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 LICENSING AND APPOINTMENT
Arkansas issued a bulletin addressing 2016 Company Appointment of Producers - Renewals and Terminations. A company is required to annually review its records on appointed producers to decide whether it will renew appointments. The bulletin sets deadlines for the renewals and terminations. Bulletin 6-2016
Maryland amended its law to require an insurance producer to file with the Commissioner a change in electronic mail address within 30 days of the change. Ins. s 10-117
AGENT / PRODUCER TERMINATION
Georgia amended its Code to provide that an insurer shall not terminate or otherwise penalize an agent for apprising a policyowner of alternatives to the lapse or surrender of an individual life insurance policy or assisting a policyowner with securing any benefits under the policy terms. House Bill 193
AUTISM SPECTRUM DISORDERS
Kentucky will require an insurer offering a health benefit plan that provides benefits for the treatment of autism spectrum disorders to make available to members a liaison to facilitate communication between the member and the insurer. Kentucky also specifies the responsibilities of the liaison. Uncodified HB 100 s 1 (2016)
Oklahoma enacted legislation regarding autism spectrum disorder. Among other things, the legislation requires health benefit plans renewed on or after November 1, 2016, to provide coverage for the screening, diagnosis and treatment of autism spectrum disorder under certain circumstances. No insurer shall terminate coverage, or refuse to renew coverage solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder. House Bill 2962
Vermont enacted legislation related to captive insurance companies, addressing protected cell conversion into an incorporated protected cell, sale/transfer/assignment of protected cells and protected cell conversion. House Bill 538
CLAIMS / CLAIMS ISSUES
Maryland amended the Consumer Health Claim Filing Fairness Act. Senate Bill 887
Maryland enacted legislation providing the circumstances under which a health insurer or health maintenance organization may pay claims submitted by certain providers of health care services using a credit card or electronic funds transfer payment method. House Bill 639
Illinois amended its Personal Information Protection Act. The definition of personal information was revised to include both health Insurance information and medical information. It requires the protection of personal information by any data collector that maintains or stores personal information and requires specific actions in the event of a breach of the security of the information. House Bill 1260
Oklahoma enacted legislation relating to dental insurance to define terms and prohibit certain acts related to dental services. Senate Bill 1377
Virginia enacted legislation relating to health insurance payment for services by dentists and oral surgeons which states that reimbursement payable or paid by a dental plan for covered services must be reasonable and not provide nominal reimbursement in order to claim that services are covered services under the applicable dental plan, and it defines "reasonable." House Bill 16
DEPARTMENT OF INSURANCE
California issued a notice to all admitted insurers and others paying taxes via Electronic Funds Transfer (EFT) that the Department's current bank account will be available for payments made by June 30, 2016. Any attempts to initiate an Automated Clearing House (ACH) EFT to the CDI account with Citibank after that date will be returned, which may cause late arrival and ensuing penalties and interest. Instructions regarding transactions with Union Bank are due in May. Notice dated April 20, 2016
Colorado published a bulletin to clarify the surcharge on fines and monetary penalties of up to 15 percent of the amount due. The surcharge is to fund development, implementation, and maintenance of a consumer outreach and education program. Bulletin B-1.26
New Jersey issued a bulletin advising that the email address of the Department of Banking and Insurance has been changed. Note that only the “domain name”, the second part of email address, changed. Examples of the new format: firstname.lastname@example.org (for individuals) and email@example.com (for general correspondence and filings). Bulletin 16-04
New Mexico issued an amended bulletin to health care insurers offering individual and group limited benefit and specified disease plans that notifies all involved parties of a new mandatory disclosure. Bulletin 2016-010
DRUG / PRESCRIPTION COVERAGE
Puerto Rico issued a circular letter to health insurers advising that all health insurance plans must cover contraceptive methods approved by the FDA. Circular Letter CC-2016-1882-D
FILING REQUIREMENTS / PROCEDURES
Alabama published a bulletin announcing that the Department of Insurance and CCIIO/HHS entered into a collaborative enforcement agreement such that the DOI will take over review of rates and forms for compliance with federal law and regulations. The rate filing deadline is changed to July 15, but form filing deadlines remain as outlined in the CCIIO Final letter dated February 29, 2016. The bulletin includes a table of deadlines and contact information. Bulletin No. 2016-02 and Bulletin 2016-03
Arizona published this message on SERFF: AZDOI updated the Major Medical & SADP General Instructions on page 6 to add an instruction regarding Excel Documents. Please read carefully. SERFF Message 05/13/2016
Louisiana issued a bulletin informing all health insurance and health maintenance organizations of the requirements relating to the time and manner of product form, rate and plan management binder filings. Bulletin 2016-02
Maine amended its requirements for individual health and small group health rate submissions (other than Affordable Care Act rate filings) by adding requirements regarding the manner by which PDFs and spreadsheets must be submitted. Insurance Rule Ch. 940 s 6
Mississippi issued a bulletin advising of a filing extension for individual and small group health plans and stand-alone dental plans offered inside and/or outside the Federally-Facilitated Marketplace, that wish to issue or renew plans in Plan Year 2017. Plans and rate filings for applicable products are required to be filed with MID via the System for Electronic Rate and Form Filing (SERFF) by June 10, 2016. Bulletin 2016-4
Montana issued an advisory memorandum providing instructions and corresponding exhibits which were developed to increase efficiency and standardization in the health insurance rate review process for the individual and small group markets. Advisory Memorandum of May 9, 2016
New Jersey provided rate and form filing requirements for fully insured student health plans. Order A16-106 dated April 18, 2016
New Mexico issued a bulletin advising that all health, and all credit life rate or form and rate filing submissions must include the actuarial justification with the submission. Any form or rate documentation requested or required that cannot be examined in its entirety at the OSI will not be considered or included in the review. Bulletin 2016-009
FRAUD / ANTI-FRAUD
Oklahoma amended its law allowing any suspected insurance fraud or pertaining to a product, an organization or licensee, to be investigated by the Anti-Fraud Unit. The Department has the authority to initiate and prosecute any administrative or civil action it deems necessary. Senate Bill 1012
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Louisiana amended its health insurance law to provide that a group health plan, and a health insurance issuer offering group health insurance coverage, must send the certification of the period of creditable coverage no more than twenty days after such certification is requested by an individual who ceases to be covered under the issuer's policy or plan. House Bill 816
Louisiana amended the definitions of large group and small groups with regard to health and accident coverage. House Bill 782
Mississippi issued a bulletin notifying all health carriers issuing non-grandfathered small group health insurance of an alternate composite premium methodology that will be allowed for all policy years and rates implemented on or after October 1, 2016. Bulletin 2016-5
Colorado issued a bulletin regarding recoupment of Life and Health Insurance Protection Association (LHIPA) assessments for the Colorado Health Insurance Cooperative, Inc. insolvency. The bulletin's purpose is to clarify the process for the required recoupment of the assessments being imposed on LHIPA member insurers. Bulletin No B-3.01
HEALTH CARE EXCHANGE / MARKETPLACE
Nebraska enacted legislation relating to the Nebraska Exchange Transparency Act by reducing the term for an appointed member of the commission to three years. It changes the sunset date to July 1, 2016. Legislative Bill 770, 44-8703, 44-8706
HEALTH INSURANCE / HEALTH RATES
Alabama enacted legislation to require contracts issued, amended or renewed on/after January 1, 2017, between a health insurer or its contracted vendor and a covered health care provider to include specific language stating that a provider's request for electronic payment via the Automated Clearing House network must be honored, and to allow covered health care providers to be paid through the use of alternative electronic funds transfer methods. Senate Bill 291
Colorado published a bulletin providing standards and guidance on the filing requirements for provider directories associated with health plans, in an effort to ensure that the Division receives complete network adequacy filings. Bulletin No. B-4.92
Florida enacted legislation relating to health care services: requiring coverage for treatment of Down syndrome; requiring health insurers or pharmacy benefit managers to use only a specified form; requiring insurers using preferred providers to post on their websites specified information about those providers; and requiring notice in policies that use preferred provider networks, issued after 01/01/17, to include a disclosure about benefits being limited when nonparticipating providers are used. House Bill 221
Florida enacted legislation relating to transparency in health care, requiring a health insurer to make available on its website methods that a policyholder may use to estimate copayment and coinsurance or deductible amounts for health care services and procedures. House Bill 1175
Georgia amended its Code to require health insurers to maintain accurate provider directories, including in them a clearly identifiable telephone number and either a dedicated email address or a link to a dedicated webpage that covered persons or the general public may use to report to the insurer inaccurate information listed in the directory. The insurer shall promptly investigate such reports of inaccuracies and verify the accuracy of the information or update it within 30 days. The insurer shall by January 1, 2017, and at least annually thereafter, review and update its entire provider directory for each network plan offered. Senate Bill 302
Georgia enacted its "The Honorable Jimmy Carter Cancer Treatment Access Act" to provide that no health benefit plan shall require an insured to fail to successfully respond to a drug (or drugs) for stage four advanced metastatic cancer prior to approving a drug prescribed by his or her physician. House Bill 965
Georgia enacted the "Georgia Right to Try Act," to provide for investigational drugs, biological products and devices for patients with terminal illnesses. House Bill 34
Idaho issued a bulletin regarding the extension of non-grandfathered transitional plans (also known as "grandmothered" plans) through December 31, 2017. Bulletin 16-03
Kentucky amended it laws to require an insurer offering a health benefit plan to establish procedures for changing an existing agreement with a participating provider following the new requirements for those procedures. Also, health benefit plans that provide prescription drug coverage must cover "therapeutic food, formulas, and supplements." The definition of "therapeutic food, formula, and supplement" has been revised. Senate Bill 18, 304.17A-258, 304.17A-578
Kentucky amended its definition of "Health care provider" or "provider" for health benefit plans. Insurance Code: 304.17A-005
Louisiana enacted legislation pertaining to contracts between a health insurance issuer and a producer. A material change made by an issuer to the terms and conditions of a contract between the issuer and a producer will not become effective until the issuer has delivered to the producer, at least ninety days prior to the effective date of the change, written or electronic notice indicating the change or changes to the contract. House Bill 596
Louisiana informed health insurance issuers, health maintenance organizations, group self-insurers and third-party administrators that many are substantially out of compliance with provisions of Louisiana law that impose various fees which partially finance the Louisiana Medicaid Program. The Directive confirms the applicability of the fees and a Code section which authorizes a 10 cent per prescription fee on every out-patient prescription filled by a pharmacy in the state and by certain out-of-state pharmacies. Directive 208
Maryland amended the period of time during which certain health insurers and health maintenance organizations are required to provide coverage for specified rehabilitative services for covered children. Senate Bill 297
Maryland enacted legislation requiring a health insurance carrier to disclose certain aggregate incurred claims to a large employer under certain circumstances within 30 days of receipt of the request. House Bill 124
Nevada issued a bulletin pertaining to provider directory standards for individual and small employer group health benefit plans. Bulletin 16-002
New Hampshire issued a bulletin to carriers licensed to write accident and health insurance that repeals and replaces INS No. 15010AB. The bulletin provided updates to the supplemental data information requested by the DOI. The due date for the submission of this data is June 30, 2016. Bulletin of March 30, 2016
New York amended legislation regarding enrollment requirements for child health insurance plans. A newborn is enrolled retroactively to the first day of the month in which the child is born, provided that the applicant for insurance submits a completed and signed application and required information and documentation within sixty days of the child's birth. Senate Bill 6421
New York amended requirements for policies that provide reimbursement for non-physician surgical first assistant services when services are performed by a registered nurse first assistant. Ins. Law s 3216, Ins. Law s 3221
Oklahoma amended its definition of a "health benefit plan" to make it clear that it does not include a plan that provides coverage ONLY for dental or vision care. 36 s 6060.4
Puerto Rico issued a ruling to all health service organizations and health insurers that extends the transition period applicable to certain health insurance renewals until September 30, 2017. Ruling CN-2016-198-AS
Texas published a bulletin to address recent legislation (House Bill 574) which expands statutory prohibitions on Health Maintenance Organizations (HMOs) and issuers of preferred provider (PPO) and exclusive (EPO) benefit plans against discouraging discussion of patient health care options. Carriers may not: (1) terminate network providers due to their informing an insured of out-of-network options; or (2) penalize providers for discussing out-of-network facilities with insureds. Bulletin B-0012-16
Utah issued a bulletin that permits health insurers that have renewed policies under a transitional policy continually since 2014, to continue to renew such policies provided the transitional coverage does not extend past December 31, 2017. Bulletin 2016-2
Washington enacted legislation requiring health carriers to use the database selected pursuant to RCW 48.165.035 to accept and manage credentialing applications from health care providers. House Bill 2335
HEALTH MAINTENANCE ORGANIZATIONS
New Jersey provided revised minimum net worth requirements for health maintenance organizations and organized delivery systems. Public Notice 16-3, Public Notice 16-4, Public Notice 16-5
Oklahoma enacted legislation requiring a health maintenance organization to provide a printed copy of a policy upon member request if the member cannot view and print such electronic copy. House Bill 2097
IIPRC / INTERSTATE COMPACT
South Carolina passed legislation to reenact the Interstate Insurance Product Regulation Compact and related provisions. House Bill 4662
Staff Vacations Limiting Your Output?
Holidays and Summertime can often become difficult for managers to balance workloads
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Arizona updated its statute regarding inducements/incentives/rebates to allow for a "reasonable incentive" of up to $200 for participation in customer feedback intended to improve the quality of the insurer's products or services. Senate Bill 1494
Georgia amended its Code to allow insurance producers to advertise or conduct promotional programs where items not exceeding $100.00 in the aggregate per customer in any one calendar year can be given to current or prospective customers and will not violate inducement restrictions so long as the giving of any such items is not contingent on the sale or renewal of a policy. House Bill 784
INTERNAL AND EXTERNAL REVIEW
Washington enacted legislation transferring regulatory authority and reporting for Independent Review Organizations from the Department of Health to the Insurance Commissioner. House Bill 2326
LIFE INSURANCE / LIFE CONTRACTS
Maryland amended it law to prohibit life insurers from refusing to insure, continue to insure, or limiting the amount or extent or kind of coverage available to an individual, or charging an individual a different rate for the same coverage solely for reasons associated with an applicant's or insured's future lawful travel except under certain circumstances. House Bill 803
Oklahoma amended the age limit for dependent children on group life insurance policies to twenty-six (26) years of age. A dependent aged twenty-six (26) years or older, who is attending an educational institution and relying upon the insured employee or member for financial support also may be included. The prior age requirement was twenty-one (21) years. 36 s 4101.1
LIFE INSURANCE AND ANNUITY SOLICITATION
Louisiana revised and reissued Directive 180 for the purpose of addressing a concern that life insurers may be marketing insurance policies in a manner that is not authorized under the law of Louisiana. Louisiana is specifically clarifying their requirements around corporations taking out life insurance policies on the lives of its employees for the benefit of the corporation. Directive 180 Revised
MARRIAGE EQUALITY / CIVIL UNIONS / DOMESTIC PARTNERS
Alabama enacted legislation to abolish common-law marriages entered into on or after January 1, 2017 and recognize the validity of those entered into before that date. House Bill 332
Louisiana amended requirements for domestic insurers in relation to their books and records. The law now provides for the maintenance of records in electronic data processing systems. Any insurer that plans to keep and maintain records outside of Louisiana must file the plan with the commissioner of insurance. House Bill 519
South Dakota published a bulletin announcing that it will participate in the Market Conduct Annual Statement (MCAS) beginning in 2017. Bulletin 16-04
MISCELLANEOUS LIFE / ANNUITY
Alabama enacted the Protection of Vulnerable Adults from Financial Exploitation Act to require reporting (to the Department of Human Resources and the Alabama Securities Commission) by qualified individuals who reasonably believe that financial exploitation of a vulnerable adult may have occurred, have been attempted, or is being attempted. Senate Bill 220
Delaware issued a bulletin requesting that all companies issuing life insurance and/or annuities in the state provide the Department an email address designated to retrieve missing policy search requests forwarded by the Department. Such addresses should be submitted to: DOI_PandC@state.de.us. Bulletin No. 87
Michigan issued a bulletin providing the new maximum amount of the cemetery or funeral assignment that is allowed for life and annuity contracts. Bulletin No. 2016-12-INS
NOTICE TO INSUREDS
Maryland amended requirements for individual health benefit plans to require that a notice of any premium increase be given to the policyholder for grandfathered health plan coverage at least 60 days before the change in premium rates is proposed to become effective. Notice must be given for nongrandfathered health plan coverage before the first day of the annual open enrollment period. COMAR 31.10.01.03
Oregon amended its law to require insurers give individuals notice of a modification of a health benefit plan subject to levels of coverage requirements not later than 30 days before the date of renewal of the plan to which the modification applies. OAR 836-053-0002
Rhode Island issued a bulletin regarding Gramm-Leach-Bliley Act Annual Privacy Notices, addressing recent changes due to the Fixing America's Surface Transportation (FAST) Act, which allows for elimination of annual notices if certain conditions are met. Insurance Bulletin 2016-2
Tennessee enacted legislation requiring any information holder to disclose a breach of security to any resident of Tennessee whose personal information was, or is reasonably believed to have been, acquired by an unauthorized person. Disclosure must be no later than 45 days from the date of discovery or notification of breach, unless legitimate needs of law enforcement extend the notification period. Senate Bill 2005
The Centers for Medicare & Medicaid Services (CMS) released draft updated Federal standard notices of product discontinuation and renewal for the individual health care market. CMS Guidance 4-21-16
ORSA: OWN RISK AND SOLVENCY ASSESSMENT
Florida enacted legislation to require Own Risk and Solvency Assessment (ORSA) reporting, with the initial ORSA Summary Report to be submitted by December 31, 2017. The DOI must be notified of the proposed annual submission date by December 1, 2016. Senate Bill 1422
COMPREHENSIVE ERM/ORSA CONSULTING SERVICES
First Consulting is now offering a full range of consulting services to create or enhance an Enterprise Risk Management (ERM) and Own Risk & Solvency Assessment (ORSA) Compliance Program for any insurance company. The services include training, assessments and easy to use “Kits”
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PATIENT PROTECTION AND AFFORDABLE CARE ACT
Maine updated its general rate submission requirements for health insurance with new specific filing requirements for policies subject to Affordable Care Act rating requirements. Insurance Rule Ch. 940 s 5
New Mexico issued a bulletin reminding all health carriers and health maintenance organizations of certain benefit requirements for tobacco cessation aids provided for under the federal Patient Protection and Affordable Care Act and clarified through guidance from the federal Department for Health and Human Services. Bulletin 2016-011
Kentucky issued a bulletin providing guidance on the local government premium tax schedule and listing of payees and addresses. Bulletin 2016-1
Tennessee amended its Code to define "funeral merchandise" and clarify language relating to pre-need funeral contracts. House Bill 199
Tennessee enacted legislation to amend its provisions regarding accreditation and reinsurance of insurance companies. House Bill 2568
California issued a bulletin addressing the Annual Aggregate Assessment for Life insurers added to the Code by Senate Bill 696 effective January 1, 2016. The aggregate assessment for 2015-16 is $1,000,000 and the bulletin provides tiers differentiated by 2014 annual premium. Companies will be invoiced based on the final tier table provided. Bulletin 2016-4
Oklahoma revised the qualifications for a single state exemption of specific product forms or product lines of a domestic company that is licensed and doing business only in Oklahoma from requirements related to the Valuation Manual. 36 s 1510
Mississippi amended its risk-based capital requirements for a company action level event for a life and/or health insurer from 2.5 to 3.0. Insurance Code: 83-5-405
STANDARD VALUATION LAW
South Carolina amended its Standard Valuation Law. Senate Bill 850
Oklahoma enacted legislation requiring any stop-loss insurance coverage issued by an insurer that provides an aggregate retention benefit shall provide an aggregate retention of no less than one hundred ten percent (110%) of the expected claims. House Bill 2996
Washington published its Stop Loss provisions general guidance and objection document as well as Stop-loss filing requirements and Stop-loss rate filing guidance on its website at: https://www.insurance.wa.gov/for-insurers/filing-instructions/stop-loss/... Stop-loss provisions general guidance and objection
THIRD PARTY ADMINISTRATORS
Oklahoma amended its code to specify that any report filed by an administrator with accumulated year-to-date premiums collected or claims paid of $50,000 or more must be reviewed by an independent certified public accountant. 36 s 1452
Florida amended rules relating to unclaimed property reporting requirements. Amendments include: claim procedures, proof of ownership, establishment of the Holder reporting Online System, and deadlines for extension requests. FAC Rule 69I-20.0021 +
Florida enacted legislation revising a presumption of when funds held or owing under a matured or terminated life or endowment policy or annuity contract are unclaimed, requiring the insurer to compare records of such contracts against the Social Security Death Master File or other Department-sanctioned database to determine whether a death has occurred in order to pursue payment of benefits. Senate Bill 966
UTILIZATION REVIEW - HEALTH CARE
Tennessee issued an Interpretive Opinion regarding applicability of utilization review and external review procedures. Interpretive Opinion No. 01-16
It’s hard to believe that the Memorial Day holiday has already passed! Holidays and Summertime can often become difficult for managers to balance workloads and letting their staff take vacations.
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Our experienced team of insurance experts can step in at any stage of your project and bring it to a speedy finish:
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COMPLIANCE TRAINING TO MEET YOUR NEEDS
Looking for fresh and relevant compliance training? First Consulting’s training is developed specifically for the insurance industry, by the insurance industry!
The distinct training topics available are:
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CERTIFICATE OF AUTHORITY CHANGES NEEDED?
Whether your Company's future includes a merger, a name change, a change of control, the addition of a new line of business, or the addition of new jurisdictions, First Consulting can help.
The Uniform Certificate of Authority Application (UCAA) has streamlined changes to an insurer's Certificate of Authority, yet a considerable amount of time must still be invested. Training staff to handle such filings may be a one-time event and the experience gained may not be used again for several years, if at all.
We are experienced with the UCAA licensing process and we are familiar with the various state-specific requirements. Our services include advising what materials are needed for each state’s filing, assembly of the filings, and follow up to secure approval of the filings. Having First Consulting provide these services can free your staff for other functions and projects.
Click here for information on how we can assist you with UCAA filings.