Life and Health News January 2012

The following is a brief review of selected items that may be of current interest to First Consulting & Administration, Inc. clients and friends.  Please feel free to copy it for distribution to your staff.  Contact us for more details about any item.  We welcome your comments and suggestions on this letter.  Please call our office.


Montana amended its rules pertaining to actuarial opinion.     Rule 6.6.6501+

Iowa adopted a new rule regarding synthetic guaranteed investment contracts which includes requirements for contract provisions, form filing and assets for segregated portfolios.     Rule 191-96.1 (505, 508)+

Rhode Island adopted a new regulation regarding civil unions which includes, among other things, coverage standards for civil unions, form filing standards, and provisions on regulatory interpretations and definitions.     Regulation 118

Arkansas issued a bulletin advising health insurers and health maintenance organizations of the amendments to its rule regarding external review as well as notifying health insurers that the forms for implementing and complying with the amended rule are available for review in the Department’s Administrative Rules section on its website.     Bulletin 10-2011

Ohio enacted legislation for health benefit plans when requests for external review of adverse benefit determinations are submitted.     House Bill 218

Alaska amended its rule pertaining to health care insurance rate filings.     3 AAC 31.235

Colorado amended its regulation providing new form filing requirements including readability and SERFF requirements for certain types of coverage.     Regulation 1-1-6

Alaska amended the formula for calculating deficiency reserves for life insurance policies.     Regulation 3 AAC 21.905

Connecticut issued a bulletin to all insurance companies noting the necessary forms and instructions for completing annual financial statements.     Bulletin FS-4-11

Illinois issued a bulletin to Chief Company Actuaries regarding financial reporting, health insurance reporting, and policy form filings.     Bulletin 2011-15

New York amended its law in relation to the treatment of qualified financial contracts in an insurance insolvency proceeding affecting a domestic, foreign or alien insurer.     Senate Bill 2713

New York issued a circular letter providing guidance and clarification regarding the two types of notices that insurers must send to policy holders and certificate holders for premium rate adjustments.     Circular Letter 2011-12

New York issued a circular letter to all insurers clarifying characteristics of an appropriate formal enterprise risk management (ERM) function and detailing the criteria that the Department will evaluate.     Circular Letter 14 (2011)

Rhode Island amended its small employer health insurance availability regulation.     Regulation 11, 1; Regulation 11, 3; Regulation 11, 4; Regulation 11, 5; Regulation 11, 6+;

Utah issued a bulletin regarding medical loss ratio reporting and calculation of rebates for small employer group health benefit plans.     Bulletin 2011-7

Utah amended its rule on its health grievance review process which, among other things, includes disability income insurance in the definition of carrier.     Rule R590-203-1+

Oregon amended its rate and form filing rules to reflect the Interstate Insurance Product Regulation Commission partnership.   The Compact will start accepting filings on January 18, 2012.     Rule 836-010-0000+, Email dated December 20, 2011

Maryland amended its rule regarding reporting requirements for the longterm care partnership program to clarify that only carriers participating in the partnership program are required to file the annual report regarding the number of longterm care polices offered in the state.     Regulation

Arkansas updated its regulations for funeral expense insurance to increase the limit for benefits for expenses incurred in connection with the death of the insured from $10,000 to $15,000.  The limit for deferred annuities also increased from $10,000 to $15,000.     Rule 30

Maryland amended its law to allow ordinary industrial life insurance policies to include certain health benefits which had previously been prohibited.  These include additional benefits for a second opinion for health conditions specified in the policy and lump-sum specified disease benefits.     COMAR

North Carolina issued a memorandum providing licensees with very important information regarding North Carolina's e-mail address procedures.     Memorandum 12-8-2011

Washington adopted a new rule that defines the requirements of filing a biographical affidavit for domestic insurers.  It outlines additional circumstances requiring a new biographical affidavit to be filed.     Rule 284-07-600+

Arkansas issued a bulletin providing rate filing requirements for all individually underwritten major medical policies, certificates, or evidence of coverage issued through an association regardless of where the association policy was issued.  The bulletin replaces Bulletin 6-2011 in its entirety.     Bulletin 6A-2011

Colorado amended its procedure for provider-carrier dispute resolution applicable to carriers providing health care services through managed care plans.     Regulation 4-2-23

New York amended its law pertaining to prescription drugs.     A. 7779, A. 5502-B

Oregon updated its new product standards for group health coverage to be issued to an association or trust group and individual and small group health benefit plan rate filings.     Email dated 12-1-2011

Tennessee repealed its rule on the filing and approval of group accident and sickness policies, forms, rates and claim forms.     Repeal Of Rule 0780-01-20+

Alaska issued a bulletin clarifying the guidelines to consider in complying with the new free look notice requirements for life insurance policies, annuity contracts, and applications.  This bulletin supersedes and rescinds the Life and Annuity Insurers section of Bulletin B 11-07.     Bulletin B 11-13

New Jersey readopted and amended its rule on actuarial opinion and memorandum for life and health insurers and its general requirements for insurance holding company systems.     Rule 11:1+

Georgia issued a bulletin to major medical insurers regarding the modification of the medical loss ratio standard applicable for the individual market.     Executive Bulletin 11-EX-4

North Dakota issued a bulletin reminding health insurers that the Patient Protection and Affordable Care Act does not supersede North Dakota insurance law, N.D.C.C. § 26.1-36-22.  Insurers must be aware that a young adult may not qualify for dependent coverage under the federal law, but could qualify under the more generous state law.     Bulletin 2011-3

Tennessee adopted a new rule on form and rate filings for health insurance not subject to the authority of The Patient Protection And Affordable Care Act of 2010 that is effective on February 20, 2012.     Rule 0780-01-92+

Nebraska issued a notice detailing the required method of filing 2012 premium taxes.     Notice Dated December 14, 2011

Nevada issued a bulletin clarifying that they no longer require insurers to furnish copies of their quarterly and annual Premium Tax Returns to the Division.  However, insurers still have the responsibility to maintain records for the Commissioner's review pursuant to Title 57 of the Nevada Revised Statutes.     Bulletin 2011-015

Virginia amended its regulation to require that a written disclosure statement be provided as part of any contract used for preneed funeral planning.     Regulation 18 VAC 65-30-230

Nebraska issued a bulletin setting forth the Department's views regarding insurance companies’ compliance with requirements for Gramm Leach Bliley Act (GLBA) privacy notices set forth in the Nebraska Privacy of Insurance Consumer Information Act.     Bulletin CB-127

Utah amended its individual and agency licensing requirements.     Rule R590-244-1

Washington replaced the requirement for submission of fingerprint cards of the directors, officers, and significant shareholders of domestic life settlement applicants with a requirement to provide 3rd party verification reports from an acceptable vendor.     Rule WAC 284-97-020

Alaska adopted a new rule on retained asset accounts that includes settlement option disclosure requirements.     Regulation 3 AAC 26.850+

Colorado amended its regulation regarding small employer health plan requirements.     Regulation 4-6-8

Is Your Company Developing or Updating an Excepted Benefits Product?
Let First Consulting use Our Experience to Help

As a result of the Patient Protection and Affordable Care Act (PPACA), many insurers are developing or updating supplemental health products, which are excepted from PPACA requirements.  These excepted benefit products include Accident, Critical Illness, Hospital Indemnity, Dental, Vision and similar products.

First Consulting has assisted large and small insurers as they prepared for and responded to PPACA by helping to develop new products, research compliance questions and handle state filings.  With regard to Critical Illness insurance in particular, First Consulting has unique expertise, having assisted with many nationwide group and individual critical illness insurance filings.  These have included standalone Critical Illness policies with a variety of designs and features, as well as Critical Illness insurance riders.

To find out more about the services First Consulting provides, click here.  

Contact Stacy Koron (816-391-2735) or Jerry Wickersham (816-391-2743), to discuss your compliance questions or for a no obligation quote.

 Stretching your Resources – Monitoring TPA’s

Working with TPA’s brings on regulatory requirements that may stretch your compliance resources beyond full.

One of our On-Line Research Services – Third Party Administrator Licensing Service – answers questions you may have about TPA Licensing.

This On-Line Research Service enables Insurers, as well as TPA’s, to find answers about:

What is a TPA?
What organizations need to be licensed?
Where does a TPA need to be licensed?
What forms are needed for licensing?
What other requirements must be met? 

Click here for more details, including the opportunity to take a Virtual Tour of our On-Line Services, pertaining to TPA Licensing Services. 

Or, you can contact Scott Sheffer (816-391-2742).