With decades of experience, Polsinelli knows the insurance industry. 

As a highly regulated industry, the insurance business is complex and rapidly evolving.  Our national platform keeps pace with this dynamic industry through our experienced and diligent attorneys who commit their practices to serving a full suite of legal services for the industry.  

Our experience across the industry includes: Accident/Health, HMOs, Brokerage, Captives, Life, Property & Casualty, Reinsurance, Risk Retention Groups, Third Party Administrators, Professional Liability, Public Entity Pooling, Workers Compensation, among others.

With the support of our Am Law 100 firm that is ranked among the Top 30 Law Firms Nationwide for Client Service Excellence*, attorneys in the Insurance Business and Regulatory Law group strive to serve as a valued resource in the insurance industry and as a partner to our clients.

Please explore our experience in the niche areas listed below and let us know how we may help you.

Insurance Company Regulation 

We have broad Federal and State regulatory and compliance experience working in all jurisdictions to provide our client’s compliance advice and assistance. These include advising on:

  • Financial examinations
  • Risk-based capital issues
  • Investments compliance
  • Financial reporting
  • Insurance Holding Company System approvals
  • Dividend distributions
  • 50 state surveys and investigations
  • Insolvency
  • Corporate governance
  • Enterprise Risk Management (ERM)

Transactions and M&A

Many of our attorneys are also corporate lawyers who have deep experience advising on transactional structures, joint ventures and reorganizations within the insurance industry. Particular areas of experience include:

  • Formations, reorganizations, mutual company transactions and demutualizations
  • M&A transactions, strategic affiliations, joint ventures and related regulatory approvals
  • Specialized insurance transactional work (e.g., funding agreements, surplus notes)
  • Drafting and negotiating management services agreements
  • Indemnity and assumption reinsurance
  • Captives, RRGs (risk retention groups) and other alternative risk mechanisms
  • Insurance Holding Company System transactions
  • Reinsurance of business through loss portfolio transfers and assumption reinsurance transactions
  • We are able to employ a multidisciplinary team for complex transactions and issues

Third Party Administrators

Polsinelli’s TPA team has significant experience representing third party administrators (TPAs) on a national basis regarding a variety of business and compliance issues. The group includes attorneys who were formerly in-house counsel for TPAs as well as attorneys who were formerly insurance regulators. Additionally, several of our attorneys are also members of the Federation of Regulatory Counsel. Particular areas of experience include:

  • National and multi-state TPA licensing projects
  • National and multi-state Pharmacy Benefit Manager (PBM) licensing projects
  • Multi-state Service Company licensing projects involving the administration of workers' compensation coverage
  • Maintaining licensure as a TPA or PBM through periodic renewal and annual report filing
  • Assistance with ancillary state filing and registration requirements such as All-Payer Claims Databases and Vaccination Assessments
  • Assistance with business, regulatory and compliance matters associated with mergers, acquisitions, and divestures involving entities licensed as a TPA
  • Multi-state and national research
  • Monitor regulatory and legislative activity and provide periodic reports regarding such activity
  • Drafting and negotiating Administrative Services Agreements
  • Assistance in developing a TPA Regulatory Addendum designed to comply with the statutorily-mandated provisions applicable under the TPA laws on a national basis
  • Assistance with inquiries and formal regulatory actions brought by state insurance departments and state attorneys general

Agencies and Producers

We have significant experience representing insurance producers and insurance agencies on a multi-state and national basis regarding a variety of business and compliance issues. The Insurance Producer team includes attorneys who were formerly in-house counsel of national insurance agencies, as well as attorneys who were formerly insurance regulators or members of the Federation of Regulatory Counsel. Particular areas of expertise include:

  • Multi-state and national licensing of insurance agencies and insurance producers
  • Assistance with maintaining licensure as an insurance agency or as an insurance producer through renewal filings
  • Assistance with multi-state and national research projects
  • Drafting agent and agency agreements
  • Drafting and negotiating agreements between insurance agencies and insurers
  • Assistance with business, regulatory and compliance matters associated with the acquisition and/or sale of insurance agencies
  • Assistance with inquiries, investigations and regulatory actions brought by state insurance departments
  • Provide advice on issues and questions arising under The Health Insurance Portability and Accountability Act (“HIPAA”) and The Patient Protection and Affordable Care Act (“ACA”)

Health Plans and Health Entities

We have significant experience representing health insurers and other health-related entities on a national basis with respect to regulatory and compliance, as well as transactional matters.  Our team provides ongoing legal support and advice for clients such as: 

  • Health Insurance Companies, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs)
  • Prepaid Service Plans
  • Third Party Administrators (TPAs), Utilization Review Organizations (UROs), and Pharmacy Benefit Managers (PBMs) 
  • Independent Practice Associations (IPAs) 
  • Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs)  

Our experience includes:

  • Organization and licensure of entities
  • Application of health insurance laws, mandated benefits, and the ACA
  • Association group laws and the AHP Regulation
  • ERISA requirements
  • Excepted benefit plans,  long term care coverage, disability, vision, dental, Medicare Supplement, and Medicare Advantage
  • Discount medical plans (DMPOs) 
  • Violent Crime and Control Act requirements
  • Policy form drafting, filings and objections
  • Sales, marketing, and advertising requirements, including telemarketing 
  • Market conduct examinations, including multi-state examinations
  • Financial examinations and inquiries
  • External and internal audits
  • Unfair trade practice laws
  • Market exits and renewability requirements
  • HIPAA privacy, Gramm Leach Bliley (GLB), and other data security requirements and business associate agreements
  • Formation of provider networks
  • Drafting of risk-based provider contracts
  • Contract drafting and negotiation 
     

Captive and Alternative Risk Transfer Arrangement

Our lawyers understand alternative risk transfer structures and have assisted our clients in selecting the proper structure, domicile and management of captives, risk retention groups and other arrangements. Our experience includes:

  • Organization and licensure of U.S. domestic captives
  • Advise on captive choice of domicile, structure and organizational agreements
  • Compliance with capitalization, financial and investment requirements
  • Prepare and file regulatory reports
  • Respond to regulatory examinations and inquiries
  • Draft and negotiate captive management agreements
  • Advise on taxation of captives, including Internal Revenue Service (IRS) regulations and issues

Representative Transactions:

  • Draft and negotiate reinsurance agreements
  • Advise on financial statement credit for reinsurance obligations
  • Develop regulatory compliance plans, including corporate governance standard
  • Design, form and implement alternative risk transfer structures, including Risk Retention Groups and Risk Purchasing Groups
  • Formation of group and single parent captive insurance arrangements
  • Representation of rental captive participants
  • Advise on self-procurement tax issues

Discount Medical Plans

Our Discount Medical team has significant experience representing discount medical plan organizations (“DMPOs”) and discount medical plan marketers on both a multi-state and national basis regarding various regulatory and compliance issues. Particular areas of experience include:

  • Multi-state and national licensing of DMPOs and marketers
  • Assistance with maintaining licensure as a DMPO through renewal filings
  • Drafting of agreements between DMPOs and marketers
  • Assisting DMPOs with website compliance
  • Assistance with reviewing DMPO advertising material for compliance
  • Assistance with inquiries, investigations and regulatory actions against DMPOs and marketers brought by state insurance departments and state attorney generals
  • Assistance with multi-state and national research projects
*BTI’s Client Service A-Team Report
Our experience covers each phase of our clients’ business, as demonstrated by these representative examples:

Market Conduct Examinations and Self-Audits
  • Assisted multiple insurance companies with respect to market conduct examinations across the United States, including a national long-term care insurer with respect to several market conduct examinations by various states. Represented a health insurer during a national multi-state examination. Engaged to conduct attorney/client privileged audits for clients, including reviewing a health insurer’s sales and marketing materials on a national basis.
Application of Insurance Laws
  • Analyzed the possible application of state insurance laws for various entities such as warranty companies, pharmacy benefit managers (PBMs), preferred provider organizations (PPOs), and health care organizations forming clinically integrated networks (CINs) or accountable care organizations (ACOs).
Entity Formation and Licensure
  • Filed formation and licensure applications for insurers and HMOs and UCAA licensure expansion applications, including the formation and licensure of a Delaware Series LLC captive insurance program and a Kansas domestic P&C insurer. Licensed numerous third party administrators (TPAs), adjusters, insurance agencies, discount medical plan organizations (DMPOs), and preferred provider organizations (PPO) on a national basis.
Acquisitions
  • Represented many entities acquiring insurers and insurance-regulated entities, including numerous agencies; represented a United Kingdom-based company on entering the American insurance market that purchased a life and health company and a property and casualty company, involving the drafting of definitive documents, obtaining the necessary approvals through Form A filings, and electronically filing the UCAA and licensure expansions.
National Legal Analysis
  • Researched and analyzed critical compliance issues on a national basis, such as electronic transaction of insurance laws, payment of premiums by automatic credit card debits, ACA issues, and referral fee requirements. Updated a national health insurer’s database to include all state health insurance mandated benefits laws and considered extraterritorial jurisdiction.
Financial Analysis
  • Our Financial Analysis practice worked with various entities with respect to financial examinations and insolvency issues. Utilized our knowledge of statutory accounting principles to assist an HMO with weak FAST ratios under aggressive surveillance by its domestic insurance department.
Loss Portfolio Transfer; Sale of Company; Exit from Market
  • Assisted clients with exiting the insurance market through the reinsurance of all business, the sale of a regulated entity and the nonrenewal of a block of business. Drafted and filed amendatory endorsements and conducted national nonrenewal for a health insurance company.