通过干预来应对健康危机的同时，却面临着经济停滞、股票市场崩盘的情况。然而几个月后，权益市场迅速复苏并进入积极状态。我们研究了信用评级机构（CRAs）的行为和S&P观察名单活动传递出来的信号。在创建了一个基于信用观察活动、能够反映私营公司信息的重要指标之后，我们发现非保险公司的迅速复苏可能是可预见的。该指标对保险公司提供的潜在预测能力较小，可能是因为对保险公司的有力监管导致CRAs可发现的私有信息变少，或者是因为保险业对经济冲击的韧性较其他行业更强。

原文链接：https://content.naic.org/sites/default/files/cipr-jir-2022-8.pdf

Addressing Low-Value Insurance Products With Improved Consumer Information: The Case of Ancillary Health Products

为消费者提供更多信息以解决

保险产品价值低的问题：

以附加健康产品为例

作者

Jackson William (Dialysis Patient Citizens)

摘要：The sale of financial services products is rife with information asymmetry favoring sellers and leads to the marketing of insurance products offering low value to consumers. Exemplifying this problem is the current market for ancillary health insurance products such as short-term health insurance and supplemental insurance. One policy option for state insurance regulators is to mandate a robust regime of disclosures and labeling, described here as comparative disclosures. This article reviews comparative disclosure regulations previously implemented in the U.S. and proposals for reforms. It then outlines a possible policy solution for the lack of value in ancillary health insurance products: expanding consumer information to facilitate shopping.

金融服务产品的销售充斥着有利于卖方的信息不对称情况，导致卖方营销的保险产品给消费者提供较低的产品价值。举例来说，当前的附加健康保险产品市场，如短期健康保险和补充保险，就充分体现了这一问题。各州保险监管机构的一个政策选项是强制实施健全的信息披露和标识制度，本文称之为比较性披露。本文回顾了美国先前实施的比较性披露法规和改革提案，随后概述了解决附加健康保险产品价值缺失的可能政策解决方案：即为消费者提供更多信息以促进购买。

https://content.naic.org/sites/default/files/cipr-jir-2022-9.pdf

Flood Insurance Redesigned: Regulatory Considerations for a Viable and Sustainable Private Market

洪水保险的重新设计：

建立可行和可持续的私营市场的监管考虑

作者

Rebecca Williams (North Carolina Rate Bureau), Lorilee Medders (阿巴拉契亚州立大学), David Marlett (阿巴拉契亚州立大学), Catherine Lattimore (加拉格尔再保险经纪公司), David Evans (Milliman)

摘要：Several factors have converged in recent years, bringing the need for admitted-market, private flood insurance options in the U.S. to the fore. Meanwhile, other factors have coincided that make modeling and pricing large segments of the U.S. flood risk exposures more accessible and more accurate than was historically possible. The National Flood Insurance Program (NFIP), despite recent rating reforms, faces daunting financial and market challenges. The U.S. flood risk has increased: The risk of severe flooding and the cost of such events continues to grow. Flood loss models that can support granular pricing are now commercially available, outperforming the Federal Emergency Management Agency’s (FEMA’s) flood maps historically used for rating and loss mitigation purposes. Several states have begun encouraging admitted insurance markets to provide flood insurance in addition to the NFIP and the excess and surplus lines coverages already available. This paper examines the private market opportunity and challenges, highlights state-level strategies, and demonstrates the importance of flexibility in program legislation and regulation—with respect to both program design and implementation. Our work contributes to the literature by: 1) exploring the market challenges in the development of private flood insurance; 2) demonstrating the importance of local risk considerations and flexible program features for state-level, private strategies that provide a sustainable framework for insurers to consider; and 3) highlighting the alignment of recent model laws and several state programs with the recommended features.

近年来一些因素汇聚，使得对美国许可市场私营洪水保险的需求日益凸显。与此同时，其他因素同时作用也使得对美国洪水风险暴露的建模和定价比历史上更易探究且更加准确。尽管最近进行了费率改革，但国家洪水保险计划（NFIP）仍面临着严峻的金融和市场挑战。严重的洪涝风险和此类事件的成本持续增长说明美国的洪水风险已经增加。可以支持细粒度定价的洪水损失模型现在已经能够商用，其表现优于联邦紧急事务管理局（FEMA）过去用于定价和减轻目的的洪水地图。除了NFIP和已经存在的超额保险条款外，一些州已经鼓励保险市场开始提供洪水保险。本文考察了私营市场的机遇和挑战，关于项目的设计和实施，我们强调了政府层面的战略，并说明了项目立法和监管灵活性的重要性。我们工作的主要贡献体现在：1）探索了私营洪水保险发展中的市场挑战；2）说明了地方风险考量以及政府层面、公司战略灵活性特征的重要性，为保险公司提供可持续框架；3）强调现有的示范法规和一些具有建议特征的州计划之间的一致性。

https://content.naic.org/sites/default/files/cipr-jir-2023-1.pdf

Abstracts of Significant Cases Bearing on the Regulation of Insurance

与保险监管有关的重大案例摘要

作者

Olivea Myers （美国保险监督官协会法律顾问）

摘要：本文介绍了2022年美国联邦上诉法院和州法院的几起与保险监管有关的重大案例，其内容涉及理赔纠纷、保险限额及费率等要求、保险公司偿付能力监管要求、保险展业要求等内容。

原文链接：https://content.naic.org/sites/default/files/cipr-jir-abstracts-cases-2022.pdf

How's the Recovery? Salvage and Subrogation in the Property Liability Insurance Industry

追回情况如何?

财产责任保险行业的残值回收与代位追偿

作者

Bisco, Jill M.(阿克伦大学) , Fier, Stephen G.(密西西比大学)

摘要：Insurers have significant flexibility in the management of the claims process and the degree to which they prioritize the collection of salvage and subrogation. These decisions could materially impact the financial well-being of insurers as well as the prices paid by consumers. Given the potential implications that salvage and subrogation can have for insurers, consumers, and regulators, we investigate the relation between the speed at which U.S. property-liability insurers recover salvage and subrogation and insurer-specific financial and operational characteristics. The analysis is conducted for commercial and personal auto lines of business and studies both physical damage and liability coverages. The findings indicate that factors such as leverage, profitability, size, and accrual decisions are associated with the speed of recovery but that considerable differences exist across coverages.

保险公司在理赔管理过程和残值回收、代位追偿的优先程度上具有很大的灵活性。这些决定可能会对保险公司的财务状况以及消费者支付的价格产生重大影响。鉴于残值回收和代位追偿可能对保险公司、消费者和监管机构产生的潜在影响，我们探究了美国财产责任保险公司残值回收和代位追偿的速度与保险公司特有的财务特征、运营特征之间的关系。本文对商业车险和个人车险业务进行了研究，包括物理损伤和责任条款。研究结果表明，公司的杠杆率、盈利能力、公司规模、计提决策等因素与追偿的速度有关，但这种关系在不同的条款之间存在较大差异。

https://content.naic.org/sites/default/files/cipr-jir-2023-2.pdf

Nuclear Verdicts, Tort Liability, and Legislative Responses

“核裁决”、侵权责任和立法应对措施

作者

Cole Cassandra R.(佛罗里达州立大学), Marzen Chad(佛罗里达州立大学)

摘要：The size of punitive damage awards has grown considerably over the years, giving rise to what has been termed “nuclear verdicts.” Such large dollar verdicts can have several adverse effects on companies, such as limited innovation, high out-of-pocket claims-related expenses, increased insurance premiums, and bankruptcy in severe cases. This article reviews the growth of nuclear verdicts, examines the details of some key cases that have resulted in large damage awards, and identifies some reasons for these verdicts. The impact of nuclear verdicts and the actions that are being taken to mitigate such verdicts, with a focus on legal strategies and state legislative activity, are also discussed.

多年来，惩罚性损害赔偿金的规模大幅增长，产生了所谓的“核判决”。如此巨额的判决可能会对公司产生一些不利影响，比如创新受限、高额自付赔款相关费用、保费增加，严重的情况下甚至会导致破产。本文回顾了“核裁决”案件的增长，研究了一些产生巨额损害赔偿的关键案例的细节部分，并识别了导致这些判决的一些原因。重点关注法律对策与立法活动，本文还讨论了“核裁决”的影响以及为减轻此类裁决而采取的措施。

[注]“核裁决”（Nuclear Verdicts）是美国保险业对赔偿金额超过1000万美元的陪审团裁决的形容，在卡车事故的赔偿裁决中较为常见。

https://content.naic.org/sites/default/files/cipr-jir-2023-3.pdf