Life and Health News
Welcome to our latest newsletter! As a thought leader in the Insurance Industry for over 48 years we are always excited to share the latest sampling of insurance compliance related bulletins, regulations and legislative activity. Please feel free to share this newsletter with others that may be interested. Contact Us with any questions on the items in this newsletter or with any other compliance related matter we can assist you with. Enjoy!
New York published filing guidance for changes to the insurance law pertaining to accelerated death benefits intended to qualify as Qualified Long Term Care Insurance for federal tax purposes. Filing Guidance of December 20, 2017
AGENT / PRODUCER LICENSING AND APPOINTMENT
Connecticut published a notice directed to all individual resident and non-resident producer licensees. Effective December 20, 2017, Connecticut will move to birth month renewals instead of birth date renewals. Licensees that currently have their birth date as their license expiration date on the Producer Database (PDB) will begin to reflect the last day of their birth month. Notice dated December 20, 2017
Hawaii issued a memorandum regarding reimbursement for licensing examinations taken by veterans. Veterans who take a Hawaii licensing exam required by the Insurance Division can be reimbursed for the cost of the exam by the U.S. Department of Veteran Affairs (VA) Memorandum 2017-11LIC
New Jersey issued a bulletin to remind insurers about producer appointment and renewal procedures. Bulletin 17-11
New Mexico issued a notice regarding 2018 insurance producer renewals. Renewals must be completed online, and renewal notices will no longer be mailed out to the licensees. 2018 License Renewal Notice dated December 8, 2017
North Dakota issued a notice regarding reimbursement for producer licensing examinations taken by veterans. Veterans who take certain licensing examinations required by the Insurance Department can be reimbursed for the cost of the exam by the U.S. Department of Veteran Affairs (VA). Notice dated December 21, 2017
AUTISM SPECTRUM DISORDERS
Georgia issued a directive regarding the Autism Coverage Annual Filing Requirement. An annual report was due on 1-5-2018 and a final submission will be required on 5-15-2018. The directive asks insurers to download a data file and receive additional instructions at www.oci.ga.gov/Insurers/ASDfiling.aspx. Directive 17-EX-9
Connecticut issued a bulletin providing financial reporting requirements for captive insurers. Bulletin FS-4C-17
Delaware issued a notice to captive insurers regarding 2017 Annual report and premium tax updates. 2017 Annual Report and Premium Tax Updates - publication dated December 20, 2017
CLAIMS / CLAIMS ISSUES
New Jersey amended its Unfair Claims Settlement Practices law to provide that no insurer offering health benefits plans shall issue an explanation of benefits, explanation of payment, and remittance advice forms with denial reasons that are not applicable to the specific claim. NJAC 11:2-17.9
New Jersey amended the definition of "adverse benefit determination" to provide for disclosure of the right of a covered person to request use of an out-of-network provider at network level cost sharing, where the network does not contain a qualified, accessible, and available provider to perform a service. NJAC 11:24-1.2, NJAC 11:24A-1.2, NJAC 11:24A-2.3
Delaware issued a bulletin directing all insurance companies to require each of their employees who correspond with the Department about the investigation of consumer complaints to include both the employee's direct dial telephone number and the employee's direct email address in that correspondence. Domestic/Foreign Insurers Bulletin 98
CONFIDENTIALITY / PRIVACY
Colorado amended its regulations pertaining to the treatment of nonpublic personal health and financial information, the standards for safeguarding customer information, and required consumer notices. The amendments clarifies consequences of noncompliance and revises definitions. 3 CCR 702 Reg. 6-4-1 and 6-4-2
Delaware issued a bulletin to clarify annual privacy notice requirements. Domestic/Foreign Insurers Bulletin 97
Kentucky amended its regulation regarding the privacy of consumer financial and health information. Definitions were expanded and added and other changes were made. 806 KAR 3:210
New Hampshire amended its rule regarding the annual privacy notice. An exemption is now available when the licensee has not changed its policies and practices with regard to disclosing nonpublic personal information since the notice was last provided. Ins 3002.02
New York amended its regulation to provide circumstances under which a licensee is not required to provide an annual privacy notice. 11 NYCRR 420.5
Illinois enacted legislation titled the Entity Omnibus Act. The legislation provides requirements for domestic or foreign entity conversion to a different type of entity and domestication. House Bill 2963
IMPORTANT CGAD ALERT!
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Maryland adopted new rules regarding dental network adequacy that apply to carriers that issue or renew dental plans and use a provider panel. COMAR 31.10.45.01
DISASTER / CATASTROPHIC EVENT
Maryland issued a bulletin asking companies to provide primary and backup contact information for use by the Insurance Administration in the event of a disaster or catastrophic event by close of business April 16, 2018. MD Bulletin 18-02
DRUG / PRESCRIPTION COVERAGE
Illinois issued a bulletin regarding step therapy requirement exceptions. The bulletin clarifies that the Managed Care Reform and Patient Right Act requires insurers to maintain a medical exceptions process and, effective 1-1-2018, to include a step therapy exception review process. The bulletin lists conditions under which a step therapy requirement exception request will be approved. Bulletin 2017-05
Massachusetts issued a Bulletin to health insurers and health maintenance organizations regarding coverage for abuse deterrent opioid drug products. Bulletin 2017-08
New Jersey amended its law to require health insurance coverage for contraceptives to include prescriptions for a six-month period. Assembly Bill 2297
Nevada added a new regulation specifying certain fees insurers are required to pay based on direct written premiums. Changes are effective July 1, 2019. NAC 680C
Maryland issued a bulletin to provide guidance to insurers and health maintenance organizations regarding filing requirements for student health benefit plan form and rate filings for plans that will be issued for the 2018-2019 school year. Bulletin 17-13
HEALTH INSURANCE / HEALTH RATES
Delaware issued a bulletin noting that several health insurers who utilize pharmacy benefits managers are not complying with Delaware requirements. The Department expects health insurers and pharmacy benefits managers to fully familiarize themselves with Chapter 33A of Title 18 and to comply with its requirements. Domestic/Foreign Insurers Bulletin 99
Idaho issued an order that directs the Department of Insurance to seek creative options that encourage and permit health insurance carriers to offer health plans that expand access for Idahoans by providing benefits and plan designs to meet consumer needs at lower costs than those now available. Executive Order No. 2018-02
Maryland adopted rules regarding network adequacy that applies to carriers that issue or renew health benefit plans in Maryland and use a provider panel for the health benefit plan. COMAR 31.10.44.01+
Maryland issued a bulletin to insurers and health maintenance organizations that offer, issue, or deliver health benefit plans to bring their attention to the modification of coverage requirements for behavioral health disorders. Bulletin 17-17
Massachusetts issued a bulletin to health insurers that concerns the prevention of emergency department boarding of patients with acute behavioral health and/or substance use disorder emergencies. Bulletin 2018-01
New Hampshire issued a bulletin to health insurance companies regarding the annual notice of consumer rights and access to out-of-network services. Bulletin INS-17-048-AB of December 11, 2017
New Jersey revised its law for carriers that are members of the Individual Health Coverage Program. Changes include amending the "triggering events" provisions that allow an individual to become eligible for a special enrollment period. NJAC 11:20-1.2, NJAC 11:20-24.2A
Oregon issued a bulletin to clarify the Division's expectations for the special enrollment of individuals who have experienced a loss of minimum essential coverage because their 2017 individual health benefit plan was discontinued. Bulletin 2017-7
Oregon issued a temporary administrative order to establish standards for shortening the period of market prohibition for health carriers that electively withdrew from a market within the state. OAR 836-053-0014
The Centers for Medicare & Medicaid Services issued a notice advising that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage are required to provide coverage of certain specified preventive services without cost sharing. It also addresses religious and moral exemptions from the requirement to provide contraceptive benefits in group health plans and health insurance coverage. CMS Notice dated November 30, 2017
The Centers for Medicare & Medicaid Services issued a notice providing the final 2019 actuarial value calculator methodology. CMS Notice dated December 28, 2017
Utah amended its uniform health billing rule. The list of HIPAA+ electronic data interchange standards was revised. Rule R590-164-6
Utah repealed rules that established the methodology for determining the solvency rating for each insurer who posts a health benefit plan on the internet portal. Rule R590-256
HEALTH MAINTENANCE ORGANIZATIONS
New Jersey amended its external appeals process for Health Maintenance Organizations. NJAC 11:24-8.7
Indiana temporarily repealed its law regarding when certain insurance holding companies are exempt or may request an exemption from filing certain forms for insurers subject to registration under IC 27-1-23-3. 760:1-15.1-3.1
INTERNAL AND EXTERNAL REVIEW
Texas issued a bulletin that notifies health insurance issuers, HMOs, IROs, and URAs in Texas of an upcoming transition and related changes and deadlines for the external review processes for some health plans. Bulletin B-0001-18
LIFE INSURANCE AND ANNUITY SOLICITATION
New Hampshire readopted and amended its law pertaining to life insurance solicitation and disclosure. Changes include references to enforcement, regulation of preneed, removal of annuity references, and revision of the suitability provision. Ins 301+
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LIFE SETTLEMENTS / STOLI
Indiana readopted its regulations pertaining to licensure of viatical settlement providers. 760:1-61-4
Utah amended its law that defines how record requests are to be made. All requests must be made in writing by completing the online request form available through Utah's Open Record Portal. Rule R590-151-2, Rule R590-151-3
Wisconsin issued a bulletin that refers to two administrative rules which were published on December 26, 2017 with an effective date of January 1, 2018. The rules pertain to credit for reinsurance and reporting requirements for new officers and directors of domestic insurers. Bulletin dated January 8, 2018
Texas established the rates for maintenance taxes and fees for calendar year 2017 for life, health, and accident insurance and the gross considerations for annuity and endowment contracts, setting them at .040 of 1 percent. 28 TAC s 1.414
REGULATORY REPORTING REQUIREMENTS
Rhode Island published an alert to all foreign insurers and insurance related licensees requiring an e-mail address for the service of process contact. The alert also notes that changes should be reported within 10 days. Industry Alert 2017-5
California amended its law pertaining to annual filings and application requirements for reinsurers. It also provides term and universal life insurance reserve financing exemptions. T. 10 s 2303.21, T. 10 s 2303.25+
REPORTS - ANNUAL / QUARTERLY STATEMENT
Louisiana issued a notice announcing annual reporting requirement changes for health insurance issuers, utilization review organizations and independent review organizations. Notice dated December 15, 2017
New York added forms and instructions to their website to be used for filing 2017 Annual Statements. NY Department of Financial Services Website, Insurance Industry tab
Oregon amended its law to specify the annual and quarterly statement blank versions to be used for submission of 2017 annual statements and 2018 quarterly statements. OAR 836-011-0000
New York published a notice regarding special considerations relating to December 31, 2017 reserves and other solvency issues for life insurers, fraternal benefit societies and insurers accredited for the reinsurance of life insurance, annuities, or accident and health insurance. Special Considerations - Reserves Notice dated 11-14-2017
STANDARD VALUATION LAW
Connecticut issued a bulletin to life, health and accident insurers that the effective date of changes made to the principle-based reserving valuation manual is January 1, 2018. Bulletin FS-32
Oregon amended its regulation to provide that the operative date of the Valuation Manual is January 1, 2018. OAR 836-031-0605
Texas promulgated regulation to adopt by reference the NAIC Valuation Manual, including subsequent changes that were adopted by the NAIC through August 9, 2017. 28 TAC s 3.9901
PBR and 2017 CSO – HELP IS HERE
First Consulting is actively helping clients to incorporate PBR and CSO changes into their products.
Click here to learn how we can help you!
Oregon amended its law relating to the prohibited use of information gathered from consumers. A provision is added to the list of unlawful trade practices concerning statements published on a website or in a consumer agreement. House Bill 2090
Illinois revised its Uniform Unclaimed Property Act. Included in the changes are certain revised definitions, a description of when property and stored-value cards are presumed abandoned and revised reporting requirements. Senate Bill 868
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Is your state one of the nine requiring your Corporate Governance Annual Disclosure (CGAD) report for the first time in 2018? Contact us to find out!
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C. J. Rathbun