Life and Health News October 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.


ADVERTISING

Utah amended its rule on insurance advertising to include "websites" and “email" to the definition of advertisement.  Also adds an enforcement date section and amends the severability provision.     Rule R590-130


AUTISM
Delaware enacted legislation requiring coverage for the screening, diagnosis and treatment of autism spectrum disorders in individuals less than 21 years of age for health benefit plans.     Senate Bill 22

South Carolina issued a bulletin indicating that the maximum benefit for coverage for behavioral therapy shall be increased to $52,100 for the calendar year beginning January 1, 2013.     Bulletin 7-2012


DISASTER OR CATASTROPHIC EVENT
North Carolina issued a bulletin to remind insurers with health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster Pursuant to NCGS 58-3-228.     Bulletin 2012-B-3


FILING REQUIREMENTS
Kansas issued a bulletin that outlines requirements for continued use of existing policy forms that must be modified due to the decrease in the maximum valuation interest rates for 2013 life insurance Issues.     Bulletin 2012-3

 
Kentucky issued a bulletin that summarizes requirements for the alteration of current policy forms as a result of the reduction in the maximum valuation and nonforfeiture interest rates.     Bulletin 2012-03


FINANCIAL REGULATION
New Jersey issued a bulletin that shows rates of interest to be used in determining minimum valuation standards and nonforfeiture values for life insurance policies and annuity contracts.     Bulletin 12-08

North Carolina issued a bulletin intended to communicate certain reporting  requirements of the Annual Financial Reporting Law, effective immediately  for financial statements as of December 31, 2012     Bulletin 12-B-04


GUARANTY ASSOCIATION
Maryland amended its regulation on notice of life and health guaranty corporation coverage to comply with new coverage limits.     Regulation 31.04.14


HAZARDOUS FINANCIAL CONDITIONS
Nevada amended provisions used by the Insurance Commissioner to determine whether an insurer is operating under hazardous financial conditions.     Regulation Chapter 680A.220+

Texas amended it rule on hazardous conditions and remedy of hazardous conditions to make it more consistent with the NAIC model regulation.      Rule 28 TAC 8.3


INSURANCE HOLDING COMPANY
California enacted legislation, which among other things, states the intent of the legislature to conform to, and maintain standards consistent with, the NAIC Insurance Holding Company System Regulatory Act as revised in 2011. It also includes enterprise risk definition and report requirements.     Senate Bill 1448


LONG-TERM CARE
North Dakota issued a bulletin that clarifies training requirements for the sale of long-term care insurance under the Partnership Program.     Bulletin 2012-2

Washington amended standards and requirements for inflation protection for long-term care insurance partnership policies.     Rule 284-83-410


MISCELLANEOUS
Maryland issued a bulletin to notify all insurers that Maryland is introducing a new electronic distribution system to notify interested people about the availability of new bulletins and other communications on their website.     Bulletin 12-17


MISCELLANEOUS - HEALTH
Colorado has set out procedures for health insurance carriers to make available a Colorado Supplement to the Summary of Benefits and Coverage Form for each policy, contract, and plan of health benefits that either covers a Colorado resident or is marketed to a Colorado resident or such resident's employer.     Regulation 4-2-20

Colorado issued a bulletin which provides the minimum benefit amount for mammograms effective January 1, 2013.     Bulletin B-4.40 (Updated)

Massachusetts now requires that health insurance plans that cover children provide coverage for the treatment of cleft lip and cleft palate for children under the age of 18.     House Bill 3928

Mississippi enacted legislation relating to time limits within which health insurers may request to audit paid claims for overpayment or for payments disbursed towards an invalid claim.     House Bill 1297

Missouri enacted legislation that no employee, employer, health care provider or any other entity shall be compelled to obtain coverage or provide coverage for abortion, contraception, or sterilization in a health plan if such items or procedures are contrary to the religious beliefs or moral convictions. It also prevents discrimination against any entity acting in a governmental capacity for failing to obtain or provide such coverage.     Senate Bill 749, Bulletin 12-02

Nebraska issued a bulletin regarding requirements for a summary of benefits and coverage for group and individual health plans.     Bulletin CB 129


MISCELLANEOUS - LIFE
California enacted legislation pertaining to notice of life insurance policy lapse or termination for nonpayment of premium.  It requires life insurance policies to contain a provision for a grace period of no less than 60 days from the premium due date, and that the policy remain in force during the 60-day grace period.     Assembly Bill 1747

Nevada adopted a regulation revising the notice that must be provided with policies of life insurance and annuity contracts that replace existing policies and contracts to conform with statutory requirements.     Regulation 686A.563


PATIENT PROTECTION AND AFFORDABLE CARE ACT
Illinois issued a bulletin advising that health care plans must now comply with the guidelines released by the Health Resources and Services (HRSA) on August 1, 2011. Those provisions apply to non-grandfathered group and individual insurance coverage without cost sharing in plan years or, in the individual market, policy years beginning on or after August 1, 2012.     Bulletin 2012-5


PREMIUM TAX
California established provisions to enable an admitted insurer to pay premium taxes on either an accrual basis or a cash basis.     Regulation 10 CCR Sec. 2327+

Wyoming issued a bulletin regarding the implementation of the NAIC's online premium tax for insurance (OPTins) for the submission of required filings and payments.  The Department encourages the use on OPTins, but does not require it.   Memorandum 03-2012


PRODUCERS
Georgia adopted a regulation regarding license renewals and continuing education requirements.  It includes a transition from annual to biennial license renewals for insurance agents, insurance agencies, subagents, counselors, insurance adjusters, and certain non-resident licensees.     Regulation 120-2-3-.05+

Nevada revised provisions relating to prelicensing requirements for persons involved in the sale or administration of insurance.     Regulation Chapter 683A.170

New York amended provisions to permit a license period of greater than two years for new applicants, provided that such term does not exceed 30 months.     Senate Bill 2704


RATE FILINGS
Maryland required notice of a rate increase to a health benefit plan policyholder in the individual market at least 45 days before the change in premium rates is proposed to be effective. Also added clarifying definitions.     COMAR 31.10.01.03

Michigan issued a bulletin regarding the matter of premium adjustment factors in health plan rate filings, including HMOs.  Market conduct examinations will take place on new and renewal business effective January 2, 2013 and later to verify compliance with this bulletin.     Bulletin 2012-13-INS


REPLACEMENT
South Dakota amended its rule to establish criteria for the sale of life insurance or annuities when replacing coverage.     Rule 20:06:08:38+


RISK-BASED CAPITAL
Kentucky amended its regulation to expand the kinds of risk-based capital events considered to be company action-level events, defines fraternal benefit society and defines the provisions that apply to a fraternal benefit society.     Regulation 806 KAR 3:190


SUITABILITY
New York adopted emergency regulations establishing standards and procedures to determine a consumers' suitability before recommending or selling annuities. Also, establishes standards and requirements for the use of senior-specific certifications and designations in the sale of life insurance and annuities.     Emergency Regulation 187 (11 NYCRR 224); Emergency Regulation 199 (11 NYCRR 225)


VIATICAL SETTLEMENT
Colorado amended its regulation regarding viatical settlements, which among other things, revises the applicability section, deleted provisions prohibiting the negotiation of viatical settlement contracts and prohibiting a person from operating as a viatical settlement provider except under certain conditions.     Regulation 2-1-11


We Know Advertising Compliance!
Concerned about advertising compliance of your contracted agencies?

You may be aware of our advertising compliance expertise. We

  • Offer the only annual training seminar to the industry,
  • Deliver in-house seminars for companies, and
  • Provide advertising compliance reviews on an overload basis to carriers.
     

You may NOT be aware that we also help agencies, brokers and National Marketing Organizations comply with insurance laws nationwide on non-company, non-product advertising.

What they like about our compliance services:

  • Marketing-friendly viewpoint
  • Mark-ups don’t just say “no” they show “how”
  • Our approachable reviewers
     

Could your contracted agencies use our help? Please pass this information along – or give us a call.

 C. J. Rathbun
816.391.2740
cj.rathbun@firstconsulting.com
 
 

Stretching your Resources – Monitoring TPA’s 
 

Working with TPA’s brings on regulatory requirements that may stretch your compliance resources beyond full.
 

One of our On-Line Research Services – Third Party Administrator Licensing Service – answers questions you may have 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 other requirements must be met?