Life and Health News

March 2017

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.

Arkansas updated previously issued 2015 bulletins, stating that the Department will permit a small group issuer to use the 1-100 employees size number for small groups issued in 2016 for purposes of Medical Loss Ratio calculations, but the issuer may elect to use the 2-50 size small group if it does not prefer to take a transition year for 2016 issued policies.     Bulletin No 15B-2015

Colorado amended its regulation regarding content of the Colorado Supplement to the Summary of Benefits and Coverage (COSSBC) required to be available for all health benefit plans covering or marketed to Colorado residents.     3 CCR 702 Reg. 4-2-20

Colorado revised its regulations governing procedures for the submission of reasonable modifications to grandfathered and non-grandfathered individual and small group health benefit plans.     3 CCR 702 Reg. 4-2-27

Delaware issued a bulletin inviting potential QHP issuers to submit a letter to the DOI indicating their intent to apply for participation on the Delaware Marketplace for calendar year 2018. It provides information relating to state-specific certifications, but does not contain proposed timelines for accepting and reviewing issuer/plan/benefit data and supporting documentation.     DOMESTIC/FOREIGN INSURERS BULLETIN NO. 92

Maine issued a bulletin advising that May 2, 2017 has been established as the uniform rate and form filing deadline for all non-grandfathered health plans and stand-alone dental plans subject to the Affordable Care Act in the individual and small group markets in this state, offered with effective dates during 2018.     Bulletin 416

Maryland issued a bulletin regarding filing requirements for individual and small employer form and rate filings for plan or policy years beginning on or after January 1, 2018. The deadlines are provided for plans sold on and off the exchange.     Bulletin 17-02

Ohio issued a bulletin pertaining to changes to definitions of Small Employer and Large Employer for purposes of medical loss ratio reporting and rebate requirements beginning with the 2017 reporting year.     Bulletin 2017-02

California published a notice requiring all licensees and applicants for licenses issued by the CDI's Producer Licensing Bureau to report any changes in background information to the CDI within 30 days of the date the licensee or applicant learns of the change.  Requirements apply to both resident and non-resident licensees and reporting of traffic citations/violations is included if they are felony or misdemeanor offenses.     Notice dated January 13, 2017

California published a notice to all insurers, producers and interested parties, that the CDI is developing an online agent language locator service for its website.  It will allow consumers to search for agents and brokers in a selected ZIP code who speak their chosen language. However, the CDI needs data from agents who speak languages other than English to populate the new locator. The notice provides instructions for the secure portal where agents may do so.     Notice dated January 18, 2017

Ohio enacted legislation requiring insurance providing basic health care services to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders.  Standards for required benefit, prior authorization or prohibited limits are outlined.  This is not applicable to some plans, such as Medicare supplement, specified disease, etc.     House Bill 463, 1751.84

Connecticut published a bulletin addressing financial reporting requirements and deadlines for captive insurance companies.     Bulletin No. FS-4C-16

Hawaii issued a memorandum addressing captive insurance company 2016 annual filing requirements, for filings due in 2017.     Memorandum 2016-4C

Florida amended its regulation addressing uniform claim forms for health and industrial life insurance policies, to establish guidelines for all prior authorization forms to ensure uniformity of such forms, and to adopt a prior authorization form for use by health insurance issuers who do not provide an electronic prior authorization process for use by contracted providers.     69O-161.001

New York issued a circular letter to life insurers and fraternal benefit societies regarding unfair claim settlement practices during the two-year contestability period.     Circular Letter 2017-1

Illinois advised that they must be notified within 30 days of the appointment or election of any new officers and directors.  Biographical affidavits are due at that time for all persons involved in the control, management, or serving as an executive officer upon being newly elected or appointed.  Illinois now requires a third-party background check to verify biographical affidavit information for all new officers and directors.     Email Dated 02-17-17, Bulletin 2016-05, Sections 915.20, 915.30, 915.50

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Utah amended its regulation addressing Credit for Reinsurance, addressing reinsurers maintaining trust funds and certified reinsurers, as well as other information.     R590-173-3

Colorado issued a bulletin addressing access to in-network retail and mail-order pharmacies.     Bulletin No. B-4.96

Massachusetts enacted legislation requiring that all policies, contracts, agreements, plans or certificates of insurance issued, delivered or renewed within the commonwealth that provide coverage for prescription eye drops provide coverage for refills of prescription eye drops.     175:47HH (House Bill 4195)

Michigan amended its law regarding certain fees and no longer requires a fee for the annual statement of foreign and alien insurers effective April 10, 2017.     500.240

Nevada adopted a temporary regulation applicable to certain insurers who are required to pay an annual fee based on written premiums.  The regulation provides the fee schedule and requires the fee to be paid no later than July 1 of each year.     NAC 680C s 1 (LCB File No. T006-16)

New Jersey issued an order advising that no modifications will be made at this time to the current file and use eligibility list.     Order A17-101 dated January 26, 2017

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The Financial Crimes Enforcement Network (FinCEN) issued an advisory on the FATF (Financial Action Task Force)-Identified jurisdictions with AML/CFT (Anti-Money Laundering/Countering the Financing of Terrorism) deficiencies.  The Democratic People's Republic of Korea (DPRK) is listed under Countermeasures and Iran is listed under Enhanced Due Diligence.     FIN-2017-A001

Maine rescinded bulletin 401 pertaining to transitional renewal of large group health insurance policies.     Bulletin 401 Rescinded

Alaska issued a Regulatory Order addressing questions about recent regulation requiring affirmative approval of groups to which group life insurance policies may be issued.  The Order clarifies that single employer, labor union and MEWAs (authorized under AS 21.85) are already approved, but that association or trust groups will require submission to the Director for approval.     Regulatory Order No. R 17-01

Arkansas adopted a rule requiring coverage of craniofacial anomaly reconstructive surgery.     Rule 111

Delaware adopted a regulation to address provider network disclosure and transparency.  Insurers are required to maintain accurate, complete provider directories while facility-based providers and non-network providers are to provide timely written out-of-network disclosures to patients.     Regulation 1317

New York issued a circular letter to all insurers writing accident and health insurance about requirements for coverage of contraceptive services.     Circular Letter 2003-1 Supplement 1

Ohio enacted legislation permitting a terminally ill patient to use an investigational drug, product or device (IDPD) provided certain conditions have been met and the patient has signed a statement of informed consent.  Health care insurers or any entity offering health care benefits are not required to provide coverage for costs incurred from the use of an IDPD.  It also provides qualified immunity to a physician or manufacturer related to providing or distributing the IDPD.     HB 290; 4731.97; 4729.89; 4731.22

Vermont published a bulletin stating its position that insurance coverage may not be denied on the basis that breast tomosynthesis is experimental or investigational, as it is no longer considered to be such.     Bulletin 191

Minnesota amended provisions for certain health insurers to address appeals pertaining to waiver of network adequacy requirements for waivers in effect on or after January 1, 2017.     Insurance Code: 62K.10

Minnesota enacted legislation, which among other things, establishes a premium subsidy program that helps eligible individuals pay for coverage in the individual health market in 2017.  Health carriers must begin paying a premium subsidy to each eligible individual who purchases a health plan in the individual market and the health carriers may seek reimbursement from the commissioner.  It provides transition of care coverage requirements for calendar year 2017 for the involuntary termination of coverage of health plans.     Uncodified SF 1 s 1 (2017)+

Ohio amended its law to, among other things, require a sickness and accident policy that covers maternity benefits to cover a physician-directed source of follow-up care or a source of follow-up care directed by an advanced practice registered nurse (APRN).     House Bill 216, Insurance Code: 3923.63

Ohio enacted legislation that, among other things, requires certain health insurance that covers prescription drugs include prior authorization requirements or other utilization review measures as conditions of providing coverage of an opioid analgesic prescribed for the treatment of chronic pain, except under certain circumstances.     Senate Bill 319, Insurance Codes: 3923.851 and 1751.691

California published a notice regarding legislative changes made to reflect changes in the NAIC Model Holding Company Act Regulations from 2010. It includes an updated checklist with new provisions added.     Notice dated January 24, 2017

Illinois renumbered it regulations regarding acquisition of control of a domestic company.     50 Ill. Adm. Code 651.20, 50 Ill. Adm. Code 651.30, 50 Ill. Adm. Code 651.40

Utah updated its Holding Company regulation to require submission of Enterprise Risk Reports.     Rule R590-70-1

Maine issued a bulletin providing revised inflation protection requirements for long-term care partnership policies.     Bulletin 419

Maine issued bulletins advising that the Maine Long-Term Care Partnership Program has been adopted.  It is a partnership between Maine and private insurers offering long-term care insurance policies.  The procedures to be followed by insurers in order to comply have been revised.     Bulletin 417, Bulletin 418

Washington amended its regulation addressing lapse notification procedures for long-term care insurance companies, requiring them to be able to demonstrate compliance with the regulation upon request.     284-54-253

Arkansas adopted a rule that participating provider agreements shall not establish fees providers may charge for services or materials not covered by a vision benefit plan and vision care providers may not charge fees higher than their normal fees for such services. Also, the agreement shall not restrict the provider's choice of optical labs, sources or suppliers of services or materials provided to an insured.     Rule 113

Illinois renumbered regulations pertaining to variable contracts.     50 Ill. Adm. Code 1551.10+

Washington adopted the 2017 CSO mortality tables.     284-74-525

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Connecticut amended its regulation regarding notice to enrollees to state that, for purposes of triggering the filing period for an external review request, notice of an adverse determination is deemed to have been received by the covered person five calendar days after the notice is mailed.     38a-591-8

Oregon adopted a new rule regarding submission of ORSA (Own Risk and Solvency Assessment) summary reports comparable to the process described in the July 2014 edition of the NAIC ORSA Guidance Manual.     836-011-0030

Florida amended its regulation prescribing various premium tax returns and reports made by insurers.     FAC 12B-8.003

Tennessee's Attorney General issued an opinion addressing the state's Prepaid Funeral Benefits Act regarding whether mortal remains transport plans qualify as "pre-need funeral contracts" under the act.     Opinion No. 17-07

Minnesota amended its law concerning public access to proposed changes to rates filed for individual health plans and small group health plans.     Insurance Code 60A.08

Colorado amended its regulation governing annual health reporting and data retention requirements.     3 CCR 702 Reg. 4-2-31

Oregon amended its regulation regarding Annual Statement Blank and Instructions to make the forms applicable for the 2016 reporting year.     836-011-0000 (Amended)

Connecticut published a bulletin addressing financial filing and other requirements for Risk Retention Groups doing business, registered or domiciled in the state.     Bulletin FS-4RR-16

The District of Columbia enacted legislation to adopt the risk-based capital trend test ratio of the NAIC and to clarify that fraternal benefit societies are subject to the District's risk-based capital requirements.     I - B 610

Georgia mandated electronic payment for annual renewal and financial statement filing fees.     DIRECTIVE 17-EX-2

Kentucky issued a bulletin providing notice of the implementation of principle-based reserving and provides the operative date of January 1, 2017 for adoption of the NAIC Uniform Valuation Manual.     Bulletin 2016-3

Minnesota amended its law regarding claims settlement provisions in stop loss policies for small employers.     Insurance Code: 60A.236

Florida issued an Informational Memorandum to notify all insurers and HMOs that, if they engage a third party to provide services, it remains the sole responsibility of the insurer or HMO to provide for competent administration of its programs.  Further, the insurer/HMO is responsible for conducting a semi-annual review of the administrator's operations when the administrator administers benefits for more than 100 certificate holders.     Informational Memorandum OIR-17-01M

Delaware enacted legislation to significantly update its unclaimed property laws, to ease administration, clarify organization and incorporate technological developments to improve efficiency and predictability in their application.     Senate Bill 13

Arkansas adopted a rule to implement its "Prior Authorization Transparency Act," requiring Utilization Review entities to update quarterly the required statistics and to maintain such information for at least a rolling three year time period.     Rule 115

Colorado reissued its bulletin addressing preauthorization of treatments or procedures by health carriers.     Bulletin B-4.13

Washington adopted regulations, under Chapter 284-43A, governing independent review organizations (IROs), as authority over them transferred from the Department of Health to the Office of Insurance Commissioner.     WAC 284-43-3010