Life and Health News July 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.

Ohio adopted a new rule for the calculation of nonforfeiture values used in annuity contracts.     Rule 3901-6-16

Tennessee enacted legislation concerning new rebuttable presumptions upon the completion of an application for insurance.     Senate Bill 2271

Alaska enacted legislation requiring insurance coverage for autism spectrum disorders.     Senate Bill 74

Louisiana amended its requirements for autism spectrum disorders coverage by raising the age requirement and eliminating the limitation on lifetime benefits.     House Bill 771

Oregon adopted temporary rules that include provisions that establish and clarify application requirements, annual reporting and audit requirements, documentation and recordkeeping requirements, provisions to assure there is no conflict of interest by directors of captive insurers, procedures for suspending or revoking a captive insurer license, forms and fee requirements.     836-029-0000+

Louisiana enacted legislation requiring certain information to be included in any written communication to an insured or a dentist that includes or pertains to a denial of benefits on the basis of a lack of medical necessity.     Senate Bill 345

Maryland enacted legislation that requires certain insurers, health maintenance organizations, and dental plan organizations to provide coverage for dental preventive care, including dental cleanings, if specified conditions are met. It prohibits specified provisions from being construed to require coverage for a specified service.     House Bill 1356

Connecticut enacted legislation providing health carriers adverse determinations appeal and review requirements.     Senate Bill 410

Florida issued a memorandum announcing upcoming changes to the online universal data letter and instruction sheet.     Memorandum 2012-04M

Idaho issued a bulletin providing guidance regarding the version of the NAIC's Accounting Practices and Procedures Manual to be used by authorized insurers when preparing 2012 quarterly and annual financial statements.     Bulletin 12-02

Louisiana enacted legislation to amend its anti- fraud laws and established the Insurance Fraud Prevention Act.     House Bill 569, Senate Bill 765

Maryland enacted legislation altering the list of persons to whom a person may report suspected insurance fraud and not be subject to civil liability.  It also provides that a person is not subject to civil liability for furnishing or receiving information relating to suspected, anticipated, or completed fraudulent insurance acts under certain circumstances.     Senate Bill 812, House Bill 1097

Maryland amended its Life and Health Insurance Guaranty Corporation Act related to coverage limits and insolvent insurers.     House Bill 1340, Senate Bill 1003

Wyoming issued a memorandum notifying insurers of updates to the Wyoming Life and Health Insurance Guaranty Association's coverage limits.     Memorandum 02-2012

Maryland issued a bulletin informing carriers providing Health Benefit Plans of changes to the rate filing process for the individual and small employer group markets.     Bulletin 12-10

Louisiana enacted legislation clarifying the minimum required capital and surplus required for each health maintenance organization.     House Bill 150

Colorado amended its regulation on non-discriminatory treatment of HIV/AIDS related illness by life and health carriers.     Regulation 3 CO ADC INS 4-2-9

Louisiana revised its laws and restructured provisions pertaining to insurance holding company systems.   Included are definitions, provisions regarding acquisition and filing requirements for those acquiring domestic insurers.     HB 1191

Colorado amended its long-term care regulation, which among other things, modifies the manner that insurers must compute the inflation protection that policies qualifying for the partnership program must provide to covered individuals.  It also amended Appendix A and updated the checklist that insurers seeking policy certification must submit to the DOI.     Regulation 3 CO ADC INS 4-4-4

Louisiana enacted legislation allowing the Insurance Commissioner to promulgate regulations for independent review of benefit determinations for long-term care insurance.     Senate Bill 118

Arkansas issued a bulletin reminding insurers that Arkansas will participate in the market conduct annual statement and that companies should collect relevant data to be included in the report. The Bulletin is applicable to all life and annuity insurers reporting $7,000,000 or more in gross premiums.     Bulletin 5-2012

Colorado amended its regulation governing the use of independent market conduct examiners and the appeal process for expenses.     Regulation 3 CO ADC INS 6-3-1

Colorado amended its insurance holding company regulation and added an applicability section.     Regulation 3 CO ADC INS 3-4-1

Colorado amended its regulation on the time period for responding to Insurance Division information requests for, among other things, market conduct and financial examinations. This regulation applies to all persons and entities over whom the Division has authority.     Regulation 3 CO ADC 1-1-8

Colorado amended its regulation pertaining to qualifications required of consulting actuaries.     Regulation 1-1-1

Colorado issued a bulletin to insurers and carriers providing guidance about the use of prepaid debit or stored value cards for payment of insurance claims.     Bulletin B-6.3

Delaware now allows the use of electronic notices and documents in an insurance transaction under certain circumstances.     House Bill 223

Georgia enacted legislation to provide that exemptions from unfair trade practices for certain wellness and health improvement programs and incentives include insurers issuing life plans, not just insurers issuing health plans.     Senate Bill 337

Louisiana enacted legislation permitting the commissioner of insurance to issue cease and desist orders for Insurance Code violations.     Senate Bill 232

New Hampshire enacted legislation allowing health care providers who are required to submit data to the department of health and human services to submit such data through a health information organization under certain circumstances.     Senate Bill 288

Ohio enacted legislation making changes to its law regulating fraternal benefit societies, its laws regulating insurance company investments, and its law regulating adverse benefit determinations.     House Bill 341

Oklahoma enacted legislation regarding insurance compliance self-evaluative audits and creating privilege related to such audits.     SB 1474

Oregon posted a notice on the Insurance Division website advising that the Division and most other state agencies will close because of budget limitations on 10 specified Fridays that fall throughout the current two-year budget period.     Notice titled Statewide budget cuts cause DCBS to close on scheduled days

Wisconsin issued a bulletin containing a summary of the provisions of newly enacted legislation.  The bulletin is found on the department's website and contains links to the described legislation.  Subjects addressed include producer licensing and education exemptions for military veteran and health insurance sold through exchanges.     Bulletin dated May 23, 2012

Colorado has adopted a new regulation regarding clean claim requirements for health carriers.     Regulation 4-2-24

Connecticut enacted legislation prohibiting health insurers from imposing a deductible for a procedure that a physician initially undertakes as a screening colonoscopy or a screening sigmoidoscopy.     Senate Bill 98

Hawaii enacted legislation requiring health insurers to provide to an independent, third party entity, no more than quarterly, a report listing its members beginning in 2014.     Senate Bill 2798

Hawaii enacted legislation stating that no insurer, mutual benefit society or fraternal benefit society shall require an insured person forty years of age and older to obtain a referral from a primary care provider or other physician for an annual screening mammogram.     Senate Bill 2084

Louisiana enacted legislation relative to group, family group, blanket, and association health and accident insurance and health maintenance organizations.  It provides notice requirements for certain premium increases, cancellations, or nonrenewals, and provides for the release of claims data.     House Bill 989

Maryland enacted legislation requiring insurers and health maintenance organizations to provide coverage for health care services delivered through telemedicine for certain circumstances.     House Bill 1149

Maryland issued a bulletin notifying insurers of new premium rate review requirements that apply to insurers that sell health benefit plans through associations.     Bulletin 12-09

Rhode Island enacted legislation regarding the primary care provider designation requirement applicable to accident and sickness insurance policies, as well as HMO policies.     Senate Bill 2129

Oklahoma adopted rules, which among other things, sets forth open enrollment period guidelines for child only policies, uniform health questionnaire requirements for small employer carriers, amends its actuarial opinion and memorandum rules and sets forth rules regarding external review regulations.     Rule 365:10-1-15+

Vermont enacted legislation, which among other things, prohibits discretionary clauses in health insurance, disability income insurance and life insurance. It amends prescription drug requirements; provides requirements for health benefit plans and grandfathered plans; and provides rebates prohibited for group insurance policies.     House Bill 559

Michigan issued a bulletin providing guidance to all insurers with individual and group health benefit plans regarding the requirements for providing a summary of benefits and coverage.     Bulletin 2012-10-INS

South Carolina has amended its laws governing pre-need funeral contracts.     House Bill 4763

Alabama enacted legislation to expedite issuance of professional licenses and certificates for spouses of active duty military personnel and to acknowledge those licenses obtained in other jurisdictions.     House Bill 638

Hawaii issued a memorandum setting forth the new continuing education requirements that are effective for renewals with an August 16, 2014, renewal date.     Memorandum 2012-3LIC

Louisiana enacted legislation updating its producer training requirements for selling annuity products.     House Bill 1177

Nebraska issued a notice regarding the statement for producers' annual appointment renewal for the 2012-2013-license year.     Notice 5-16-2012

Oklahoma amended the producer licensing requirement that CE credit hours must be in the lines in which the producer is licensed.     Rule 365:25-3-1

Oregon adopted temporary rules requiring electronic submission of license applications and continuing education materials to the extent possible.  All fingerprints are to be submitted electronically from the exam vendor testing facilities; continuing education providers will be required to report course completion information electronically via instructions from the division; and non-resident applicants must supply background information electronically.     Temporary Rule 836-071-0110+

Louisiana enacted legislation which clarifies definitions and company-action level events relative to risk-based capital for domestic insurers.     Senate Bill 230

The Objective is Clear

Like you, many insurance company and health plan Compliance leaders are struggling to implement risk management programs. You are probably aware of the New York published Circular Letter #14 (12/19/11). The circular letter sets out guidance to meet Enterprise Risk Management (ERM) standards. However, you may not be aware that NY regulatory examiners are now emphasizing the need for companies to get in step with the Circular Letter. Whether in NY or not, the guidance laid out in this letter may be helpful in determining your company’s best ERM strategy.

In either case, we can help.

We know how to get started, and where to begin. We help you establish strategic action plans for (1) Leadership and (2) Operations. Then we support your implementation, measurement and reinforcement of the changes needed.

The objective is clear. We can help coach your company to reach the goal.

C. J. Rathbun


Critical Illness Insurance and other Excepted Benefits

The adoption of the Patient Protection and Affordable Care Act has spurred rapid growth in the excepted benefits market, and the Supreme Court decision upholding the essential features of the Act means that this growth is likely to continue. 

First Consulting has helped large and small insurers develop and file a variety of critical illness and other excepted benefit health coverages.  This expertise can help your company develop a new product or enhance existing products in a way that best suits your market.

Contact me for more information about how First Consulting can assist with your critical illness insurance or other excepted benefit compliance concerns.

Stacy Koron

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