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
New Mexico has amended its bulletin concerning required continuing education credit hours for insurance producers. Bulletin 2015-017
AGENT / PRODUCER LICENSING AND APPOINTMENT FEES
Maine amended its general licensing requirements regarding when to notify the superintendent of any changes in business information for producers, adjusters, consultants and business entities. 24-A s 1419
West Virginia has adopted the updated NAIC Annuity Disclosure Model Regulation #245, including the adoption of the updated 2013 Annuity Buyer's Guide and 2012 IAR Annuity Mortality Tables. Effective July 23, 2015 with phase-in period ending January 1, 2016. 114 CSR 11E+, 114 CSR 45, and Letter No. 192
DATA CALLS/REGULATORY REPORTING
Oklahoma enacted legislation, which among other things, requires certain insurers to file with the Insurance Commissioner an actuarial opinion prepared by a qualified actuary within one hundred eighty (180) days immediately following the close of the fiscal year. Senate Bill 340
DISABILITY INCOME INSURANCE
Maryland authorized the use of surplus lines insurance for disability income insurance coverage. House Bill 565
Illinois declared DeKalb and Ogle counties as disaster areas following severe storms. Insurers have been provided guidelines relating to cancellations/nonrenewals, extensions, underwriting, and instructions for notice of noncompliance to the DOI. Company Bulletin 2015-8
FILING REQUIREMENTS / PROCEDURES
Arizona has a new regulation regarding form filing exemptions for life, health and disability, and group long term care form filing. Regulatory Activity Order of May 4, 2015
New Hampshire issued a bulletin providing additional guidance on standards for extended transition of group health insurance policies and employee counting. INS-15-021-AB
HEALTH CARE EXCHANGE/MARKETPLACE
The Center for Medicare & Medicaid Services has issued a notice regarding guidance on annual eligibility redeterminations and re-enrollments for marketplace coverage for 2016. Regulatory Activity CMS Notice dated April 22, 2015
HEALTH INSURANCE/HEALTH RATES
Arizona has amended its regulation regarding charges for services of health care professionals. 32-3216
Arizona has amended its regulation regarding laboratory testing without a health care provider's request or authorization. HB 2645, 36-468
Arizona has amended its regulations pertaining to children's rehabilitative services. HB 2102, 36-2907.08, 36-2912, and 36-264
Arizona has amended its regulations related to health care entity quality assurance activities. HB 2556, 36-2401, 36-2402, 36-2403
Indiana enacted legislation for employee health plans, accident and sickness insurance and individual and group contracts that provide coverage for prescription eye drops regarding refill requirements. Senate Bill 26
Indiana revised its developmental disability terminology by revising the term "mental retardation" to "intellectual disability" in its individual policy form requirements, comprehensive health insurance requirements and required group policy provisions. 27-8-5-2, 27-8-5-19, 27-8-10-5.1
Maryland enacted legislation applicable to certain health insurers and HMO's to permit an insured, a subscriber, or a member to submit a claim for reimbursement for certain expenses by first-class mail. It also provides other requirements for claim reimbursement. Senate Bill 450
Maryland enacted legislation for the purpose of repealing the termination date of certain provisions of law relating to direct reimbursement by health insurers and health maintenance organizations for transportation by ambulance and generally relating to direct reimbursement of ambulance service providers under health insurance. House Bill 562
Maryland enacted legislation that requires health insurers and health maintenance organizations that provide hospital, medical, or surgical benefits to provide coverage for all medically appropriate and necessary equipment and supplies for the treatment of ostomies. Senate Bill 241, 15-848
Minnesota enacted legislation permitting the use of investigational drugs, biological products, or devices by certain eligible patients. SF 100, 151.375
Montana amended its law to require health insurance coverage sold in the group or individual market to provide coverage for the diagnosis and treatment of down syndrome for a covered child 18 years of age or younger. House Bill 318
North Dakota amended its requirements for purposes of classifying ambulance services for an accident and health insurance policy. House Bill 1255
Oklahoma enacted legislation permitting health insurance carrier to provide coverage for investigational drugs, biological products and devices. It provides clarification that health insurers are not obligated to pay for any care or treatments consequent to the use of the investigational drug, biological product or device. House Bill 1074
Oklahoma enacted legislation prohibiting health benefit plans from holding cancer therapy to a higher standard of clinical evidence for benefit coverage decisions than other therapies. House Bill 1515
Utah has issued a bulletin pertaining to requirements for hospital indemnity and other fixed indemnity policies sold in the individual market. Bulletin 2015-6
IIPRC / INTERSTATE COMPACT
The Interstate Compact has issued a public notice regarding updated logo change procedures. Weekly Tip 05-11-15
LIFE INSURANCE/ LIFE CONTRACTS
Maryland has revised its Standard Nonforfeiture law for life insurance as to the effects on the basic cash value of supplemental life insurance, annuity benefits, or family coverage. Senate Bill 555, Section 16-312
Alaska amended the premium tax for individual life insurance policies. SB 15, 21.09.210
Arizona has amended its regulations relating to insurance premium taxes. HB 2568, 20-224 , 20-224 .02, 20-416
Maryland altered the time period within which a certain seller of preneed goods or preneed services is required to submit a certain report regarding preneed burial contracts and preneed trust accounts to the Director of the Office of Cemetery Oversight. Senate Bill 148
Michigan issued a bulletin to life insurer's advising of the new maximum amount of the cemetery or funeral assignment. Bulletin No. 2015-10-INS
New Mexico has rescinded its bulletin related to health stop loss or excess benefit insurance. Bulletin 2015-010, Bulletin 2015-005
Maine has adopted the 2010 NAIC Suitability Model Regulation. Rule 917
UTILIZATION REVIEW - HEALTH CARE
Montana revised its health insurance laws by adopting and revising processes that provide for utilization review, grievances and external review of a health insurance issuer's actions. Senate Bill 83
Illinois amended its viatical settlement reporting requirements, which among other things, specifies the reports that viatical settlement brokers are required to file on or before March 1 of each year. 50 Ill. Adm. Code 5701.100
ADVERTISING SEMINAR FINAL EARLY BIRD NOTICE – ENDS JUNE 7
Premier Advertising Compliance Training
August 3-4, 2015
Kansas City, MO
June 7 ends our early bird registration period and registration rates go up $50/person.
“ways presented to help outcomes”
“relevant and riveting”
Take advantage of the price break still available and register here by Sunday!
Read more: Click Here
C. J. Rathbun, FLMI, CCEP, HIA, AIRC
FIRST CONSULTING NOW OFFERING EMPLOYEE ANTI-FRAUD TRAINING
FOR ALL LINES OF INSURANCE
First Consulting delivers
• individual anti-fraud training
• accessible on desktop or laptop
• life & health
• property & casualty
• in compliance with state fraud statutes
Visit our website or contact me to learn how we can assist you with Anti-Fraud Training or to enroll in a free demo!
Carol Stern, FLMI, AIRC, ACS
LET FIRST CONSULTING STRETCH YOUR RESOURCES – MONITORING TPA’S
Working with TPA’s brings on regulatory requirements that may stretch your resources. First Consulting is happy to announce a couple tools that can assist you in monitoring your TPA’s.
• We can deliver online individual fraud training to supplement our live webinar fraud training already available.
• We can also assist your company with establishing anti-fraud procedures and processes, record keeping, reporting requirements, and training as required in some states.
And, as always, our On-Line Research Services – Third Party Administrator Licensing Service – answers questions 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 are the responsibilities of Insurers that use TPA’s?
• 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 me regarding any of the above services.