Life and Health News
January 2022
Welcome to our latest newsletter! As a thought leader in the Insurance Industry for over 50 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!
CAPTIVES
Connecticut's Insurance Department issued a bulletin regarding financial reporting requirements for captive insurers. This pertains to captive insurers domiciled in Connecticut as well as captives not domiciled in Connecticut but doing business there. It also applies to Risk Retention Groups formed as captives. Bulletin FS-4C-21
CREDIT FOR REINSURANCE
Colorado amended the Credit for Reinsurance Regulation to bring Colorado law into alignment with revisions to the NAIC Credit for Reinsurance Model Regulation (Model Regulation 786). Regulation 3-3-3
Texas adopted new regulations for credit for reinsurance. The changes eliminate collateral and physical presence requirements for certain insurers and regulate aspects of reserve financing. 28 TAC Sec. 7.614 - 7.616
CREDIT INSURANCE
Indiana's Insurance Department announced revised credit life and credit accident and health insurance rates based on the state's triennial review. Bulletin 262
DISASTER / CATASTROPHIC EVENT
Wisconsin's Commissioner of Insurance informs health carriers of the credentialing of temporary licensed health care providers during the COVID health emergency. Health care providers credentialed in another state may provide care in Wisconsin if they apply for a temporary license within 30 days. Health carriers are asked to refrain from making coverage determinations based solely on the fact a health care provider is operating under a temporary license. Bulletin dated December 2, 2021
DRUG / PRESCRIPTION COVERAGE
Arkansas promulgated a rule that requires a health insurer, HMO, hospital medical services corporation, self-insured governmental or church plan, or Arkansas Medicaid program that provides coverage for prescription eye drops to provide early refills under certain conditions. Rule 120
Arkansas promulgated a rule to implement the administration of coverage for use of certain off-label drug treatments to treat patients diagnosed with acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection. Rule 127
Arkansas promulgated a rule regulating Medication Step Therapy Protocols for group health benefit plans that provide prescription drug coverage. Rule 107
FINANCIAL REGULATION
New York's Department of Financial Services adopted the NAIC Accounting Practices and Procedures Manual as of March 2021. It also added language regarding risk-based capital. 16th Amendment to 11 NYRCC 83, Regulation 172
HEALTH INSURANCE - COMPREHENSIVE
Arkansas promulgated Rule 106 establishing minimum standards for the creation and maintenance of networks by health carriers and to assure the adequacy, accessibility and quality of health care services offered under health benefit plans. This regulation complies with the federal requirement that Qualified Health Plans provide sufficiently accessible medical providers. Rule 106
Delaware's Department of Insurance issued a bulletin to health insurers regarding the Department's authority and intention to enforce certain provisions of the Federal No Surprises Act. Domestic & Foreign Insurers Bulletin No 127
The Federal Department of Health and Human Services (HHS) published Frequently Asked Questions (FAQs) regarding Notice of Consent requirements and the No Surprises Act pertaining to out-of-network providers and facilities. FAQs dated December 22, 2021
Georgia's Insurance Commissioner reminds health insurers that HB 454 goes into effect on January 1, 2022. This law requires an insurer to reimburse a provider at in-network rates for 180 days if the provider is listed as participating in the insurer's provider directory at the time a covered person elects their benefit plan, and that provider then becomes out of network subsequent to open enrollment in the succeeding plan year. Bulletin 21-EX-16
Nevada's Insurance Department provides guidance to comply with NRS 679B.124. This law requires the commissioner to develop, prescribe and make available a form letter that a health carrier must use to notify a provider of health care of the denial of the application to be included in the carrier's network of providers. Bulletin 21-001 Revised
New Hampshire's Insurance Department issued a bulletin regarding the Federal No Surprises Act and State Balance Billing Protections. The Commissioner gives guidance relating to state and federal law differences. Bulletin INS 21-103-AB
New York's Department of Financial Services amended Regulation 62 to add Section 52.16(p). This section requires policy language prohibiting an insured from paying a copayment, coinsurance, or annual deductible for visits to a provider to diagnose COVID or laboratory tests to diagnose COVID. A carrier must provide written notice to its in-network providers that they cannot collect a copayment, deductible, or coinsurance for these services. 57th Amendment to 11 NYCRR 52, Regulation 62
Ohio's Insurance Department adopted a rule protecting insureds against surprise medical billing. The rule pertains to reimbursement for unanticipated out-of-network care. OAC 3901-8-17
Washington's Insurance Commissioner issued a memorandum to self-funded plans that opted-in to Washington's Balance Billing Protection Act with an "Auto Renewal" option. When each group renews on and after January 1, 2022, it will be protected from balance billing under both state law and the Federal No Surprises Act. The two laws will work together. Washington state law will apply first and where state law does not provide protection, the federal law will be initiated. Each group must consider whether it is more advantageous to continue to be protected by one or both laws. Memorandum dated December 7, 2021
INTERNAL AND EXTERNAL REVIEW
New Jersey's Insurance Department updated the address, email, phone number and other contact information of the Insurance Claims Ombudsman for consumers seeking review of disputed claims. NJAC 11:25-1.3
MISCELLANEOUS
Arkansas adopted a rule to implement the Insurance Business Transfer Act. The rule sets standards and procedures for the transfer of insurance policies from a transferring insurer to an assuming insurer and completely transfers all risks, obligations, and liabilities to the assuming insurer. Rule 126
REGULATORY REPORTING REQUIREMENTS
Federal DOL, HHS and IRS issued interim final regulations implementing the requirement for group health plans (insured, self-funded, non-federal governmental plans, church plans, others) and insurers who write group and individual health insurance to report prescription drug and health care spending to the federal government. Enforcement action will not be initiated against plans or insurers that submit the required data for the 2020 and 2021 reference years by December 27, 2022. 5 CFR Part 890; 26 CFR Part 54; 29 CFR Part 2590; 45 CFR Part 149
Maryland's Insurance Commissioner adopted a new regulation regarding filing of nonquantitative treatment limitation comparative analysis reports by carriers for Mental Health Benefits and Substance Use Disorder Benefits. COMAR 31.10.51.01
RISK RETENTION GROUPS
Connecticut issued a bulletin to risk retention groups regarding 2021 and 2022 Financial Filing and other requirements. This applies to Risk Retention Groups doing business, registered, or domiciled in Connecticut. Bulletin FS-4RR-21
RISK-BASED CAPITAL
New York's Department of Financial Services promulgated a new regulation dealing with risk-based capital. 11 NYCRR 77, Regulation 220
SERVICE AND ADMINISTRATIVE FEES
Delaware's Insurance Department issued a bulletin directed to insurance carriers that issue health benefit plans in Delaware. The bulletin provides updates for assessment year 2022 and reminds applicable carriers of their obligation to pay the assessment. Domestic & Foreign Insurers Bulletin No. 113 (Reissued)
UTILIZATION REVIEW - HEALTH CARE
Kentucky issued an Advisory Opinion to all insurers with health lines of authority and all Utilization Review entities licensed in Kentucky regarding its interpretation of utilization review requirements. Licensees must notify their agents and employees of the interpretation which is effective for all new and renewed Utilization Review applications beginning January 1, 2022. Advisory Opinion 2021-05