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 CONTINUING EDUCATION
Indiana readopted rules regarding continuing education requirements and amended the language in the retirement exemption form. Regulation 760:1-50-2+
New York revised its law by adjusting the maximum training allowance subsidies for agents for certain life and annuity insurance. 11 NYCRR 12.2
Ohio removed references to the insurance agent education advisory council from its continuing education requirements. Insurance Code: 3905.481
Puerto Rico issued a circular letter to all domestic insurers advising that certain required courses or seminars are now offered online through an application that will be available twenty-four hours a day. Circular Letter CC-2016-1898-SR
AGENT / PRODUCER LICENSING AND APPOINTMENT
California posted a notice of Statutory Limits on Taking Insurance License Examinations. Effective January 1, 2017, any insurance license exam candidate failing an exam ten times within the previous 12-month period will be barred from taking the same exam for a period of 12 months, beginning the date of the last failed exam. Licensing Notice dated December 15, 2016 (A)
ANNUITIES / ANNUITY CONTRACTS
Michigan amended legislation to provide that judgments of divorce and separate maintenance shall make provision in satisfaction of the claims of the wife in the property of the husband and in satisfaction of the claims of the husband and wife in contracts of insurance and annuity upon the life of the husband or wife, and in satisfaction of claims of the husband and wife to any annuity, or accumulated contributions in any annuity, including any rights or contingent rights in and to unvested annuity benefits. Senate Bill 5520
Hawaii published a memorandum addressing 2016 annual filing requirements for captive insurers authorized in Hawaii and providing an electronic option for filing. Memorandum 2016-4C
CERTIFICATE OF AUTHORITY FILINGS
Colorado amended its regulation concerning issuance of a certificate of authority, effective January 1, 2017. 3 CCR 702 Amended Regulation 2-1-7
IS YOUR COMPANY PLANNING TO EXPAND ITS AUTHORITY?
A name change, re-domestication, acquisition, merger, or adding a new line of business requires a state filing to change an insurance company's certificate of authority. Click here to see how First Consulting can help.
CLAIMS / CLAIMS ISSUES
Nevada amended its law relating to the forms that must be accepted by a payer for dental claims submitted under a contract for health insurance. NAC 686A.288
New Hampshire amended its law for health insurance carriers and third-party administrators providing claims administration services to certain self-funded private employers. Health insurance carriers and third-party administrators must provide each self-funded employer a copy of the "NHID Opt-In Form" for purposes of determining whether the employer directs the carrier or third-party administrator to submit its health care claims data. Regulation 4005.03
Texas updated its regulation addressing complaint information available through the Department's toll-free telephone number to include prescribed methods of reporting policy count information electronically. TAC s 1.603
CONFIDENTIALITY / PRIVACY
Iowa amended its rule regarding the required annual privacy notice to customers, effective January 25, 2017. Regulation 191-90.4
Washington amended its regulation to relieve licensees of the requirement to provide an annual privacy notice to customers if the licensee provides nonpublic information to nonaffiliated third parties only in accordance with applicable regulations and has not changed its policies and practices from the policies and practices that were most recently disclosed to the customer. WAC 284-04-205
Nevada adopted a rule requiring a licensed insurer that is domiciled in the State to adopt a conflict of interest policy for its attorneys-in-fact, trustees, managers, officers and directors. It specifies what the policy must include. NAC 679B s 1+ (LCB File No. R078-16)
Ohio enacted legislation providing the corporate governance annual disclosure (CGAD) filing requirements. Senate Bill 273
WHAT REPORTS WILL YOU SUBMIT IN 2017?
Want help with CGAD, ORSA and other reporting readiness?
First Consulting has answers! Click here to learn more.
CREDIT FOR REINSURANCE
Hawaii promulgated regulations to address credit for reinsurance. 16-168-2 through 16-168-13
Illinois reminded health issuers who provide short-term, limited-duration insurance of the notice that must be prominently displayed (at least 14 point type) in all relevant contracts and application materials beginning January 1, 2017. The notice reads as follows: "THIS IS NOT QUALIFYING HEALTH COVERAGE (“MINIMUM ESSENTIAL COVERAGE”) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES." Insurers that have not already done so, must file redlined materials through SERFF. 12-21-16 SERFF Message
Michigan issued a bulletin that sets forth the requirements that currently apply to fixed indemnity and hospital indemnity policies in the individual market. It advises of the revised guidelines for an individual market fixed indemnity plan to qualify as excepted benefits. Bulletin No. 2016-23-INS
South Carolina published a bulletin addressing supplemental cancer and other specified disease policies in view of the State Supreme Court's decision in Kirven v. Central States, which prohibits application of Section 38-71-242 (C), prohibiting payment of benefits based on actual charges or actual fees, to contracts entered into prior to the statute's effective date. Bulletin 16-15
FILING REQUIREMENTS / PROCEDURES
Maryland issued a bulletin regarding student health plan form and rate filing instructions for the 2017-2018 school year. Bulletin 16-35
New Mexico updated its bulletin regarding the requirement to re-file all non-compliant forms and matrix filings, extending the date for compliance to December 31, 2017 and providing some additional clarity. Bulletin 2016-019 Updated
Washington adopted regulations to provide guidelines for filing of grandfathered individual and small group health plans by health care service contractors and health maintenance organizations and for stand-alone dental plans and stand-alone vision plans offered by health service contractors, health maintenance organizations and disability carriers to individuals and small groups. WSR 16-23-019
TRANSFORM YOUR COMPLIANCE DEPARTMENT FROM “NO” TO “GO”!
Tired of that feeling that you are holding up a product from going to market? First Consulting can help transform your Compliance from the “Department of No” to the “Department of Go!”
Click here to learn more.
Michigan issued a bulletin that provides guidelines for the regulation of Alternative Financing and Delivery Systems (AFDS), recognizing that AFDS have categorical differences from HMOs that result in differences in regulation. Bulletin No. 2016-22-INS
Nevada amended its laws regarding the audit of financial statements for certain insurers. NAC 680A.189
HEALTH INSURANCE - COMPREHENSIVE
Delaware published a bulletin giving notice to health insurers of the 2017 operative date of network disclosure and transparency provisions. Regulation 1317 will not become effective February 11, due to an extended public comment period, but the Department expected carriers to comply as of January 1, 2017. Domestic/Foreign Insurers Bulletin No. 90
New Jersey issued a bulletin informing health insurance companies, health maintenance organizations, and carriers offering health benefits plans through the individual health coverage program and the small employer health benefits program of the requirements concerning coverage for synchronization of prescribed medications. Bulletin 16-12
Puerto Rico advised insurers writing health insurance with pharmacy coverage that they must cover the medications Oseltamivir and Zanamivir for all covered individuals or insureds with influenza symptoms, regardless of the results of the quick test for influenza. Circular Letter CC-2016-1899-AS
Puerto Rico issued a circular letter advising health insurers of the protocols and procedures for the screening of pregnant women and pre- and post- natal care. Circular Letter CC-2016-1896-D
Puerto Rico issued a ruling to all insurers that write health insurance regarding guidelines and specifications for coverage of glucometers. Ruling CN-2016-209-AS
Vermont promulgated a new regulation to standardize the posting of qualified health plan Prescription Drug Formularies by health insurers. Regulation 2016-1
Michigan issued an Order providing holding company forms and instructions. Order No. 2016-053-M
Nevada amended its requirements regarding the use of Form A - Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer. NAC 692C.020
IIPRC / INTERSTATE COMPACT
The Interstate Insurance Product Regulation Commission (IIPRC) published a Filing Information Notice addressing Guaranteed Living Benefit Increases for Qualifying Events to provide clarification of the recent revision of the GLB Standards. Filing Information Notice 2016-3
The Interstate Insurance Product Regulation Commission (IIPRC) published an FAQ document for applications, the form most commonly submitted for review to the Compact. Application Process FAQ
LONG-TERM CARE INSURANCE
Maryland issued a bulletin to insurers regarding long term care insurance rate increases. Bulletin 17-01
MANAGED CARE PLANS / HMOS
Maine adopted changes to rules that clarify the application submission requirements for applicants seeking a health maintenance organization (HMO) certificate of authority. The rules subject HMOs to specified standards. Rule Ch. 191 s 1+
Vermont amended its regulation addressing consumer protection and quality requirements for managed care organizations. Regulation H-09-3
Connecticut published a bulletin announcing that, beginning with 2017, it will be participating in the Market Conduct Annual Statement data collection system (MCAS). Any licensed company writing at least $50,000.00 of gross premium in Life, Annuity, Private Passenger Auto or Homeowner's lines of business in the state will be required to file MCAS data with the Department. Bulletin MC-22
"I WOULD LOVE TO DELEGATE THIS RESPONSIBILITY"
Have you ever had this thought when you are trying to stay current with legislation applicable to your block(s) of business? First Consulting can help! Click here to learn more.
Delaware issued a bulletin to provide information as to the Department's position on Charitable Premium Assistance Programs. Domestic/Foreign Insurers Bulletin 93
Georgia amended its regulation to specify how insurers doing business in the state will be assessed for participation in the Special Insurance Fraud Fund. Payment of the assessment will be due on September 1 of the year of the assessment, which will be made on or before July 1. 120-2-72-.05
Illinois issued a bulletin to insurers regarding financial reporting, health insurance reporting and specified policy form filings. The bulletin also addresses valuation manual issues. Company Bulletin 2016-9
Missouri adopted an emergency regulation that describes the use of electronic signatures and seals by notaries and provides definitions regarding the use of those terms. 15 CSR 30-110.010; 15 CSR 30-110.020
Nebraska issued a bulletin revising the Department's Schedule of Fees. Bulletin CB-38 (amended)
Pennsylvania amended its law to provide exemptions for internal audit function requirements. If an insurer exempt from the internal audit function requirements no longer qualifies for that exemption, the insurer has until December 31 of the year in which the annual statement was filed showing the exemption threshold to comply with the requirements. 31 s 147.8a
Texas adopted amendments concerning the 2017 assessment of maintenance taxes and fees to adjust the rates of assessment on the basis of gross premium receipts using methodology described. 28 TAC s 1.414
The District of Columbia enacted legislation to provide procedures and requirements regarding the request for and dispensation of covered medications to qualified patients seeking to die in a humane and peaceful manner and to address details of such decisions affecting health care providers involved or opting out of involvement, issues involving the qualified patient's estate, insurance or annuities, or the District government and to establish criminal penalties. I - B 38
MISCELLANEOUS HEALTH / ACCIDENT
Kentucky amended its law to require a promoter to provide insurance for a contestant for any injuries sustained in a boxing or kickboxing show. The minimum amount of coverage per contestant shall be $5,000 health and $5,000 accidental death benefits. The deductible expense under the policy for a contestant shall not exceed $1,000. Regulation 201 KAR 27:011, 201 KAR 27:016
MISCELLANEOUS LIFE / ANNUITY
California published a bulletin providing its Principle-Based Reserving Assessment for Fiscal Year 2016-17. Bulletin 2016-08
Michigan amended its law regarding mortality tables used in life and annuity policies. House Bill 5514
Delaware issued bulletins to all captive insurance companies and other companies subject to premium tax and/or fees to clarify annual premium tax and fees filing instructions and procedures for calendar year 2016 tax filings. While OPTins, the Online Premium Tax for Insurance program, is the preferred method, it remains optional for 2016. Captive Insurance Bulletin 7/ Domestic-Foreign Insurers Bulletin 89
Hawaii published a memorandum addressing electronic filing and payment of premium taxes. Memorandum 2016-5E
REPORTS - DATA CALLS & OTHER REPORTS
Arkansas promulgated a rule to implement the Prior Authorization Transparency Act, which requires utilization review statistics to be reported quarterly for publication of prior authorization and nonmedical review criteria and statistics. Rule 115
Oregon adopted a rule pertaining to the disclosure of information about complaints regarding unlawful claims settlement practices. OAR 836-005-0405
STANDARD VALUATION LAW
Oregon adopted a regulation specifying that when insurers establish reserves using a principle-based valuation, they shall use the Valuation Manual with NAIC adoptions through August 29, 2016. The operative date of the valuation manual is January 1, 2017. OAR 836-031-0605
South Carolina published a bulletin announcing the operative date of the Principle-Based Valuation Manual, which is January 1, 2017. Bulletin 16-12
Texas adopted by reference the NAIC Valuation Manual, effective January 1, 2017. 28 TAC 3.9901
Washington adopted the valuation manual of the National Association of Insurance Commissioners with an operative date of January 1, 2017. 284-74-600
THIRD PARTY ADMINISTRATORS
Alaska published a bulletin stating that anyone acting as a Third Party Administrator in the state must register as such, but that a licensed insurer in good standing also acting as a TPA is exempt from registration, provided that it files a certification with the Director and receives the Director's approval of the exemption. Further, the insurer is still required to meet all other applicable TPA requirements. Bulletin B 16-12
UTILIZATION REVIEW - HEALTH CARE
New York amended its law pertaining to utilization review determinations of step therapy protocols and override determinations. Senate Bill 3419, Ins. Law s 3217, Law s 4900, Ins. Law s 4902, Ins. Law s 4903
Ohio amended its insurance code regarding prior authorization request standards for health insurance. Insurance Code: 3923.041
Do your marketing partners consider your compliance area to be the “Department of No”? Tired of that feeling that you are holding up a product from going to market? First Consulting can help transform your Compliance from the “Department of No” to the “Department of Go!”
Whether you have a backlog of new products, or a new product that that requires additional expertise, contact me today to learn how First Consulting can help to improve your speed to market and allow you to become the Department of Go!
Have you ever had this thought when you are trying to stay current with legislation applicable to your block(s) of business?
Reviewing legislation to determine if the new law is applicable to your specific open or closed block of business and determining what steps are necessary to ensure you stay in compliance is time consuming. First Consulting can help.
First Consulting’s Compliance Monitoring service will:
- Review and summarize legislation that apply to your business;
- Advise which products and business area(s) are impacted; and
- Provide summaries weekly and a report of all summaries monthly.
We will help you RAPidly move through the legislation!
Because we understand that your needs are unique, we customize the Monitoring Services specific to your company.
Wait no longer, delegate to First Consulting. Call us today to discuss how Compliance Monitoring will help keep your block of business current with new legislation in 2017.