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.
AFFORDABLE CARE ACT
Alabama issued a bulletin correcting bulletin 2017-02, providing the age curve for the individual and small group health insurance market in plan year 2018. Bulletin 2017-03
Alaska published a bulletin regarding non-grandfathered plan extended transition. Bulletin 17-03
Missouri issued a bulletin providing notice of key filing dates for health benefit plan coverage to be offered in the 2018 plan year. Bulletin 17-03
South Carolina issued a bulletin as Addendum D to Bulletin 2013-12, addressing the extension of transitional policies through calendar year 2018. Bulletin 17-02
South Carolina issued a memorandum with the filing timeline for non-grandfathered health insurance and stand-alone dental plans to be offered for the 2018 policy year. Memorandum dated April 21, 2017
Utah published a bulletin addressing 2018 plan year requirements for health benefit plan and stand-alone dental plan filings subject to PPACA. Bulletin 2017-1(a)
AGENT / PRODUCER COMPENSATION
Arizona revised its statutes to require that insurance producers shall not charge or receive a fee or service charge in addition to the premium in connection with the transaction of insurance unless both of the following apply: 1) the fee and the specific services for which it's charged are disclosed and agreed to in writing by the insured and 2) the amount of fee is reasonably related to the cost of the service rendered and doesn't duplicate or increase any fee or service charge included in the insurer's rate filing. House Bill 2279
Maryland enacted legislation allowing for insurance producers to charge and collect certain expenses from insureds for payment of policy premiums and other fees or taxes by credit card, subject to specified conditions. House Bill 800
AGENT / PRODUCER CONTINUING EDUCATION
Arizona enacted legislation stating that a producer may not solicit the sale of an annuity product unless he has adequate knowledge of the product and is in compliance with the insurer's standards for product training. A producer with a Life insurance line of authority is required to complete at least a one-time 4 credit hour annuity training course provided pursuant to Section 20-2904. House Bill 2160
AGENT / PRODUCER LICENSING AND APPOINTMENT
Connecticut announced that the Department has launched a new licensing website with online tools that allow agents and brokers to apply, renew, update and print a license, find continuing education classes and get the latest news from the licensing division. Notice dated April 20, 2017
ANNUITIES / ANNUITY CONTRACTS
Montana enacted legislation to prohibit annuities from charging a surrender penalty after 10 years from the date of issuance or from the date of the most recent voluntary deposit not required by the contract. However, the insurer must provide written notice of any surrender penalty imposed under the contract, including subsequent notices if the annuitant voluntarily contributes separate premium deposits. Senate Bill 222
Georgia enacted legislation addressing captive insurance companies. Senate Bill 173
Vermont enacted legislation addressing captive insurance companies and annual reports, licensing, security by trust fund or funding by irrevocable letter of credit and various definitions. House Bill 85
CLAIMS / CLAIMS ISSUES
Arizona amended its statutes to include an article addressing out-of-network claim dispute resolution, and, specifically, "surprise out-of-network bills." Senate Bill 1441
Arkansas amended its law addressing medically necessary foods used in the treatment of congenital errors of metabolism, requiring that plans issued, delivered, amended or modified in the state after January 1, 2018, provide minimum benefits for specified medical foods. House Bill 1900; 23-79-703+
Colorado issued a bulletin providing guidance regarding the acceptable reimbursement levels and coverage for prosthetics, pursuant to Section 10-16-104(14), C.R.S. Bulletin B-4.97
Kentucky amended its law to redefine the term "mammogram" to encompass digital mammography including breast tomosynthesis. House Bill 78; KRS 304.17-316
Maryland amended its insurance law addressing insurance reimbursement for the services of licensed counselors and therapists to include licensed clinical professional art therapists. House Bill 298; Section 15-704
Maryland enacted legislation to prohibit carriers, except under certain circumstances, from imposing a deductible, copayment or coinsurance requirement for diabetes test strips. House Bill 730; 15-822
Massachusetts issued a bulletin addressing its General Laws Chapter 176O, §27, which requires the Division to develop a common summary of payment (SOP) form for use by commercial health insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and Health Maintenance Organizations. The SOP form must be issued to insureds and must meet the requirements specified in the bulletin. Bulletin 17-02
Montana enacted legislation establishing hold harmless requirements for patients and dispute resolution processes for air ambulance providers and insurers. Insurers or health plans are to assume the covered person's responsibility, if any, for amounts charged in excess of allowed amounts for covered services, supplies, applicable copayments, coinsurance and deductibles when a covered person receives services from a non-Montana hospital-controlled out-of-network air ambulance service for an emergency medical condition. Senate Bill 44
Montana revised its health insurance laws to expand freedom of choice of practitioners to include licensed marriage and family therapists. House Bill 469
Nebraska enacted legislation prohibiting insurers of: group or individual health policies; hospital, medical or surgical expense-incurred policies; or self-funded employee benefit plans (to the extent not preempted by federal law) from excluding a service from coverage solely because it is delivered through telehealth instead of in-person consultation between a licensed health care provider and a patient. Legislative Bill 92
New Jersey issued a bulletin to all health service corporations, hospital service corporations, medical service corporations, health insurance companies, health maintenance organizations, organized delivery systems and other interested parties providing information about the implementation of Chapter 28, which requires certain coverage for treatment of substance use disorders and places certain restrictions on opioid and other prescription drugs. Bulletin 17-05
New York issued a Circular Letter stating that every issuer of accident and health insurance must provide coverage for infertility treatment to any individual who meets ASRM's (American Society for Reproductive Medicine) definition of infertility when all of the other terms and conditions of the policy are satisfied, regardless of the individual's sexual orientation, marital status or gender identity. Insurance Circular Letter No. 7 (2017)
North Dakota enacted legislation creating a new section of its Code addressing informed decisionmaking in choosing air ambulance service providers, preferred provider arrangement requirements for insurance prior authorization for air ambulance services and air ambulance subscriptions. Senate Bill 2231
Oklahoma enacted legislation prohibiting a health benefit plan that provides coverage for prescription eyedrops from denying coverage for refills under specified conditions. House Bill 1819
Oklahoma enacted legislation requiring health benefit plans to provide for synchronization of prescription drug refills and prorate cost-sharing charges for prescription drugs under specified circumstances. House Bill 1824
West Virginia enacted legislation to expand its law preventing receipt of property, including proceeds from insurance, by the person convicted of feloniously killing another. The law now includes those convicted of causing the death of an incapacitated adult and those convicted of abuse or neglect of an incapacitated adult. House Bill 2404; 42-4-2
CONFIDENTIALITY / PRIVACY
Illinois adopted an amendment to its regulations regarding annual privacy notices, exempting licensees from having to provide them if the licensee: 1) provides nonpublic personal information to nonaffiliated third parties only in accordance with Sections 4002.130, 4002.140 and 4002.150; and 2) has not changed its policies and practices with regard to disclosing nonpublic personal information from the policies and practices that were disclosed in the most recent disclosure sent to consumers in accordance with Section 4002.40. However, if at any time a licensee fails to comply with any of the criteria described, the licensee will be required to provide the annual notice and all licensees are required to provide the initial privacy notices required by Section 4002.40. 50 IAC 4002.50
Maine amended its insurance law to conform it to federal law on the subject of annual privacy notices. In the case of policy renewal, reinstatement or a change in insurance benefits, a notice must be provided if a change has been made to the regulated insurance entity's information practices. For renewals, the notice must be provided by the renewal date and for reinstatements or benefit changes it must be provided upon the carrier's receipt of the request. 24-A MRSA s 2206, sub- s 1
Montana amended its Insurance Code effective October 1, 2017, to replace the requirement for annual notice of a licensee's privacy policies and practices with a requirement for notification within 60 days after any material change, other than typographical, in the licensee's privacy policies or practices. However, delivery of notice continues to be required upon delivery of any new product or service or upon reinstatement, if any notices already provided are no longer current. 33-19-202
Nebraska enacted legislation to relieve licensees from the annual privacy notice requirement if the licensee: 1) provides nonpublic personal information to nonaffiliated third parties only in accordance with sections 44-913 to 44-915; and 2) has not changed its policies and practices with regard to disclosing such information from the policies and practices that were disclosed in the most recent disclosure to consumers. Legislative Bill 241
Texas amended its regulation to provide an exception to the annual privacy notice requirement. 28 TAC s 22.9
Wisconsin promulgated an emergency rule to provide an exception to the annual privacy notice requirement when a licensee provides nonpublic personal information only in accordance with the chapter and the licensee has not changed its policies and practices with regard to disclosing nonpublic personal information from the policies and practices that were disclosed in the licensee's most recent disclosure to consumers. Emergency Rule 25.13
Ohio promulgated a rule to establish the procedures for filing, and the required content of, the corporate governance annual disclosure. Rule 3901-3-19
FIRST CONSULTING HAS CGAD COVERED
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Colorado enacted legislation prohibiting an insurance carrier from setting fees for dental services not covered in the insurance policy. Senate Bill 190
DISASTER / CATASTROPHIC EVENT
Arkansas issued bulletins addressing a major disaster declaration for several counties affected by severe storms, tornadoes and floods and announcing a 60-day moratorium on cancellation/nonrenewal of policies for nonpayment of premiums. However, interested policyholders must request the delay. Bulletin 5-2017; Bulletin 5A-2017; Bulletin 5B-2017
Missouri issued a bulletin, contemporaneous with the State of Emergency declared by the Governor in Executive Order 17-13, requesting that all insurers licensed in the state allow coverage to remain in force for any Missouri resident residing in a county affected by recent severe flooding. Further, the Department requests that health insurers allow insureds affected by flooding to receive out-of-network care as if it were in-network. Executive Order 17-16 extends the State of Emergency to June 11, 2017, unless further extended. Bulletin 17-04
Oklahoma enacted legislation authorizing electronic delivery of certain insurance documents, declaring electronic delivery of documents to be legally equal to mail delivery, specifying terms of consent for electronic delivery, requiring verification of receipt of delivery in certain situations, prohibiting denial of policy due to electronic delivery of documents or withdrawal of consent for electronic delivery and providing other related details. Senate Bill 372
FILING REQUIREMENTS / PROCEDURES
New Hampshire adopted revisions to its regulations to establish standards and procedures for the filing of life, accident and health insurance forms to be used within the state to facilitate consumer understanding in the purchase of life, accident and health insurance and the coverages provided. Ins 401
New Mexico issued a bulletin to all insurance carriers that offer or administer life or health related insurance plans requiring that forms delivered or issued for delivery be brought into compliance with the Insurance Code and applicable regulations no later than January 1, 2018. The Bulletin refers to examples of forms that are not compliant, displayed on the OSI website. Bulletin 2017-003
THE BATTLE BETWEEN WORK AND VACATION
It’s hard to believe that Memorial Day weekend has already passed!
This holiday typically ushers in the start to the summer vacation season,
and that can often become a difficult time for managers to balance workloads and letting their staff take vacations.
Click here to find out how First Consulting can help!
FRAUD / ANTI-FRAUD
Oklahoma announced that the Anti-Fraud Annual Fee is due by July 1, 2017, and must be paid electronically. OPTins will be the website used to process electronic payments and registration for OPTins may take up to 2 weeks. Special Notice dated May 3, 2017
Utah revised its Mandatory Fraud Reporting rule to indicate a new email address for submitting a report directly to the commissioner: firstname.lastname@example.org. R590-248-4
Arkansas amended its Code section addressing group health policies and the requirement that they provide benefits for conditions arising from mental illness. Benefits may be limited within parameters specified, which vary for small versus large groups. 23-86-113
Washington enacted legislation to allow funeral planning and funeral services to be included with group life or group disability insurance as a non-insurance benefit, but requires disclosure that the benefit does not constitute an insurance funded prearrangement contract. Senate Bill 5042
Minnesota enacted legislation to allow group life insurers to limit payment to a beneficiary to the amount of premiums that have been paid to the insurer under the policy if the insured's death occurs directly or indirectly as a result of the insured's furtherance of terrorism. House File No. 1397
HEALTH INSURANCE - COMPREHENSIVE
Georgia enacted legislation requiring major medical policies to provide coverage for the billed charges of one hearing aid per hearing impaired ear not to exceed $3000.00 per hearing aid for covered individuals 18 years old and younger. Such coverage is also to provide for the replacement of hearing aids every 48 months and, in the event a hearing aid is determined to be unable to be adjusted to meet the needs of the patient, to provide for a replacement within 2 months of such determination. Senate Bill 206
Vermont issued a bulletin reminding insurers of the Department's position on the importance of offering tobacco cessation programs and communicating to members and providers the availability of the programs. Bulletin 193
HEALTH MAINTENANCE ORGANIZATIONS
New Jersey issued Public Notice 17-1 regarding minimum net worth requirements for health maintenance organizations and the increase in the medical component of the Consumer Price Index. Existing HMOs are required to make adjustment for the minimum net worth no later than July 1, 2017 and the required deposit is due by the same date. Public Notice 17-1
Texas promulgated a new version of Title 28, Chapter 11, to implement several Code chapters applicable to HMOs, effective August 1, 2017. 28 TAC s 11.1 +
INTERNAL AND EXTERNAL REVIEW
Colorado enacted legislation concerning required provisions in contracts between health insurance carriers and health care providers addressing medical communications regarding disagreements in health care decisions. Specifically, the carrier may not take adverse action against a provider because the provider expresses disagreement with its coverage decisions. House Bill 1173
MEDICARE SUPPLEMENT INSURANCE
Idaho adopted a rule to implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act. IDAPA 18.01.54
Massachusetts issued a bulletin providing a PDF of their Addendum to "2017 Guide to Health Insurance for People with Medicare." Regulations require the addendum to be provided along with the annual federal publication "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare" to persons eligible for Medicare. Bulletin 17-03
Maine revised its insurance law to include a new section prohibiting an insurer from limiting or refusing to issue coverage to an individual who donates all or part of an organ while still living. This prohibition applies to any life, disability or long-term care insurance policy. 24-A MRSA §2159-D
MISCELLANEOUS HEALTH / ACCIDENT
Colorado enacted Article 49 of its Code, entitled "Transparency in Health Care Prices Act." 25-49-101+
MISCELLANEOUS LIFE / ANNUITY
Michigan issued a bulletin that supersedes Bulletin 2016-12-INS and allows a new cemetery or funeral maximum assignment value of $10,540. Bulletin 2017-04-INS
Indiana enacted legislation to update its Insurance Code. Among other things, it notes acceptable forms of proof of mailing and updates producer continuing education requirements. House Bill 1318
ORSA: OWN RISK AND SOLVENCY ASSESSMENT
Maryland enacted legislation to require certain carriers to maintain a risk management framework, requiring carriers or insurance groups to conduct an Own Risk and Solvency Assessment (ORSA) and requiring certain carriers to submit ORSA reports to the Insurance Commissioner. Senate Bill 8; 32-101 through 32-110
West Virginia enacted legislation to provide requirements for maintaining a risk management framework, completing an own risk and solvency assessment and instructions on filing an ORSA summary report with the Insurance Commissioner. House Bill 2619; 33-40B-1 through 33-40B-11
Massachusetts issued a bulletin stating that the Division expects all carriers to permit those covered in individual health plans to make premium payments in a non-electronic manner. Carriers may permit insureds to choose to make payments via the internet or withdrawal from their banks, but the choice to make payments electronically rests with the insured. Bulletin 17-01
Arizona revised its statutes relative to insurance tax payments, allowing the Director to require that reports and payments be submitted electronically. House Bill 2069
REPORTS - DATA CALLS & OTHER REPORTS
Georgia issued a data call to all insurers issuing benefit payments under a health benefit plan in order to collect rate statistical data. Submissions are to include paid claims data for services incurred January 1 to December 31, 2016 which are paid by the time the insurer submits the data filing to the Department. Submission deadline is Friday, June 16, 2017. Forms and additional instructions are on the website at: www.oci.ga.gov/Insurers/ACRfiling.aspx. Directive 17-EX-4
New Hampshire issued a Supplemental Data Request to all licensed health insurance companies, health maintenance organizations, fraternal benefit societies and third party administrators. The requirements for submitting data are similar to the requirements for submitting claims data under INS 4000. Carriers should confirm that they have applied the same reporting criteria to both submissions or identify and explain differences. Bulletin of April 7, 2017
New Mexico issued a data call requiring all life and health insurance forms from previously approved matrix filings, that the insurer intends to continue to use be submitted to OSI no later than January 1, 2018. "Matrix" means forms compiled of multiple "insert pages" with differing form numbers or made up of interchangeable bracketed provisions. Forms approved before OSI use of SERFF must have a complete copy, including the approval date, submitted and ones approved via SERFF must be listed by their SERFF tracking numbers. Bulletin 2017-004
Tennessee promulgated emergency rules to provide the basis for assessing the minimum reserve standards for individual and group accident and health insurance policies in accordance with the National Association of Insurance Commissioners Life and Health Valuation Manual. TAC 0780-1-69-6+
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New Mexico issued a bulletin announcing that, as of July 1, 2017, medical stop loss is defined and regulated exclusively as a casualty product, not a health product. Health carriers as well as casualty carriers may continue to issue stop loss coverage in the state, but forms must have first been submitted through the Property/Casualty business type on SERFF using TOI 17.0025. Additional details are provided in the bulletin. Bulletin 2017-005
THIRD PARTY ADMINISTRATORS
Kansas issued a bulletin noting that, as of June 1, 2017, the Department will not renew nonresident administrator licenses for nonresident administrators holding resident licenses in states other than Alaska, Delaware, Florida, Idaho, Indiana, Missouri, New Hampshire or West Virginia, as those states' laws are similar to those of Kansas. Also, effective January 1, 2018, all administrators holding Kansas licenses will be required to renew by December 31, 2018 for a two year period. Bulletin 2017-2
Delaware issued a bulletin to remind any/all persons and companies engaged in any aspect of the business of insurance, that it is unlawful to “[make] any assertion, representation or statement with respect to the business of insurance or with respect to any person in the conduct of the insurance business, which is untrue, deceptive or misleading.” It is the Department’s position that any explanation to any consumer that suggests the Department is responsible or otherwise the cause for any premium rate increase constitutes a violation of 18 Del. C § 2304(2) and will be prosecuted accordingly. Universally Applicable Bulletin No. 1
Nebraska enacted legislation to adopt the Unclaimed Life Insurance Benefits Act, requiring an insurer to perform a comparison of its in-force policies and retained asset accounts against a death master file at least semi-annually and to take prescribed actions upon finding a potential match. The comparison applies to group policies when the insurer's records include specified information. Legislative Bill 137
UTILIZATION REVIEW - HEALTH CARE
New Hampshire adopted rules requiring health carriers, health maintenance organizations, health service corporations, preferred provider organizations and managed care organizations or those using a utilization review entity to use the Uniform Prior Authorization Form for prior authorization of prescription drugs. Ins 2705.01+
It’s hard to believe that Memorial Day weekend has already passed! This holiday typically ushers in the start to the summer vacation season, and that can often become a difficult time for managers to balance workloads and letting their staff take vacations.
First Consulting can help!
Our experienced team of insurance experts can step in at any stage of your project and bring it to a speedy finish:
Let First Consulting help keep your projects on target. Contact me today to find out more and get a no obligation quote!
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Twenty states have now either introduced or enacted requirements for you to file an annual Corporate Governance Annual Disclosure (CGAD).
Current Board challenges? Haven’t started? Bogged down? We’re here for you!
1. Board training – Tailored, on site or by webinar; and through training slide decks (with presenter notes)
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3. Governance consulting geared to your need – At any touch point in your process, from design or implementation of controls to a second set of eyes on your draft report
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C. J. Rathbun, FLMI, CCEP, HIA, AIRC