Life and Health News
We are celebrating over 25 years of providing selected items of current interest to our clients and friends. The items contained in this newsletter are derived from bulletins, regulations and legislative activity affecting the insurance industry. Please feel free to share this newsletter with others that may be interested. Contact our office for further details about any of the items contained in the newsletter.
AGENT / PRODUCER COMPENSATION
Louisiana amended its law relative to producer compensation to authorize agency fees on individual and group health insurance policies and supplemental benefit insurance policies and to provide for commissions and other forms of compensation. House Bill 407
Louisiana published a bulletin addressing the state's allowance of agency fees, at specified limits and under specified conditions, as an additional charge over and above the premium quoted to the insured and any expense reimbursement due to the producer. Bulletin 2017-05
AGENT / PRODUCER LICENSING AND APPOINTMENT
Alabama revised its regulation regarding renewal of licenses and continuing education for producers and service representatives. 482-1-110
Delaware revised its bulletin informing all insurers and licensees that new resident and new non-resident applicants declaring Delaware to be their home state must provide a federal criminal history report from the Federal Bureau of Investigation, in addition to a State criminal history report as part of the application process. BULLETIN 22 (revised)
Louisiana amended the licensing fees paid by insurance producers. House Bill 503
Louisiana clarified its law pertaining to producers of record, providing that, if an insurer receives a producer of record letter for an application, the insurer must provide the new producer of record with a quotation or proposal based on new applications submitted by the new producer of record regardless of any other outstanding quotations or proposals. The bill also changes 15-day notice requirements to 10 calendar days. House Bill 408
Maine amended its law regarding appointment of a producer as an agent to provide that a producer, including a nonresident producer acting pursuant to a national nonresident producer license issued through the National Association of Registered Agents and Brokers, may not act as an agent of an insurer unless the insurance producer becomes an appointed agent of that insurer. 24-A s 1420-M
Michigan issued a memorandum to notify licensed business entity producers (agencies) that branch registration transactions can now be performed through the Insurance Licensing Online System (ILOS). Memorandum of June 28, 2017
ANNUITIES / ANNUITY CONTRACTS
Idaho issued a bulletin announcing that effective July 1, 2017, insurers must pay a minimum of 6.25% interest on deferred payment of cash surrender values. Bulletin No. 17-03
Iowa amended its requirements regarding synthetic guaranteed investment contracts. Regulation 191-96.3+
AUTISM SPECTRUM DISORDERS
Nevada amended its definition of autism spectrum disorder. Assembly Bill 304, 689A.0435
CANCELLATION / NON-RENEWAL / PREMIUM OR COVERAGE CHANGES
Vermont added a section to its law stating that no individual life insurance policy covering an insured age 64 or older that has been in force at least 1 year may be cancelled for nonpayment of premiums unless, after the expiration date of the grace period and at least 21 days before the cancellation date, a notice of impending cancellation is mailed to the policyholder and specified secondary addressee, if such a designation has been made. Notice is to be provided annually of the right to specify a secondary addressee. Senate Bill 56; 8 V.S.A. Section 3762(d)
Alabama revised its regulation 138 regarding captive insurers. 482-1-138
Connecticut enacted legislation to allow a dormant captive insurer to apply to the Insurance Commissioner for a certificate of dormancy, subject to renewal every two years and forfeited if the dormant captive commences transacting insurance business or fails to timely renew the certificate. House Bill 7183
Texas amended its Insurance Code related to the regulation of captive insurance companies stating, among other things, that such companies may not issue life insurance except under employee benefit plans subject to ERISA, and that they may cede risks to or take credit for reserves on risks ceded to nonaffiliated reinsurers under specified conditions. House Bill 1944; 964.001+
Vermont amended its regulation regarding annual financial reporting requirements for captive insurers. C-81-2 s 2; C-81-2 s 3;
C-81-2 s 4
CLAIMS / CLAIMS ISSUES
Connecticut amended its law to require that reimbursement for covered services rendered in the state by an out-of-network health care provider for diagnosis or treatment of a substance use disorder be paid under the insured's individual or group health insurance policy directly to the provider if the provider is otherwise eligible for reimbursement for such services. House Bill 5140; 38a-488a
CONFIDENTIALITY / PRIVACY
Oregon amended its trade practices law by eliminating, effective January 1, 2018, the requirement that an insurer provide an annual notice to the consumer regarding policies and practices for disclosing personal information, if the insurer provides such information to nonaffiliated third parties in accordance with law and if the insurer has not changed its privacy policies and practices since it last notified customers. Senate Bill 986
West Virginia issued an Informational Letter to insurers and other interested parties regarding annual privacy notices. Annual notices are not required so long as the licensee provides nonpublic personal information to nonaffiliated third parties only in accordance with applicable law and has not changed its policies and practices from those that were disclosed in the most recent disclosure sent to consumers. Informational Letter No. 198
Maine amended several sections of its Insurance Code to maintain conformance with national standards. Included are: MRSA §423-A, regarding interim financial reporting requirements; MRSA §423-G, regarding Corporate Governance Annual Disclosure; MRSA §4208, regarding Annual and interim reports; and MRSA §222, sub-§7-C, regarding Groupwide supervision, among others. Senate Paper 539
Louisiana amended its law to require that dental benefit plan documentation identify the plan's insurer. Every identification card, membership card, insurance coverage card, or other documentation of coverage issued to any policyholder or health plan participant by a health insurer for a plan that is fully insured shall include the phrase "Non-ERISA" prominently displayed on its face. House Bill 165
DRUG / PRESCRIPTION COVERAGE
Nevada amended its law for insurers that offer or issue a policy of health insurance which provides coverage for prescription drugs to require publication of certain information on the internet during each period for open enrollment. Senate Bill 539, 689A.405
Oregon amended its Code related to prescription contraceptives. It specifies the conditions under which pharmacist consultations for prescription contraceptives must be covered. House Bill 2527, 743A.066
Delaware published a bulletin advising that on July 1, 2017, the state legislature enacted laws to take effect immediately to increase fees and charges collected by the Department of Insurance. Payments postmarked July 1 and later must be at the new rates. Questions may be emailed to DOI-Legal@state.de.us. Universally Applicable Bulletin No. 2
Louisiana amended its law to require an annual license renewal fee for viatical settlement providers and, when applicable, a late renewal fee for insurance claims adjusters. House Bill 643, R.S. 22:821
Pennsylvania issued a notice providing updated per diem charges for financial examinations conducted by the insurance department. Notice 2017-07
FRATERNAL BENEFIT SOCIETIES
Maine amended its Code providing annual statement filing requirements for fraternal benefit societies. 24-A s 4134
FRAUD / ANTI-FRAUD
Florida amended its laws related to insurance fraud requiring that, by December 31, 2017, all insurers admitted in the state establish and maintain a designated anti-fraud unit to investigate and report possible fraud and that the insurer adopt an anti-fraud plan and file it with the state as prescribed. House Bill 1007
Florida amended its laws to protect the confidentiality of insurers' anti-fraud education and training, the descriptions of their anti-fraud investigative units and their rationales for the resources and staffing provided to their anti-fraud investigative units when this data is reported to the Department under applicable requirements. House Bill 1009
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Florida amended its Code addressing applicability of the Florida Life and Health Insurance Guaranty Association Act relative to certain annuity contracts, revising the association's maximum aggregate liability with respect to one life covered by an insolvent carrier and specifying the association's maximum liability as to certain health insurance policies. House Bill 307; 631.713
HEALTH INSURANCE - COMPREHENSIVE
Colorado enacted legislation adding a section to its Code requiring that health insurance carriers update their online provider directories at least every thirty days, to keep pace with updates to websites maintained by applicable health care prescriber boards and remove providers whose licenses have been revoked or suspended by the applicable prescriber board. House Bill 1165; 10-16-146
Colorado enacted legislation mandating that health benefit plans required to cover contraception reimburse dispensers for dispensing a multiple-month's supply of prescription contraceptives. House Bill 1186; 10-16-104.2
Colorado enacted legislation to prohibit insurance carriers from requiring a covered person to undergo step therapy and, in connection with that, requiring coverage for a prescribed medication that is part of the carrier's formulary. Senate Bill 203; 10-16-145
Connecticut amended its statutes to require that health carriers' provider directories, when listing a particular provider as accepting new patients, must also note whether such provider is accepting new patients on an outpatient services basis. Senate Bill 546; 38a-477h
Connecticut enacted legislation to expand infertility coverage requirements to include preservation of fertility for insureds diagnosed with cancer. House Bill 7124; 38a-509
Florida enacted legislation which addresses medication synchronization, to allow an insured to align at least once in a plan year the refill dates for prescription drugs covered by the policy. Senate Bill 800; 627.64196
New York amended its law to require that insurance policies providing hospital, surgical, or medical expense coverage must include coverage for medically necessary abortions. 11 NYCRR 52.1, 11 NYCRR 52.71
Rhode Island amended its laws regarding health insurance coverage for infertility. It now mandates coverage for standard fertility-preservation services when a medically necessary treatment may cause iatrogenic infertility to a covered person. House Bill 6170; Senate Bill 821; 27-18-30; 27-19-23; 27-20-20; 27-41-33
Texas amended its Insurance Code addressing payments for prescription refills. A health benefit plan covering prescription drugs may not require a covered person to pay for a prescription an amount greater than the lesser of the plan copayment, the allowable claim amount or the amount he would pay for the drug without insurance. Further, refills of prescription eye drops must be allowed under conditions specified. Senate Bill 1076; 1369.0041
Texas amended its Insurance Code to require a health benefit plan to provide coverage for a medication dispensed in accordance with the dates established in a medication synchronization plan as described in the subchapter. House Bill 1296; 1369.451+
Vermont amended its law to require health insurance plans to provide coverage for health care services delivered through telemedicine to the same extent that the plan would cover the services if they were provided through in-person consultation. Senate Bill 50; 8 V.S.A. Section 4100k
MAINTAINING COMPLIANCE ISN’T AS TIME CONSUMING AS YOU THINK
Reviewing and analyzing every regulatory change for your open and closed block of business is time consuming.
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HEALTH INSURANCE / HEALTH RATES
Kentucky amended its regulation regarding preferred and exclusive provider arrangements for health insurers. 806 KAR 18:020
Maine enacted legislation concerning required coverage for contraceptive supplies. HP 860
Maine enacted legislation pertaining to protection from surprise billings, network providers and network provider directories. HP 1073
Massachusetts issued a notice to health carriers submitting 2018 rate filings to provide information regarding the submission of filings required under M.G.L. c. 176J, § 6, for rates to be effective beginning January 2018 for coverage issued or renewed to merged market (individual and small group) members. HC Filing Guidance Notice 2017-D
Minnesota added a provision to its Code requiring a carrier that provides coverage under a health plan for cancer chemotherapy treatment to indicate the level of coverage for orally administered anticancer medication within its pharmacy benefit filing with the commissioner. 62A.3075
Nevada amended its law pertaining to health insurance by requiring that payments for treatment relating solely to mental health or the abuse of alcohol or drugs be made directly to certain providers of that treatment and requiring a licensed clinical alcohol and drug counselor to be directly reimbursed for providing treatment under certain circumstances. Senate Bill 262
Nevada amended its law regarding health insurance by revising among other things, requirements for mammograms, human papillomavirus vaccine and testing, hormone replacement therapy and prescriptions. Senate Bill 233
Nevada enacted legislation requiring all health insurance plans to provide certain benefits relating to contraception. Assembly Bill 249
New Hampshire enacted legislation stating that, if substance use disorder services are a covered benefit under a health benefit plan, a health carrier that has authorized or approved medication-assisted treatment for such services shall not require a renewal of a prior authorization more frequently than once every 12 months. Senate Bill 158
Oklahoma enacted the "Health Care Choice Act" effective August 25, 2017. Among other things, it provides requirements for exemptions from certain provisions of the insurance code, establishes certain requirements of out-of-state insurers who offer health and accident policies in the state, establishes required language for certain applications and policies and requires certain out-of-state insurers to pay applicable premium taxes. 36 s 4414
Oregon amended its law pertaining to health benefit plan requirements by removing reference to Public Employees’ Benefit Board (PEBB) and Oregon Educators Benefit Board (OEBB). It also requires that benefit plans offered by the board which reimburse cost of health services and supplies comply with requirements for health benefit plan coverage described in 743A.058, 743B.601, and 743B.810 effective January 1, 2018. Senate Bill 46
Oregon amended its law pertaining to health benefit plans by replacing the term "woman" with "individual" and removing certain gender-specific language from the law regarding various examinations. It also amended the definition of "small employer" and revised internal and external review procedures. House Bill 2341
Oregon amended the definitions of detainee and detention facility and prohibits companies denying or canceling coverage when an insured is in custody. Senate Bill 368
Oregon enacted legislation establishing the Health System Fund and the Oregon Reinsurance Program. The bill includes information about how insurers will be assessed for them. House Bill 2391
Oregon enacted legislation to define behavioral health assessment and behavioral health crisis. It requires health insurance policies providing hospital or medical expenses to provide coverage for a behavioral health assessment and treatment of a behavioral health condition, effective January 1, 2018. House Bill 3091, 743A.012, 743A.168, 414.025, 414.065, 414.690
HEALTH MAINTENANCE ORGANIZATIONS
Louisiana amended its law to provide eligibility criteria for a health maintenance organization in regard to premium tax credits. House Bill 664
Nevada enacted legislation requiring health maintenance organizations to provide certain data relating to health insurance claims to the person responsible for overseeing the health care plan of certain group purchasers of health insurance upon request and prohibiting the further disclosure of such data except in certain circumstances. Senate Bill 394
New York amended its requirements regarding HIV-related testing and reporting. 10 NYCRR 63.3
Mississippi amended rules addressing insurance holding company regulation. Rule 20.01+
INTERNAL AND EXTERNAL REVIEW
Louisiana amended its law to require the costs of the external review charged to a health insurance issuer be reasonable for the actual review performed. Any health insurer that believes that the amount charged for a review by an independent review organization is not reasonable may appeal those charges to the commissioner. House Bill 188
LIFE INSURANCE / LIFE CONTRACTS
Missouri amended its law to clarify that life insurance riders, endorsements and amendments may include a suicide exclusion. After initial coverage commences, if the insured adds or increases death benefits for the policy, an exclusion for suicide is allowed for one year after the effective date of the additional or increased death benefits. House Bill 336
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LONG-TERM CARE INSURANCE
Pennsylvania issued a notice providing a list of certified independent review organizations that are approved by the Department to review long-term care benefit trigger determinations. Notice 2017-06
MEDICARE SUPPLEMENT INSURANCE
Alabama promulgated a regulation addressing 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to persons newly eligible for Medicare on or after January 1, 2020. 482-1-071-.09-2
MENTAL HEALTH PARITY
Texas amended its Insurance Code to require that a health benefit plan provide benefits and coverage for mental health conditions and substance use disorders under the same terms and conditions applicable to the plan's medical and surgical benefits and coverage. House Bill 10; Sec. 1355.254
MISCELLANEOUS HEALTH / ACCIDENT
Colorado published a bulletin to provide the Division's position as to Accidental Death and Dismemberment insurance and mandated health benefits, in order to eliminate confusion. Bulletin B-4.45 dated 6-28-2017
Connecticut enacted legislation to address short-term care health insurance, and promulgated regulation to provide minimum standards, required disclosures and filing requirements, among other details. House Bill 7183, 38a-501 a-1 +
Connecticut issued a bulletin noting that Section 38a-999b requires certain entities to implement by October 1, 2017, and maintain a comprehensive information security program (ISP) to safeguard the personal information they compile, requiring at least annual updating and that the ISP be certified to the Insurance Commissioner annually as being in compliance with 38a-999b. Bulletin MC-23
Texas amended its Insurance Code relating to coverage for certain breast cancer screening procedures, among other things, requiring a health benefit plan that provides coverage to a female who is 35 years old or older must include coverage for an annual screening by all forms of low-dose mammography, as defined, for the presence of occult breast cancer. House Bill 1036; Sections 1356.001+
Texas amended its Insurance Code to require a health benefit plan to provide coverage for the cost of a medically necessary hearing aid or cochlear implant and related services and supplies for a covered person who is 18 years old or younger. House Bill 490; Sec. 1367.253
Utah issued a bulletin to health insurers regarding its legislature's Insurance Opioid Regulation, a bill providing a voluntary framework intended to minimize risk of opioid addiction and overdose for plans issued or renewed on or after July 1, 2017. Insurers are required to submit a report to the Insurance Department on or before September 1, 2017, and annually thereafter, indicating whether or not the insurer has adopted an opioid policy as described in 31A-22-615.5(2) and (3). Bulletin 2017-3
West Virginia enacted legislation which, among other things, prohibits an insurance plan from limiting the practice of physician assistants. Senate Bill 1014; 33-15-14
Nevada revised its laws regarding the administrative supervision of insurers, regulation of network plans and annual statement requirements. Assembly Bill 83
Maryland amended its regulation to require that, at the time of application and prior to accepting the applicant's initial premium for a preneed funeral contract or prearrangement funded by a life insurance policy, the insurer must disclose certain information to the applicant in writing. COMAR 31.15.03.06
REGULATORY REPORTING REQUIREMENTS
Louisiana enacted legislation requiring each risk-bearing entity authorized by the commissioner to annually inform the commissioner by electronic means of the name, mailing address, phone number, and electronic mail address of each individual responsible for certain duties. R.S. 22:41.2
Texas amended its Insurance Code relating to authorized reinsurance, financial statement credit and accounting for reinsurance. Senate Bill 1070; 493.002+
REPORTS - DATA CALLS & OTHER REPORTS
Colorado amended its regulations related to the All-Payer Claims Database and revised the reporting schedule. 10 CCR 2505-5 s 1.200.1+
Illinois amended its regulation regarding the accident and health reserve valuation standards. The standards have been moved to the Valuation Manual by the NAIC. The standards were previously in the Accounting Practices and Procedures Manual. 50 Ill. Adm. Code 2004.10
Delaware revised its Code related to abandoned or unclaimed property. Senate Bill 79
Tennessee amended its laws regarding abandoned or unclaimed property to require electronic reporting of such property each year that is subject to the custody of the State Treasurer. 66-29-123+
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C. J. Rathbun, FLMI, CCEP, HIA, AIRC
Reviewing and analyzing every regulatory change for your open and closed block of business is time consuming. First Consulting can help!
Compliance Monitoring Levels:
• Level One – Review and summarize legislation and advise which products and business area(s) are impacted.
• Level Two – All of Level One and provide a list of action items required to maintain compliance. (For example, you may need to draft and file an endorsement, send endorsement to insureds and update procedures.)
• Each level will provide summaries on a weekly or monthly basis.
Don’t see what you need in Level One or Level Two above? We will create a custom compliance monitoring service tailored to you and your company’s needs.
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Whether you are concerned with just a few challenging states, or utilizing the IIPRC, or submitting to all 50+ jurisdictions, First Consulting is the solution to your speed to market goals. For added convenience, all of the filings can be made on your SERFF instance!
Contact me today to find out more on how First Consulting can help you.