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!
AFFORDABLE CARE ACT
Louisiana issued a bulletin to all health insurance issuers and health maintenance organizations to give notice that Bulletin No. 2011-03, issued on December 29, 2011, is rescinded. It provided guidance regarding the definition of "small employer" for the purposes of reporting medical loss ratio (MLR) under the Patient Protection and Affordable Care Act. Bulletin 2018-03
AGENT / PRODUCER CONTINUING EDUCATION
Wyoming amended and repealed sections of its regulation governing continuing education. Ch. 20 s 2+
AGENT / PRODUCER LICENSING AND APPOINTMENT
Louisiana adopted a regulation that sets forth requirements and procedures for applying for and maintaining a license as an insurance producer, claims adjuster, public adjuster, insurance consultant and business entity acting as a producer. LAC 37:XIII.15501
Delaware amended its regulation regarding the arbitration of health insurance disputes between individuals and carriers. The amendment to the definition of "authorized representative" will sunset on January 1, 2020 unless expressly reauthorized prior to that date. Regulation 1315
Hawaii issued a memorandum to captive insurance companies providing requirements for the 2017 annual filings that are due in 2018. Memorandum 2017-9C
CLAIMS / CLAIMS ISSUES
Louisiana amended its regulation pertaining to coordination of benefits for all accident and health products and health maintenance organization products that are issued on or after January 20, 2018. LAC 37:XIII.301+
New Jersey amended its regulation for health benefit plans regarding prompt payment of claims and requirements for denied and disputed claims. NJAC 11:22-1.6
CONFIDENTIALITY / PRIVACY
Delaware updated a bulletin issued in December 2017 to provide clarification on the circumstances under which an annual privacy notice is not required. The bulletin was updated on January 8, 2018. Domestic-Foreign Insurers Bulletin 97 (Updated)
New Jersey amended its law to clarify the scope of corporate by-laws and provide that by-laws may include a forum selection clause. Assembly Bill 2162
New Jersey amended its law to permit a corporation to impose reasonable limitations or conditions on use or distribution of books and records by shareholders. Assembly Bill 2975
IMPORTANT CGAD ALERT!
Is your state one of the nine requiring your
Corporate Governance Annual Disclosure (CGAD)
report for the first time in 2018?
Click here to learn more!
Nebraska published guidelines pertaining to the interest rate on death proceeds. The interest rate to be paid on death proceeds not paid within 30 days of receipt of proof of death is 3.214%, effective October 19, 2017. 2018-1
New Jersey amended its law by extending health benefits coverage of a newborn infant to 60 days instead of 31 days. Assembly Bill 2665, 17B:27-30, 17B:27-56
DISASTER / CATASTROPHIC EVENT
Puerto Rico published a ruling that repeals the grace period established in Ruling Letters No. CN-2017-221-D, CN-2017-222-D, and CN2017-227-D for the payment of premiums due on or after January 15, 2018. CN-2018-231-D
Wisconsin amended its law to lower the annual fee for appointing or renewing an appointment for nonresident agents to $30. The reduction is effective January 1, 2019. 601.31
Connecticut issued a bulletin regarding filing requirements for individual and small employer group health insurance policies subject to the Affordable Care Act (ACA). Bulletin HC-90-18
Connecticut issued a bulletin that sets forth the requirements for all rate filing submissions for health insurance. Bulletin HC-81-18
Maryland issued a bulletin to provide guidance to insurers, nonprofit health service plans, health maintenance organizations and dental plan organizations ("carriers”) regarding filing requirements for individual and small employer form and rate filings for plan or policy years beginning on or after January 1, 2019. Bulletin 18-03
Oregon amended its regulation to require insurers offering individual and small group health benefit plans that spend less than 12% of total medical expenditures on payments for primary care to include with each health benefit plan rate filing a plan to increase spending on payments for primary care by at least one percentage point each year. OAR 836-053-0473
Oregon updated its product standards for pediatric dental forms and rates and the product standards for limited wraparound or similar coverage. A list of current filing forms can be found at http://dfr.oregon.gov/rates forms/Documents/current-filing-forms.pdf. Oregon Email dated 1-31-18
DRAFTING AND FILING BACKLOG?
Has your marketing department ever needed
a policy form developed and filed yesterday,
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First Consulting can help. Click here to learn more.
Illinois issued a bulletin to the chief actuaries of life/accident and health insurance companies concerning financial reporting, health insurance reporting and the valuation manual. Company Bulletin 2018-01
Wyoming promulgated a new regulation to establish uniform, national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and universal life insurance policies with secondary guarantees. Ch. 69 s 1+
HEALTH CARE EXCHANGE / MARKETPLACE
The Centers for Medicare & Medicaid Services (CMS) is providing additional opportunities to enroll in Federally-facilitated Exchange (FFE) coverage for individuals affected by the recent hurricanes in Puerto Rico and the U.S. Virgin Islands. The notice applies to Federally-facilitated Exchange (FFE) Qualified Health Plan (QHP) and Stand-alone Dental Plan Issuers. CMS Notice dated January 17, 2018
HEALTH INSURANCE / HEALTH RATES
Arizona amended a subsection of the regulation governing the reasonableness of benefits in relation to premium charged for individual disability insurance policy forms. The effect of the rule change is to expand the number of policies that meet the low-dollar premium category to reflect pricing in the current insurance market. R20-6-607
New Jersey amended its law to require health benefits coverage for donated human breast milk under certain conditions. Senate Bill 2976
New Jersey amended its legislation to require health insurers to provide coverage for digital tomosynthesis for screening and diagnostic purposes related to breast cancer. Assembly Bill 2793
New Jersey enacted legislation to prohibit health insurance carriers from requiring optometrists to become part of a vision care plan as a condition to becoming a provider in the carriers’ panel of providers and to prohibit certain practices under vision care provider contracts. Assembly Bill 2336
Oregon issued a bulletin to insurers offering health benefit plans. If the Director declares that a disease outbreak exists, health benefit plans must cover the cost of necessary vaccinations or similar preventative measures to prevent the spread of the disease. Bulletin 2018-1
The District of Columbia amended its law to require insurers to cover certain health care services without cost-sharing, to require that insurers authorize dispensing of up to a 12-month supply of a self-administered hormonal contraceptive prescribed and dispensed by a licensed pharmacist and to provide to certain employers a religious exemption from, or accommodation for, the coverage of contraceptive products and services. Bill 106, 31-3834.01
INTERNAL AND EXTERNAL REVIEW
Delaware amended its regulation pertaining to the internal and external review processes for health insurance claims. Regulation 1301
LONG-TERM CARE INSURANCE
Illinois issued a bulletin asking that long-term care premium increase filings include policyholder notification letters. The Department is also requesting that these filings comply with specified sections of the Senior Issues Task Force Model Bulletin (Aug 9, 2013); and for purposes of demonstrating compliance with minimum loss ratio standards after a proposed rate increase, the future projected incurred claims are to be calculated on a best-estimate basis. Company Bulletin 2018-01
MEDICARE SUPPLEMENT INSURANCE
South Carolina adopted changes concerning Medicare Supplement standards. Effective January 1, 2020, the standardized benefit redesignated as Plan G with a high deductible may be offered to any individual who was eligible for Medicare prior to January 1, 2020. Regulation 69-46
Louisiana issued a bulletin advising all risk bearing entities and insurers that they are required to provide accurate contact information to the Commissioner. They must also annually certify via electronic means the accuracy of the name, mailing address, phone number, and electronic mail address of individuals appointed as contact representatives. Bulletin 2018-02
Nebraska issued a notice on January 31, 2018 regarding the Department's physical location within the Terminal Building. The suite number was changed from "Suite 400" to "Suite 220". The PO Box mailing address and phone numbers remain the same. January 31, 2018 Notice
First Consulting editorial note: The Department’s website has been updated to show that the Terminal Building location is temporarily closed due to a fire that occurred on February 19, and a temporary location has been established in the lower level of the State Office Building, 301 Centennial Mall South.
2018 COMPLIANCE TRAINING, ARE YOU PREPARED?
First Consulting’s training is the simple and inexpensive way
to satisfy the state training requirements
for your Home Office and TPA staff.
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Florida amended its rule regarding premium taxes, fees and surcharges. The rule provides revised links to certain forms and revised website and telephone contact information. FAC Rule 12B-8.003
New Mexico issued a bulletin to all insurers to clarify the application of Medical Insurance Pool ("MIP") credits to premium tax liability. Bulletin 2018-001
REPORTS - DATA CALLS & OTHER REPORTS
New Hampshire issued a bulletin to health insurers regarding annual network adequacy reporting submission procedures. Bulletin INS-18-005-AB of February 2, 2018
California issued a bulletin to licensed life insurers advising that the Department adopted an aggregate annual assessment tier table for fiscal year 2017-18. Bulletin 2018-1
Wyoming amended its regulation that governs suitability in annuity transactions. Ch. 64 s 1+
Ohio amended rules to clarify the explanation of the selection process for state-initiated involuntary examinations. Provisions were also added regarding the closing review. Rule 1301:10-1-01, Rule 1301:10-3-04
Has your marketing department ever needed a policy form developed and filed yesterday, but you are too backlogged to get to it on a timely basis? First Consulting can help.
First Consulting’s Drafting and Filing services will provide:
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2018 Is flying by fast! Has your company prepared for their 2018 compliance training yet? First Consulting’s training is the simple and inexpensive way to satisfy the state training requirements for your Home Office and TPA staff.
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C. J. Rathbun
LICENSING ASSISTANCE FROM FIRST CONSULTING
In addition to our insurer and third party administrator licensing services, First Consulting & Administration, Inc.’s licensing services are also available to other industry entities such as Discount Medical Plan Organizations, Limited Health Service Organizations, Pharmacy Benefit Managers and Warranty Service Providers.
Our team of dedicated professionals have years of experience navigating the license process and are able to assist you from start to finish. We can advise you on the materials needed for each filing, assemble the filings, and follow up to secure approval of the filings.
Contact me today, or click here to learn more about our TPA and specialty licensing services.