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
California has amended the prelicensing and continuing education regulations for all education providers and other interested parties. Licensing Notice dated November 20, 2014
New Hampshire issued a bulletin pertaining the requirement that producers selling annuities take a one-time 4 credit training course specifically on suitability. Individuals who obtain a life insurance sales authority on or after the effective January 1, 2015 may not engage in the sale of annuities until the annuity training course required is completed. Bulletin of December 9, 2014 (A)
AGENT / PRODUCER LICENSING AND APPOINTMENT FEES
California announced, effective March 1, 2015, a 10 percent increase in fees for all insurance producers, bail agents, insurance adjusters and insurers operating in the state. Bulletin No. 2014-6
Wisconsin reminds resident and non-resident producers that their 2015 annual initial and renewal appointment fee invoices will be mailed shortly after January 1, 2015 and payments must be submitted by Electronic Funds Transfer (EFT) on their website: oci.wi.gov. Bulletin dated December 8, 2014
Illinois issued a bulletin outlining policy form filing requirements for the continued use of existing policy forms that must be modified due to the amendments which include the adoption of the 2012 Individual Annuity Reserving (2012 IAR) table for contracts issued on or after January 1, 2015. Company Bulletin 2014-11
New Jersey provided that the 2012 IAR Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2015. NJAC 11:4-26.3
Nebraska issued a notice regarding the interpretation of "covered service" in a new law governing dental plans. Notice of December 8, 2014
Utah has updated the rules regarding dependent coverage to comply wIth the Affordable Care Act, Extension of Dependent Coverage, updated citation references, and made technical changes. Rule R590-259-1
Illinois provided notice requirements that are required at the time of purchase of fixed indemnity contracts. 50 Ill. Adm. Code 2007.80
Connecticut has a new bulletin related to 2014 and 2015 financial filing requirements for accredited reinsurers. Bulletin FS-4AR-14
Connecticut has adopted a new bulletin regarding the annual and quarterly financial filing requirements for domestic insurers, health care centers, and foreign insurers. Bulletin Number FS-4-14
Delaware repealed regulation 403 regarding domestic insurers/sale and purchase of options. 403 s 1.0
Illinois issued a bulletin to chief actuaries of life/accident and health insurance companies and fraternal organizations, about certain submission requirements related to financial reporting, health insurance reporting, and policy form filings. Company Bulletin 2014-12
Texas has amended its regulation concerning the NAIC Accounting Manual. 28 TAC §7.18 and §7.85
HEALTH INSURANCE/HEALTH RATES
Arizona has amended behavioral health services under Arizona Health Care Cost Containment System. R9-31-1201, R9-31-1202, R9-31-1203, R9-31-1204, R9-31-1205, R9-31-1206, and R9-31-1207
Arizona has amended the location of definitions under Arizona Health Care Cost Containment System. R9-22-101
Arizona has enacted the house bill concerning the Terminal Patients' Right to Try Act (aka "Proposition 303") HB 2005
Connecticut has adopted a new bulletin regarding health insurance coverage for work related injuries, accidents, and/or sicknesses under health insurance policies for disability income protection, accident only, and travel health policy forms. Bulletin HC-101
Massachusetts issued a bulletin to set forth the 2014-2015 enrollment requirements in Massachusetts for insured health benefit plans. Bulletin 14-11
New Jersey amended its requirement for carriers that are members of the Individual Health Coverage Program, which among other things, revises the annual open enrollment period and provides a definition of renewal period. NJAC 11:20-1.2
New Mexico issued a bulletin advising health insurers that all forms that will be distributed to a policyholder or prospective policyholder must be submitted for review, unless specifically excluded by NMSA. Bulletin 2014-018
Texas has amended its regulation regarding the reimbursement methodology for the community living assistance and support services waiver program. 1 TAC s 355.505
Colorado made some technical and clarifying changes to existing citations related to the insurance holding company system rules, removes provisions related to "foreign" insurers, and adopted a new regulation regarding enterprise risk report. 3 CCR 702 Reg. 3-4-1
INTERNAL AND EXTERNAL REVIEW
Louisiana issued a bulletin informing all health insurance issuers and health maintenance organizations (issuers), utilization review organizations and independent review organizations of the electronic process established for external reviews. Bulletin 2014-08
LIFE INSURANCE/ LIFE CONTRACTS
New York expanded its definition of "life insurance" to include contracts that provide a special surrender value upon an insured receiving end of life or palliative care for a period of three months or more, at a residential health care facility, home care services or hospice with the expectation that such insured will continue to require such services until death. Ins. Law s 1113
LONG-TERM CARE INSURANCE
Nebraska issued a bulletin regarding alternative filing requirements for long-term care premium rate increases. Bulletin CB-133
Oregon issued a bulletin to address rate increases for long-term care insurance policies currently in force, in particular pre-rate-stability and post-rate-stability premium rate increase filings for long-term care policies. Bulletin INS 2014-3
MEDICARE SUPPLEMENT INSURANCE
Maine amended rules to provide that a carrier issuing a subsequent Medicare supplement policy may not deny any claim otherwise covered under the policy on the basis that the enrollee is entitled to an extension of coverage under a prior policy. Maine also provides that Medicare is creditable coverage and includes an example of how the preexisting condition exclusion period may be reduced because of this. Insurance Rule Ch. 275 s 8, Insurance Rule Ch. 275 s 8.1, Insurance Rule Ch. 275 s 11
MENTAL HEALTH PARITY
Washington repealed and added provisions regarding parity in mental health and substance use disorder benefits. WAC 284-43-990 +
MISCELLANEOUS HEALTH / ACCIDENT
Arkansas has adopted a new regulation related to network adequacy requirements for health benefit plans and certain stand-alone dental plans. Rule and Regulation 106 s 1
Michigan issued a bulletin to inform health insurers of the new minimum substance abuse benefit level. The bulletin applies to grandfathered plans, small group market transitional plans, extended transitional plans, and to individual market transitional and extended transitional plans. Bulletin 2014-16-INS
New York issued a circular letter providing guidance to issuers regarding health insurance coverage for the treatment of gender dysphoria. Circular Letter 2014-7
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Colorado adopted a new regulation regarding special fee assessments for the Colorado Health Exchange. Regulation 4-2-52
Illinois amended its prohibited policy provisions to provide that no policy can limit or exclude coverage by type of illness, accident, treatment or medical condition, except for injury, illness, treatment or medical condition arising out of, with respect to excepted benefit policies and grandfathered health plans, suicide (sane or insane), attempted suicide or intentionally self-inflicted injury. 50 Ill. Adm. Code 2007.60
Illinois expanded its definition of excepted benefits to include hospital indemnity or other fixed indemnity insurance paid as a fixed dollar amount per day or other period, paid per event or service, or upon benefits paid upon a basis other than period of time, regardless of the amount of expenses incurred. 50 Ill. Adm. Code 2001.2
Illinois provided that the inclusion of essential pediatric oral care benefits shall be deemed to be satisfied for qualified health plans made available in the small group market or individual market in Illinois outside the Health Benefits Exchange, issued for policy or plan years beginning on or after January 1, 2015, that do not include the essential pediatric oral care benefits if the health insurance issuer has obtained reasonable assurance that the pediatric oral care benefits are provided to the purchaser or enrollee of the qualified health plan. 50 Ill. Adm. Code 2001.11
The Federal government has amended the regulations related to "excepted benefits" for group health plans and group health insurance issuers for plan years beginning on or after January 1, 2015. 26 CFR 54.9831-1
Utah revised rules to comply with the Affordable Care Act requirements regarding health benefit plan enrollment. Rule R590-176-3
Virginia amended the law regarding renewal of health benefit plans. It provides that a health carrier may offer to renew any health benefit plan that would otherwise be required to be canceled because it does not meeting the requirements of the ACA or related regulations, to the extent that the appropriate federal authority has suspended enforcement of those provisions. HB 5011
Washington amended provisions concerning pediatric vision services, required as part of essential health benefits specified in the ACA. WAC 284-43-880
Kentucky amended their Local Government Premium Tax Schedule and clarified the responsibilities of insurers and surplus lines brokers relative to payment of LGPT. Bulletin 2014-3
Alabama repealed a regulation related to the sale and funding of preneed services and merchandise. However, they retained a revised regulation governing preneed sales, both effective January 1, 2015. 482-3-001-.01 and 482-3-003-.07
Texas has amended regulations regarding insurance consumer financial information privacy. 28 TAC §§22.2, 22.3, 22.10, 22.11, 22.22, 22.26, and 22.27
The Delaware department of Insurance now offers the public the ability to view insurance rate and form filings via the System for Electronic Rate and Form Filing (SERFF) interface, commonly referred to as SERFF Filing Access (SFA). Access is free and available through: www.delawareinsurance.gov/serff/. SERFF Announcement
Colorado has amended the regulation related to certification and regulation of assuming reinsurers, and conditions where credit will be allowed for ceded risk. 3 CCR 702 Reg. 3-3-3
South Dakota updated the risk-based capital (RBC) reporting requirements. 20:06:36
YOUR FRIEND IN ANNUITY COMPLIANCE
Annuities continue to be among the fastest growing products in the insurance marketplace. As consumer demand continues to rise, companies continue to adapt in order to provide new and more innovative annuity products. Many of the new annuity products offered do not look very similar to those offered only a few short years ago. These new products now include complex indices and inventive riders, and in some cases are having trouble fitting within the regulatory constructs in place.
As companies continue to create and introduce these new products to the market, new compliance issues arise. Speed to market slows down as regulators review new products more closely and with more objections. Market conduct and advertising compliance issues develop as new annuity features are introduced. Companies may find themselves with more compliance gaps than resources to fill them.
Let First Consulting and its over 45 years of insurance and regulatory compliance expertise help you meet your annuity compliance goals. Whether it is speed-to-market, annuity suitability concerns, annuity advertising review, or an issue-specific research project, we have the expertise to help you “fill your compliance gap” and will work with you to do so within your budget.
To learn more about our services, click here.
Contact me for a no obligation proposal and cost estimate.
Kevin W. Mechtley
YOUR PRODUCT DRAFTING RESOURCE
Insurers work hard to keep their products relevant and in compliance. Insurance policies, certificates, riders, applications and other forms need regular review and revision to ensure they comply with changes in the law and regulations. Changing consumer needs lead to new products or new features in existing products. For over 45 years, First Consulting’s skilled staff has helped insurers with all of these drafting challenges.
First Consulting tailors its approach to your company’s drafting project based on your company’s specific needs. We can help with all or a portion of your project by:
- drafting generic product language;
- developing state variations in all or some states; or
- revising existing contracts to add new benefits or features.
Co-Sourcing with First Consulting allows you to maintain a role at whatever level is most appropriate for your specific company and project.
To learn more about Co-Sourcing click here.
Contact me for a no obligation proposal and cost estimate.