Detailed Description of Border Rows in P&C Insurance 

Related to Value Stream:Policy Update 

MGAs can have the ability to Rate, Bind, and issue policies. Once they have done that work and have an in-force policy, they send the border row to the insurance company for logging of the policy information tofacilitatebilling, collection, and policy administration. 

What Are Border Rows? 

Border rows, often referred to as "bordereaux" in the insurance industry, are detailed reports that list data related to insurance policies, claims, premiums, and other relevant transactions. These rows are essential for managing and tracking insurance data, especially in delegated authority arrangements involving Managing General Agents (MGAs) and Third-Party Administrators (TPAs). 

How Are They Used for Policies by TPAs and MGAs? 

  1. Policy Issuance and Management: 

  1. MGAs: MGAs use border rows to capture and manage detailed policy information, including coverage limits, deductibles, policy periods, and more. This data helps in underwriting and issuing policies on behalf of insurers. 

  1. TPAs: TPAs use border rows to manage claims associated with these policies. They record detailed claim information, such as claim amounts, dates, and statuses, ensuring efficient claims processing and management. 

  1. Data Integration: 

  1. Border rowsfacilitatethe integration of data from various sources, ensuring consistency and accuracy. This is crucial for seamless data exchange between insurers, MGAs, and TPAs. 

  1. Reporting and Compliance: 

  1. Both MGAs and TPAs use border rows to generate reports and ensure compliance with regulatory requirements. Accurate border rows help in tracking policy performance and meeting legal standards. 

  1. Risk Assessment and Management: 

  1. By analyzing border rows, MGAs and TPAs can assess risk more effectively, adjust underwriting criteria, and develop tailored insurance products. 

Sample Structure of a Policy Border Row 

A typical policy border row might include the following fields: 

  • Policy ID: Unique identifier for the policy. 

  • Policy Number: The number assigned to the policy. 

  • Product Line: The type of insurance product. 

  • Effective Date: The start date of the policy. 

  • Expiration Date: The end date of the policy. 

  • Status: Thecurrent statusof the policy (e.g., Active, Cancelled, Expired, Pending). 

  • Coverage Limit: Themaximumamount covered by the policy. 

  • Deductible: The amount the policyholder must pay out-of-pocket before the insurer pays a claim. 

  • Premium Amount: The cost of the policy. 

  • Agent ID: Identifier for the agent who sold the policy. 

  • MGA ID: Identifier for the MGA managing the policy. 

  • Policyholder ID: Unique identifier for the policyholder. 

  • Policyholder Name: Name of the policyholder. 

  • Policyholder Contact Info: Contact information for the policyholder. 

 

 

 

 

Who Creates Border Rows in the Policy Use Case? 

  • Underwriters: Create border rows when issuing new policies, capturing key details. 

  • Claims Adjusters: Generate border rows when processing claims, recording necessary information. 

  • Data Entry Personnel: Manually input data into the system, creating border rows. 

  • Automated Systems: Automated data feeds and integration processes also create border rows to ensure consistent data representation. 

  • IT and Data Management Teams: Oversee the creation and maintenance of border rows through batch processing and data integration efforts. 

Direction of Border Rows Flow 

  • From MGAs to Insurers: MGAs send border rows to insurers to report on policies issued, premiums collected, and other relevant data. This flow ensures that insurers have up-to-date information on the policies managed by MGAs. 

  • From TPAs to Insurers: TPAs send border rows to insurers to report on claims processed, payments made, and other claims-related data. This flow ensures that insurers haveaccurateandtimelyinformation on claims management. 

  • From Insurers to TPAs: Insurers send border rows to TPAs to delegate the management of claims, policy administration tasks, and for data reconciliation purposes. This ensures that TPAs have the necessary information to manage claims and policies effectively. 

How Are They Typically Sent? 

  • Manual Submission: Border rows can be manuallysubmittedvia email or secure file transfer protocols. 

  • Automated Data Feeds: Data from external sources is automatically sent through APIs or data feeds. 

  • Batch Processing: Large volumes of data are sent in batches, often during off-peak hours. 

How Are They Typically Ingested into the Policy System? 

  • Manual Data Entry: Data entry personnel input the data into the system. 

  • Automated Ingestion: Automated systems and APIs ingest data directly into the policy management system. 

  • Batch Processing: Data is ingested in large batches, ensuring the system is updated with new or modified border rows. 

What Type of Data Is Usually in Them? 

Border rows typicallycontain: 

  • Policy Details: Policy ID, policy number, product line, effective andexpirationdates, status, coverage limits, deductibles, and premium amounts. 

  • Claim Information: Claim ID, policy ID, claim date, claim amount, and status. 

  • Agent and MGA Information: Agent ID, MGA ID, and contact details. 

  • Financial Data: Premium amounts, payment dates, and methods. 

  • Coverage Information: Types of coverage, limits, and endorsements. 

  • Policyholder Information: Policyholder ID, policyholder name, and contact information. 

By effectively managing andutilizingborder rows, MGAs and TPAs can improve operational efficiency, ensure regulatory compliance, and provide better service to their clients. If you have any more questions or need further details, feel free to ask!