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.
ADVERTISING / SALES & MARKETING
Arkansas posted a message on SERFF that the Department would be spot-checking Major Medical advertising pieces as they are filed. Dispositions of "Filed" indicate no review at the time of submission and "Approved" indicate review. The Department may, at any time, review previously submitted ads for compliance, but items marked as noted above may be used immediately. The message referred to Rule 11 regarding advertising requirements. SERFF Message dated 08/19/2015
AGENT / PRODUCER LICENSING AND APPOINTMENT
Arkansas issued a bulletin regarding state-specific continuing education and training requirements upon annual renewal of an exchange license. Bulletin 10-2015
CERTIFICATE OF AUTHORITY FILINGS
Vermont has amended its regulation regarding stockholder listing and certificate of authority. T. 8 s 3308; T. 8 s 3309; T. 8 s 3681
California enacted legislation to have insurers submit a Corporate Governance Annual Disclosure; require holding company systems to register with the commissioner; and to file capital structure, general financial information and specified transactions between the insurer and its affiliates and authorize the commissioner to act as supervisor for any internationally active insurance group. AB 553
DATA CALLS / REGULATORY REPORTING
Oklahoma updated its annual reporting requirements for captive insurance companies to provide requirements for when a company elects to file its annual report on a fiscal year basis. 365:25-15-2
Texas issued a data call for rate information for the Texas Long-Term Care Rate Guide. All companies writing individual LTC insurance for customers after August 1, 2015 must respond. The deadline for submitting information is October 1, 2015. The rate collection form is located at: http://www.tdi.texas.gov/forms/form10other.html Commissioner's Bulletin B-0018-15
Colorado promulgated a regulation to require insurers to see that all purchasers are fully informed as to coverages provided in policies, specific premiums charged and any limitations, exceptions or exclusions for which coverage is not provided. Regulation 6-1-1
FRAUD / ANTI-FRAUD
Texas enacted legislation to allow their Insurance Commissioner to investigate insurance fraud, both in-state and out-of-state and to aid in enforcing laws related to insurance fraud including providing technical or litigation assistance to other governmental agencies. SB 782
HEALTH CARE EXCHANGE / MARKETPLACE
Kentucky issued an order relating to the establishment and operation of the Kentucky office of health benefit and information exchange. Executive Order 2015-387
New Hampshire issued a bulletin providing guidance regarding required notices of benefit changes for recertified plans and required notices of withdrawal from the New Hampshire Health Marketplace. The bulletin reaffirms the Department's 2014 guidance provided in Bulletin INS-14-023-AB that details the process issuers must follow to comply with redetermination notice requirements. Bulletin of August 25, 2015
HEALTH INSURANCE / HEALTH RATES
Delaware issued a bulletin to provide guidance regarding the Department's implementation and enforcement of federal rules regarding hospital indemnity and other fixed indemnity policies sold in the individual market. Domestic/Foreign Insurers Bulletin 76
Illinois amended its infertility coverage law pertaining to group policies of accident and health insurance, providing coverage for more than 25 employees, that provides pregnancy related benefits. Coverage must be provided for infertility treatments for individuals unable to attain a viable pregnancy or maintain a viable pregnancy, as well as to individuals unable to attain or sustain a successful pregnancy, through other specified treatments. The definition of infertility was revised. Senate Bill 1764
Illinois amended its mammogram/mastectomy coverage requirements to require coverage for a screening MRI when medically necessary, as determined by a licensed physician and requires coverage for breast tomosynthesis. House Bill 3673, Senate Bill 215 ILCS 5/356g
Illinois prohibited insurers that provide coverage for prescription topical eye medication from denying coverage for the refilling of a prescription for topical eye medication for chronic conditions under certain circumstances. House Bill 3137
Louisiana enacted legislation that health insurers receiving claims for covered healthcare services rendered in conducting a forensic medical exam waive any applicable deductible, co-insurance, and co-pay if the forensic medical exam is for a victim of a sexually oriented criminal offense. In addition, the health insurer must allow the victim to designate the address to send the explanation of benefits or allow the victim to designate that no explanation of benefits be generated or transmitted. House Bill 835
New Jersey amended its health information electronic data interchange technology act ("HINT") non-group enrollment/change request form. All health insurance companies, individual and group health insurers, health maintenance organizations, dental service corporations, dental plan organizations and prepaid prescription service organizations shall utilize the revised HINT Enrollment Forms as provided on the Department's website. Order A15-108 dated August 25, 2015
Oklahoma issued a bulletin to inform all health carriers and health maintenance organizations that an optional use of composite premium rating in the small group, non-SHOP market, has been approved by the Centers for Medicare and Medicaid Services for the 2016 plan year. Bulletin No. LH 2015-01
HEALTH MAINTENANCE ORGANIZATIONS
Oklahoma amended the definition of "Plan" in its regulation pertaining to health maintenance organizations. The revised definition applies to plans that are delivered, issued for delivery, or renewed on or after January 1, 2016. A contract that is in force on January 1, 2016, must be brought into compliance with the definition of "Plan" on the next anniversary date or renewal date of the contract, or the expiration of any applicable collective bargaining contract under which it was written. 365:40-5-51; 365:40-5-58
Wisconsin issued a bulletin announcing revised reporting requirements for insurers that are part of an insurance holding company system. Bulletin dated September 8, 2015 (A)
LIFE INSURANCE / LIFE CONTRACTS
Idaho issued a bulletin stating that insurers must pay a minimum of 5.375% interest on deferred payment of cash surrender values effective July 1, 2015 from the date the surrender request is received by the insurer or its authorized agent or representative, if payment of surrender value has not occurred within 30 days of having received the surrender request. Bulletin 15-04
New York made several revisions to regulations regarding the valuation of life insurance reserves, determining minimum reserve liabilities and nonforfeiture benefits. 11 NYCRR 100.2, 11 NYCRR 100.12
LIFE INSURANCE AND ANNUITY SOLICITATION
Wisconsin issued a bulletin announcing the Department's adoption of the NAIC Buyer's Guide and 2012 IAR Table. Bulletin dated September 8, 2015 (B)
MEDICARE SUPPLEMENT INSURANCE
Maine issued a bulletin describing recent amendments and reminding carriers of some of the important requirements applicable to medicare supplement coverage. Bulletin 407
Oklahoma amended its regulation to provide that the 2012 IAR mortality table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2015, except under certain circumstances. Regulation 365:10-9-3
NOTICE TO INSUREDS
Kansas amended its notice required to be sent to individual medical policyholders approaching the age of 65 or medicare eligible. Regulation 40-4-29a
Delaware amended its Code and laws relating to unclaimed property. SB 141
North Carolina enacted legislation establishing the Unclaimed Life Insurance Benefit Act (this does not amend, modify or supersede the North Carolina Unclaimed Property Act). This new act requires insurers to perform a comparison of in-force policies, annuities, and account owners against a death master file (DMF), on a semi-annual basis, to identify potential death master file matches. The law provides instruction on what an insurer must do within 90 days of learning of the possible death of a person, through a DMF match or otherwise. Senate Bill 665
DISTRICT OF COLUMBIA ALLOWS MULITIPLE CRITICAL ILLNESS
Good news, critical illness is again allowed in District of Columbia! If you were previously unsuccessful in gaining approval or need assistance drafting, contact First Consulting as we can help with drafting and filing.
This year District of Columbia has changed their position..
Previously the Department had allowed multiple critical illnesses within one policy, and then they changed their position and said that it was not allowed. Their position was that there could only be one critical illness per policy which is not how the industry sells this product. Earlier this year the Department changed their position and District of Columbia is again allowing multiple critical illnesses within one policy.
Don’t have time? Contact First Consulting as we have years of experience in drafting state specific language the department wants to see.
Want to know more about how First Consulting can help draft and/or file your policy, click on one of the links below:
Or contact Vickie Goodman. We are here to help with your drafting and filing needs.
ANTI-FRAUD TRAINING FOR ALL LINES OF INSURANCE
Finally, Anti-Fraud Training developed specifically for the Insurance industry, by members of the Insurance industry!
First Consulting delivers:
- accessible online from desktop or laptop
- customizable with your logo and company anti-fraud policies
- individual employee anti-fraud training
- life & health
- property & casualty
- in compliance with state fraud training 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!
Sign-up for our free monthly Fraud News Update for latest trends in new fraud legislation, fraud schemes and red flags seen in the marketplace here.
Carol Stern, FLMI, AIRC, ACS