Life and Health News November 2011

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.

Rhode Island enacted legislation allowing two individuals of the same sex to enter into a civil union. Such a union provides the same benefits available to a person who is lawfully married.     House Bill 6103

Wisconsin issued a bulletin regarding revised prima facie credit life and credit accident and sickness insurance rates.     Bulletin 9-22-2011

California amended existing law relating to discretionary clauses by declaring life or disability insurance provisions void or unenforceable that reserve discretionary authority to the insurer to determine eligibility, interpret the terms of the policy, or provide standards of interpretation that are inconsistent with state law.     Senate Bill 621

Washington adopted rules regarding review of adverse benefit determinations and their requirements.     Admin. Code 284-43-525, 284-43-526, 284-43-528, 284-43-529

Massachusetts amended its emergency regulation by revising the timeline for an  external review to be requested.     CMR 105, § 128.400

Kentucky issued a bulletin advising insurance companies of the Department’s current position regarding the policy form certification privilege program and the reference filing procedure.     Bulletin 2011-05

Alaska issued a bulletin that defines "small employer" and  "large employer" for purposes of medical loss ratio reporting and rebate requirements.     Bulletin 2011-9

Alaska issued an order explaining that an insurer may not deliver a policy or contract unless the Notice of Protection Provided by the Alaska Life and Health Insurance Guaranty Association is delivered to the policy or contract owner at the time of delivery. This document must also be made available upon the request of a policy owner.     Order R2011-3

New York amended its law in relation to assisted care facilities.     A. 7368–A

Texas issued a bulletin reminding companies that the marketing of Medicare Advantage (MA), Medicare Advantage Prescription Drug Plans (MA-PDPs), Prescription Drug Plans (PDPs), and 1876 Cost Plans, is subject to the Medicare Marketing Guidelines. Any company marketing these products must ensure that its agents and subcontractors are in full compliance with the rules, the Guidelines, transmittals, and other CMS requirements.     Commissioner's Bulletin B-0042-11

Washington amended its benefit standards for policies or certificates issued or delivered on or after June 1, 2010 for medicare supplement.     Rule 284-66-064,

California amended its insurance code, which among other things, prohibits life and disability insurers from using gender identity or gender expression as a factor in accepting, cancelling, denying, or limiting coverage.     Assembly Bill 887

California enacted legislation providing that a health care service plan or health insurance policy many not discriminate in coverage between spouses or domestic partners of a different sex and spouses or domestic partners of the same sex. Provides that every group health care service plan contract and every group health insurance policy that is marketed, issued, or delivered to a resident is subject to the requirement to provide equal coverage to domestic partners as is provided to spouses, irrespective of an out-of-state employer.     Senate Bill 757

Colorado issued a bulletin providing  health carriers with the minimum benefit amount for mammograms effective January 1, 2012.     Bulletin No. B-4.40

Colorado issued a bulletin providing guidance to health carriers regarding the notification to be provided to the Colorado Division for Developmental Disabilities when the individual or group health coverage of an eligible child has been terminated or cancelled.     Bulletin No. B-4.39

Colorado issued a bulletin providing health carriers with the annual maximum benefit amount for early intervention services effective January 1, 2012.     Bulletin No. B-4.31

Colorado reissued a bulletin intended for all carriers marketing or selling individual health benefit plans to self-employed business groups of one.  It provides a sample of the health benefit plan description form for the standard health benefit plans.     Bulletin B-4.22

Connecticut issued a bulletin addressing several new laws that impact individual and group health insurance policies, which among other things includes autism spectrum disorders, modification of existing state requirements pursuant to the Patient Protection and Affordability Act; coverage for magnetic resonance imaging, colorectal cancer screening, bone marrow testing and prescriptions for pain management.     Bulletin HC-70-11

Delaware enacted legislation to any health carrier providing coverage under an individual or group health benefit plan amending requirements of coverage for certain immunizations and preventative services.     Senate Bill 98

Massachusetts amended its emergency regulation regarding coverage or treatment pending resolution of internal grievance.     CMR 105, § 128.312

Massachusetts issued a bulletin providing commercial health insurers and Health Maintenance Organizations with the consumer guide on limited provider networks to be distributed to Massachusetts insureds when offering a limited, regional or tiered provider network plan.     Bulletin B-2011-17

New York amended its law in relation to coverage of oral chemotherapy treatments.     S. 3988–B

Texas issued a bulletin to all insurers with preferred provider health benefit plans (PPBPs) and all health maintenance organizations (HMOs) regarding the call for reports for provider claims processing and additional clarification on reporting requirements, due on November 15, 2011.     Commissioner's Bulletin B-0040-11

Utah amended its requirements regarding the notification of denial to applicants to be submitted to HIPUtah on the 1st of each month.     Rule R590-172-4

California enacted legislation regarding life insurance benefit settlement option requirements.     Senate Bill 599

Maryland amended exemptions for health insurance coverage prohibited in individual life insurance policies.  The amendments, among other things, will allow life insurance policies to include a lump sum benefit for a disease specified in the policy.     Regulation

North Carolina revised its law regarding an insurers obligation to provide information to a funeral director or establishment, when requested, regarding a deceased person's life insurance to include group life; to include information about any beneficiaries, the amount of any liens or loans outstanding on the policy, the amount of benefits payable to the beneficiaries, and whether the policy has been reinstated within the last 24 months.     House Bill 664, Advisory Notice Dated October 4, 2011

South Dakota amended its rule on life insurance disclosure requirements.     Rule 20:06:14:04

Wisconsin has adopted changes to its insurance policy language simplification regulations.     Admin. Code § Ins 6.07


California enacted legislation, which among other things, amends its law regarding provisions for producer licensing and education, variable contracts, disability income insurance, long term care insurance, market conduct examinations, and annuities.     Assembly Bill 1416

California enacted legislation that requires health insurers to comply with requirements the Patient Protection and Affordable Care Act requirements, which among other things, relates to a lifetime limit prohibition, minimum medical loss ratios, and certain required rebates to each insured.     Senate Bill 51

Colorado updated its bulletin providing guidance on ensuring rates and policy forms are submitted properly, compliance with Colorado laws and regulations and speed to market.  The bulletin applies to all insurers selling health insurance coverage required to comply with the Patient Protection and Affordable Care Act.     Bulletin B-4.35

Connecticut issued a bulletin modifying rate and form filing submissions requirements for association business based on recent amendments made to Federal Rate Increase Disclosure and Review Final Rule.     Bulletin HC-88

Florida notified health insurers and health maintenance organizations of the recent amendment of the federal interim final rules relating to Internal Claims and Appeals and External Review Processes as required by the Patient Protection and Affordable Care Act (PPACA).     Informational Memo OIR-11-07M

Nevada issued a bulletin defining the requirements for insurers handling of internal claims, internal appeals and the external review process required by the Patient Protection and Affordable Care Act.     Bulletin 2011-013

Delaware amended its insurance code relating to cost-sharing, deductible or co-insurance for tier IV or specialty tier prescription drugs.     Senate Bill 137

Kentucky issued a bulletin regarding privacy of consumer financial information.     Bulletin 2011-06

Alaska issued a notice regarding changes in licensing types and fees.     Notice 10-13-2011

Alaska repealed and readopts provisions to streamline fees charged for producer and broker licenses as well as other miscellaneous fees.     Regulation 3 AAC 31.020+

Indiana issued a notice regarding an increase in licensing and renewal fees for certain non-resident producers.     Indiana Notice of 9-9-2011

Kentucky issued an Advisory Opinion directed to all licensees providing guidance regarding the need to have current contact information on file with the DOI.     Advisory Opinion 2011-06

Louisiana enacted legislation regarding producer licensing requirements.     LAC 37:XI.505

Puerto Rico amended its rules on reinsurance intermediaries and credit for reinsurance.     Rule 97, Rule 98

California enacted legislation regarding retained asset account requirements.  It among other things, requires insurers to provide written disclosures to life insurance beneficiaries before a retained asset account is selected or established as the benefit payment, provides definitions, and requires one statement per quarter for benefits placed in a retained asset account.     Senate Bill 713

Illinois revised the original bulletin on retained asset accounts by increasing the interest rate on proceeds payable from 9% to 10%.  This is the only change to the original bulletin.     Bulletin 2011-03 (Revised)

New York has provided guidance for filing responses to the July 2011 request for special reports pursuant to section 308 of the insurance law relating to investigating claims and locating beneficiaries with respect to death benefits under life insurance policies, annuity contracts and retained asset accounts.     Notice Dated September 28, 2011

New Jersey issued a bulletin to insurers writing stop loss insurance to small employers.  The Department intends to promulgate regulations to prohibit the consideration of health status in the offering or pricing of stop loss insurance offered to small employers.  In the interim, carriers are urged to refrain from engaging in this unfair trade practice.     Bulletin 2011-20

California enacted legislation providing suitability requirements for annuity transactions.     Assembly Bill 689

Illinois amended its annuity suitability transactions rule to conform with changes to the NAIC Suitability in Annuity Transactions Model Regulation, making standards more consistent with Financial Industry Regulatory Authority standards, specifying producer training requirements and modifying definitions section.     Rule 3120.01+

Maryland issued a bulletin responding to inquiries with regard to the adoption of the NAIC Suitability in Annuity Transactions Model Regulation and new requirements for insurance producers selling annuity products.     Bulletin 11-28

Nevada issued a bulletin regarding viatical producer filing requirements.     Bulletin 11-011

Product Drafting and Regulatory Approval

Now is the time to make use of First Consulting & Administration, Inc. for product development, drafting and regulatory approval assistance. We are experts in drafting all types of policy forms, including state specific versions.  Our team can handle state insurance department approval filings, as well as Interstate Compact filings. We process any size form or rate filing from nationwide to a single insurance department.

Whether your company’s need is a rush filing before the end of this year, or the development of a new product during 2012, First Consulting is the answer for truly professional assistance.

For more information about our services: Click here Services.

Or contact John Palmer
816-391-2744 or 800-927-2730
Or any First Consulting Associate

 Product Maintenance

Changes in insurance legislation occur on an on-going basis all year.  It seems like new legislation never stops arriving in your in-basket.  Regardless of your product line, new legislation often times results in the need to revise your products. 

First Consulting can assist with any product maintenance you may need.

We can assist with the review of the new legislation, as it arrives or after the fact, to see if it affects your products.  And, if it does, we can assist with the creation of revised forms to address the new requirements.  We can also assist with any form filings that result from legislative changes.

Contact me today to see how First Consulting can serve as a resource in the review of new legislation, and the resulting product changes and filings that result therefrom.

Jerry L. Wickersham


With our Co-Sourcing approach, we can assist in the manner best suited for your company’s unique requirements.  Your staff maintains a role in the process at whatever level is most appropriate for your company and specific project.  

Get more information about First Consulting and our services

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