Life and Health News September 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.


ADVERSE BENEFIT DETERMINATION
Utah adopted a rule for health insurers providing a uniform standard for the establishment and maintenance of an independent review procedure.  It assures that a claimant has the opportunity for an independent review of an adverse benefit determination.     R590-261


DENTAL
Rhode Island requires all nonprofit dental plans to give participating dentists 15 day’s notice of any changes in coverage or payment for dental services and requires electronic notification.     Senate Bill 474, House Bill 5425


FILING REQUIREMENTS
Michigan notified insurers of requirements for filing disability insurance policy forms and rates with the insurance commissioner.     Bulletin 2011-14-INS

Missouri amended its regulation on filing requirements for life, health and annuity policy forms, rates, contracts or related forms, which among other things, requires filing through SERFF.     Rule 20 CSR 400-8.200

Wisconsin adopted a rule relating to readability and electronic access to insurance policies.     Rule 6.07


FINANCIAL REGULATION
Illinois adopted a new rule to establish minimum standards for nonforfeiture values for certain life insurance policies having intermediate cash values.     Rule 1415.10+

Missouri adopted a rule amending the calculation requirements for premium deficiency reserves with respect to life insurance policies.     Rule 20 CSR 200-1.160

Missouri incorporated by reference new versions of NAIC manuals, instructions, and handbooks on accounting practices and procedures, annual statements, securities valuation, and insurers' financial condition.     Rule 20 CSR 200-1.005

Nevada issued a bulletin regarding requirements that insurers are required to provide reasonable exceptions in their rates, rating classifications, tier placement and underwriting rules and guidelines for certain extraordinary life circumstances of an applicant or existing policyholder.     Bulletin 2011-005

New Jersey issued a bulletin showing the rates of interest to be used for determining minimum valuation standards and nonforfeiture values applicable to life insurance policies issued in 2012, and annuity contracts issued or undergoing a change in fund in 2011.     Bulletin 2011-12

South Carolina issued a bulletin that constitutes official notice of the tentative credit accident and health insurance rates for 2012.     Bulletin 8-2011, Bulletin 6-2011

Wisconsin provided insurers writing accident and health insurance guidance regarding rate filings made on or after September 1, 2011, and guidance to insurers whose rate increases meet or exceed the threshold of a potential unreasonable rate increase.     Bulletin 7-18-2011


FRAUD
New York amended the definition of insurance fraud.     Senate Bill 5562


GROUP HEALTH
Connecticut issued a bulletin to clarify what copayments are allowed for mental health office visits to comply with state and federal mental health parity laws.  It also sets forth additional filing requirements for carriers seeking to subject mental health providers to the specialist copayment in the large group market.     Bulletin HC-87

Kansas amended its law, which among other things, amends adverse decision requirements, the emergency medical condition definition and the maximum lifetime benefit of $2,000,000 is increased to $3,000,000 per covered individual.     House Bill 2075


GROUP LIFE
California enacted legislation providing group life insurance for dependent children, until 26 years of age, regardless of the child's marital status or whether the child is attending an educational institution.     Senate Bill 220


GUARANTY ASSOCIATION
Alaska issued a bulletin informing insurers about the "Notice of Protection Provided by the Alaska Life, Accident and Sickness Insurance Guaranty Association" that is required to be delivered with life and annuity policies and contracts.  It conforms with the NAIC model act.     Bulletin B 11-06

California issued a bulletin providing notice of the Insurance Commissioner's approval of an updated Life and Health Insurance Guarantee Association (CLHIGA) Summary Document which describes the general purposes and current limitations of coverage provided.     Bulletin No. 2011-3

Montana amended its regulations regarding the Life and Health Insurance Guaranty Association Act and its notice concerning coverage limitation and exclusions.     Admin. R. 6.6.4603, Rule 6.6.4601+


LIFE SETTLEMENT
New York adopted emergency regulations regarding license fees and financial accountability requirements for life settlement providers and brokers.     Emergency Regulation 198 (11 NYCRR 381.1), Emergency Regulation 198 (11 NYCRR 381.2)


LONG-TERM CARE
Maine enacted legislation requiring insurance companies to reissue qualifying long-term care partnership policies.     MRSA § 5082 (L.D. 642)


MISCELLANEOUS
California issued a notice regarding corporate applications and similar filings where expedited review is requested by the end of the year 2011.     Notice 8-5-2011

Georgia issued a bulletin concerning the use of credit cards to pay insurance premiums.     BULLETIN 11-EX-2

Missouri amended its regulations to delete a requirement that bar codes appear on certain domestic insurer filings.     Rule 20 CSR 200-1.030

New York advised domestic insurers exempt from Insurance Law Article 15, to furnish a copy of the National Association of Insurance Commissioners' (‘NAIC‘) insurance holding company system annual registration statement if the insurer or its parent authorized insurer filed the statement in another state, and a report in advance of engaging in any activity that results in the insurer acquiring control or in advance of engaging in certain other transactions.     Circular Letter 2010-10 (Supplement) (#1)

Pennsylvania has a new address for the Insurance Department's Philadelphia Regional Office.     Notice 2011-07


MISCELLANEOUS - HEALTH
Connecticut issued a bulletin clarifying the categories to which entities must be licensed to perform utilization review.  Utilization review license must be renewed annually each October 1. This bulletin supersedes Bulletin HC-48 (Rev.).     Health Care Bulletin HC-86

Oregon adopted the uniform standards for administrative simplification of health insurance.  It establishes the uniform administrative standards that health insurers and health care entities are required to comply with.  The standards pertain to health care benefit eligibility inquiries and responses and are set forth in the "Oregon Companion Guide for the Implementation of the ASC X12N/005010X279, Health Care Eligibility Benefit Inquiry and Response (270/271)."     OAR 836-100-0100, 836-100-0105, 836-100-0110, 836-100-0115, 836-100-0120

Oregon issued a news release announcing that all children under the age of 19 may sign up for health insurance throughout the year.     News Release dated 08/01/11


MISCELLANEOUS - LIFE
Wisconsin amended its regulation regarding insurance policy language simplification for life insurance.     Admin. Code § Ins 6.07


OMNIBUS LEGISLATION
Alaska issued a bulletin that highlights recent changes to insurance laws, including free look periods for annuity contracts, long-term care insurance training requirements, claims limitations and rate filing requirements for health insurance.     Bulletin B 11-07


PATIENT PROTECTION AND AFFORDABLE CARE ACT
Arizona notified health insurance issuers of the impact of the Department of Health & Human Services' (HHS) Technical Release 2011-02 on the external review processes.     Regulatory Bulletin 2011-7

Delaware enacted legislation regarding limitations on pre-existing condition limitations for minor children.     House Bill 161

Delaware issued a bulletin providing guidance to health insurers while Delaware is in the process of revising Regulation 1301 for compliance with the Patient Protection and Affordability Care Act.     Domestic Foreign Insurers Bulletin 44

Hawaii enacted legislation eliminating all provisions for and references to the termination of the Hawaii Prepaid Health Care Act.     House Bill 1134

Iowa issued a bulletin outlining the new procedures carriers should follow regarding review of rates in the small group market.   Effective September 1, 2011, small group rates must be submitted for prior approval via SERFF.     Bulletin 2011-6

Maine amended its law regarding the requirements that implement the Patient Protection and Affordable Care Act.     H.P. 1140

New Hampshire enacted legislation to implement federal health care reform.     House Bill 601

New York amended its law in relation to implementation of the Patient Protection and Affordable Care Act in health insurance policies and contracts.     S. 5800

Pennsylvania issued a notice to all persons and entities impacted by the Accident and Health Filing Reform Act concerning the review process for rates in the individual and small group markets.     Notice 2011-06

Washington adopted a rule to bring grandfathered health plans into compliance with the Patient Protection and Affordable Care Act requirements for review of adverse benefit determinations, and provide that all plans, both grandfathered and non-grandfathered, must continue to address grievances.     R 2011-14


PRIVACY NOTICES
Virginia issued an administrative letter regarding privacy notice compliance.     Administrative Letter 2011-06


PRODUCERS
Hawaii issued a memorandum responding to inquires with regard to annuity training requirements for insurance producers.     Memorandum 2011-2LIC

Illinois approved changes to its code to allow certain webinars to be used to satisfy course study requirements for insurance producer licensing.     HB 1287

Maine issued a bulletin explaining how the repeal of the independent producer license authority affects licensed producers.  It also clarifies when an appointment by the insurer is required.     Bulletin 380

Nevada removed the requirement that a resident producer of insurance maintain a place of business in Nevada which is accessible to the public and where he or she principally conducts transactions.     Senate Bill 143

Oklahoma issued a bulletin concerning life insurance policy information that must be provided to certain insurance producers who have been terminated but who are still the agent of record or servicing agent.     Bulletin No. LH 2011-04


THIRD PARTY ADMINISTRATOR
Connecticut issued a bulletin regarding changes to third party administrator licensing and registration requirements.     Bulletin L-17


Take Advantage of First Consulting’s Fraud Research!

Since 1969, First Consulting has been tracking and researching some of the insurance industry’s most important compliance issues.  Now you can put that experience to work for you!
 

Our Fraud Compliance Service provides clear and concise summaries on the fraud related topics that are the most important to the insurance industry.  You will find information on fraud warnings, definitions of "fraudulent insurance activities," mandatory fraud reporting requirements, fraud plans and fraud investigation responsibilities.  These summaries include the laws and regulations in all 50 states plus D.C., Guam, Puerto Rico and Virgin Islands.

This information will be a key resource for your Compliance, Legal and Claims departments.  And it’s all available 24/7 in a convenient, easy to use, searchable website!

Contact Sean Cox to learn more about this service, or click any of the links below:


Click here if you are a Life or Health insurer
Click here if you are a Property and Casualty insurer
Click here if you are a Life Settlement provider

 Sean Cox
First Consulting & Administration, Inc.
1020 Central, Suite 201, Kansas City, Missouri 64105
800-927-2730, ext. 2737 or 816-391-2743

sean.cox@firstconsulting.com


 2012 Budgeting

Have you anticipated all your compliance needs, while making your plans and budgets for 2012? 
 

Whether the need is for a quick answer to a question, assistance in developing a new product, expanding insurance operations (UCAA filings), or operational compliance review, First Consulting can be the solution. Put its knowledge, experience and reputation to work for you and your Company.
   

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 specific company and project.
 

Get more information about First Consulting and our services on our website at www.firstconsulting.com.
 

Or contact John Palmer
john.palmer@firstconsulting.com
816-391-2744 or 800-927-2730
Or any First Consulting Associate