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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
New Hampshire amended it law regarding the marketing and advertisement of benefits payable, losses covered or premiums payable for life, accident, and health insurance. Ins 2601.06
AGENT / PRODUCER COMPENSATION
Alabama published a bulletin regarding producer authority to collect fees from consumers and charges for non-producer services. The bulletin provides a schedule for certain services and notes that the fees must be disclosed to consumers as a charge by the producer, separate from insurance premiums. Bulletin 2016-06
ANNUITIES - CHARITABLE
Oklahoma issued an order to all qualified charitable organizations issuing qualified charitable gift annuities. They must file the annual audited financial statements within ninety days of receipt of the final audit report. This should be filed by electronic format effective on or before December 1, 2016. Elec. Filing Annual Financial Stmt. 16-0640-PRJ
Hawaii revised its rules governing captive insurance companies. Chapter 16-17, Hawaii Administrative Rules
CLAIMS / CLAIMS ISSUES
Montana advised that the state Supreme Court has issued a notice-prejudice rule. Insurers may only deny coverage for late notice of a claim if the insurer can demonstrate it was prejudiced or injured by the lateness of the claim. Advisory Memorandum of August 17, 2016
DATA CALLS / REGULATORY REPORTING
Texas issued a data call for calendar year 2015 regarding credit life and credit accident and health insurance in force or written on loans or other credit transactions of 120 months or less. Submissions are due by close of business on October 31, 2016. Bulletin B-0018-16
Texas issued a data call to all insurers licensed to write Accident and Health insurance in the state, all basic service HMOs and all other related entities, including certain Third Party Administrators, regarding data collecting and reporting relating to mandated health benefits and mandated offers of coverage. For the reporting period October 1, 2015 to September 30, 2016, submissions are due by December 1, 2016. Bulletin B-0021-16
WHAT REPORTS WILL YOU SUBMIT IN 2017?
Want help with CGAD, ORSA and other reporting readiness?
First Consulting has answers! Click here to learn more.
DISASTER / CATASTROPHIC EVENT
North Carolina issued a bulletin to remind health benefit plans of compliance requirements involved in obtaining extra prescriptions under a state of emergency or disaster. Bulletin 16-B-4
Oregon issued a bulletin clarifying prohibitions against unfair discrimination in the transaction of insurance and to reiterate expectations of the Department of Consumer and Business Services (DCBS) about how insurers and other licensees, and authorized entities must address issues related to transgender persons. Bulletin 2016-1
California enacted legislation to clarify that a digital signature may be used to satisfy requirements of an electronic signature under the Uniform Electronic Transactions Act. Assembly Bill 2296
E-COMMERCE AND DIGITAL MARKETING ASSISTANCE
Is your Company planning to market its products online? If so, then there’s a lot to consider.
First Consulting can help. Click here to learn more.
FILING REQUIREMENTS / PROCEDURES
Connecticut promulgated regulations to define certain terms and provide requirements for timing and the process of rate filings for individual health insurance to ensure rates are not excessive, inadequate, or unfairly discriminatory. 38a-481-1, -5, -6, -7, -8, and -9
Oklahoma adopted a regulation that clarifies the procedures for submitting life, accident, and health form filings. Regulation 365:10-1-17
FRAUD / ANTI-FRAUD
The US Department of the Treasury, FinCEN (Financial Crimes Enforcement Network) issued an Advisory, FIN-2016-A004, updating its list of jurisdictions with strategic Anti-Money Laundering/Countering the Financing of Terrorism (AML/CFT) deficiencies. FIN-2016-A004
Michigan rescinded Order No. 06-021-M. This amendment, effective July 1, 2016, specifically recognizes noncompliance with minimum contribution requirements as a basis for nonrenewal. As a result, Declaratory Ruling 06-021-M is moot. Order No. 16-045-M
Montana issued a Memorandum regarding reports, inquiries, and complaints concerning "early renewal" marketing practices in the small employer group market that appear to be an attempt to circumvent 2017 rate increases implemented by certain health insurers. Advisory Memorandum of September 15, 2016
HEALTH INSURANCE / HEALTH RATES
California enacted legislation to prohibit any grandfathered or nongrandfathered plan issued, renewed or amended on or after January 1, 2017, from changing the cost-sharing provisions during the plan or policy year, except when required by state or federal law, similar to existing requirements for health care service plans governed by the Knox-Keene Health Care Service Plan Act of 1975. Senate Bill 923
Massachusetts amended the sunset date for the emergency legislation requiring medical expense coverage policies to provide coverage for long-term antibiotic therapy for a patient with Lyme disease. 176G:4BB
Nevada issued a bulletin to inform health carriers that changes to commission structures that were not included in rate filings may be an unfair method or deceptive act. Bulletin 16-007
New Mexico adopted a new rule for health carriers that provide, offer or administer health benefit plans to establish a uniform and efficient provider credentialing process and to ensure that providers receive prompt payment from health carriers for clean claims and interest on unpaid claims. This rule also establishes a process for resolving payment-related credentialing disputes between health carriers and providers. Regulation 188.8.131.52+ NMAC
Oregon adopted regulations that apply to all insurers offering individual or small group health benefit plans in this state that are issued or renewed on or after January 1, 2017. OAR 836-053-0300 to OAR 836-053-0350
Oregon issued a notice to all issuers selling health benefit and pediatric dental plans offered on or off the exchange to provide a timeline for addressing rate and binder filings. Notice dated August 18, 2016
Tennessee published a bulletin relating to chiropractic physician coverage and reimbursement. Bulletin 16-03
HEALTH MAINTENANCE ORGANIZATIONS
Oklahoma amended its requirements for individual conversion contracts and specifies that HMOs will not be required to offer individual conversion contracts to subscribers or their enrolled dependents. 365:40-5-42
The District of Columbia released a notice to all insurance companies in the District to inform them that it had updated the "Notice and Consent Form for Testing to Determine Exposure to the Causative Agent of AIDS." The new form is to be used for all policies issued or renewed on or after October 1, 2016. Notice dated August 16, 2016
HIV RESEARCH AND ANSWERS CAN BE FOUND HERE
The First Consulting HIV Informed Consent Service provides answers and valuable research on a
broad range of HIV related insurance issues. Click here to learn more.
IIPRC / INTERSTATE COMPACT
The Compact updated its uniform standards for Individual Term Life Insurance products. Changes are to be effective December 5, 2016. L-04-I
The Compact updated its uniform standards for Individual Whole Life Insurance products. Changes are effective December 5, 2016. L-07-I
INSURER INVESTMENTS / SECURITIES
Oklahoma amended it regulation regarding security notice filings wherein insurers offering a security in the state are required to file a notice with the Administrator in compliance with Regulation D, Rule 506, adopted by the SEC. 660:11-11-61
LONG-TERM CARE INSURANCE
Pennsylvania issued a notice providing guidance regarding inflation protection for Qualified Partnership Policies. Notice 2016-11
MEDICARE SUPPLEMENT INSURANCE
Texas issued a bulletin reminding marketers of Medicare Advantage and related plans of Medicare Marketing Guidelines and agent licensing requirements related to certain Medicare plans and Prescription Drug plans. Open enrollment for Medicare is from October 15 through December 7, 2016. Bulletin B-0019-16
California enacted omnibus insurance legislation that, among other things, updates its law to conform with the NAIC Insurance Holding Company System Model Regulation; allows for denial of a license application if the applicant is convicted of a felony or misdemeanor or if the applicant fails the license examination 10 times within a 12-month period; adds maturity dates for fixed annuities at the annuitant's 70th birthday or the 10th anniversary of the contract; requires more extensive rate history for long-term care insurance rate filings; and allows the Commissioner to establish an internet-based complaint filing system. Assembly Bill 2884
Ever wanted someone or a resource for questions on filings, marketing compliance,
or industry practices? We can give you that! Click here to learn more.
PATIENT PROTECTION AND AFFORDABLE CARE ACT
The Centers for Medicare & Medicaid Services (CMS) published a notice addressing frequently asked questions regarding verification of special enrollment periods for health insurance sold via federally facilitated marketplaces. CMS Notice dated September 6, 2016
The Centers for Medicare & Medicaid Services (CMS) released a bulletin to announce that, during the open enrollment period for the 2017 coverage year, it would display information on the relative size of provider networks for plans in a limited number of states on Healthcare.gov. This will help CMS understand how consumers make use of network breadth information. CMS Notice dated August 19, 2016
The Centers for Medicare & Medicaid Services (CMS) released a notice addressing frequently asked questions regarding crosswalk of enrollees into alternate plans offered by other issuers. CMS Notice dated September 2, 2016
The Centers for Medicare & Medicaid Services (CMS) updated the Qualified Health Plan Certification Agreement and Privacy and Security Agreement that is used between Qualified Health Plan Issuers and CMS. CMS Notice dated September 1, 2016
Rhode Island enacted legislation providing for a reduction in premium tax for qualifying insurers if sufficient jobs are created by the industry in the state. House Bill 8058
California amended requirements concerning obligations to disclose a breach of security of personal information to the affected person(s). It provides information to be included in the notice and parameters for its presentation. Assembly Bill 2828
Texas issued a bulletin to domestic or commercially-domiciled insurance companies and health maintenance organizations regarding the reporting of cybersecurity incidents. A company should contact its assigned financial analyst at TDI if it experiences or discovers an unauthorized acquisition, release or use of personal information or sensitive company information. Bulletin B-0022-16
STANDARD VALUATION LAW
Delaware issued a bulletin announcing that the Principle-Based Valuation Manual will be effective for all policies issued on or after January 1, 2017. Domestic-Foreign Insurers Bulletin 88
Georgia issued a bulletin announcing the operative date of the uniform valuation manual, for purposes of the Georgia Standard Valuation Law, is January 1, 2017. Bulletin 16-EX-1
Nevada issued a bulletin to inform life, health, and annuity insurers that the four triggering events to establish the operative date of the Valuation Manual have occurred on or before July 1, 2016. The operative date of the Valuation Manual in the State of Nevada is January 1, 2017. Bulletin 16-008
New Hampshire issued a bulletin advising that the operative date of the uniform valuation manual, for purposes of the New Hampshire Standard Valuation Law is January 1, 2017. Bulletin of September 6, 2016
Pennsylvania issued a notice regarding principle based reserving to confirm that the operative date of the Valuation Manual will be January 1, 2017. Notice 2016-10
West Virginia promulgated a rule to adopt the most recent changes to the Valuation Manual adopted by the National Association of Insurance Commissioners. The operative date of the Valuation Manual for the state is to be January 1, 2017. 114-98-1
California enacted legislation to add to its suitability information whether the consumer intends to apply for means-tested government benefits, including, but not limited to, Medi-Cal or the veterans' aid and attendance benefit. Senate Bill 924
Illinois enacted legislation requiring recognition of the Uniform Disposition of Unclaimed Property Act and requires the complete and proper disclosure, transparency and accountability relating to any method of payment for life insurance, annuity, or retained asset agreement death benefits. House Bill 4633, Uncodified HB 4633
Is your Company planning to market its products online? If so, then there’s a lot to consider.
First Consulting can help. We are prepared to assist you and your team relating to insurance commerce, including:
Through First Consulting’s innovative Co-Sourcing approach, we can help you and your team with all or part of any project. We are here to help you succeed in getting your projects completed.
Contact me to learn more about how First Consulting can help.
Ever wanted someone or a resource for questions on filings, marketing compliance, or industry practices?
We can give you that!
Our “general compliance” account – we call it the “Help Line” – means you can call or email us, and we respond within 24 hours!
Disclaimer: No legal advice. Practical input for your compliance puzzles and questions based on our industry expertise.
Call or email me for details and we’ll get you set up for our Help-Line!
C. J. Rathbun, FLMI, CCEP, HIA, AIRC