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
Arkansas issued a bulletin providing 2018 plan year requirements for Qualified Health Plan certification. Bulletin No. 3-2017
Hawaii issued a memorandum extending transitional health policies through calendar year 2018. Memorandum 2017-3H
Idaho published a bulletin extending transitional plans through December 31, 2018. Bulletin 17-01
Louisiana issued a bulletin informing all health insurance issuers and health maintenance organizations of the requirements relating to the time and manner of product form and rate filings. Bulletin 2017-04
Maine issued a bulletin providing the updated uniform deadlines for rate, form, and QHP filings for non-grandfathered individual and small group health plans with effective dates of coverage during 2018. Bulletin 421
Michigan issued a bulletin regarding 2018 form and rate filing requirements for medical plans both on- and off- marketplace. Bulletin No. 2017-05-INS
Mississippi issued a bulletin providing guidance for filers of individual, small group and stand-alone dental plans, offered inside or outside of (or both) the Federally-Facilitated Marketplace (FFM), that wish to issue or renew plans in Plan Year 2018. Bulletin 2017-1
Montana issued an Advisory Memorandum to provide guidance regarding 2018 health plan form and rate filing requirements. Advisory Memorandum 1 of April 5, 2017
Nebraska updated its Bulletin CB-130 to provide guidance for filers of individual, small group and stand-alone dental plans, offered on and off the Federal Facilitated Marketplace, that wish to issue or renew plans in Plan Year 2018. Bulletin CB-130 (Amended)
New Hampshire issued a bulletin to detail the process issuers must follow to have their non-grandfathered individual and small group health plans certified as Qualified Health Plans (QHPs) to be offered on the federally-operated New Hampshire Health Insurance Marketplace (Marketplace) for calendar year 2018 as well as the standards that apply to QHPs offered on and off the Marketplace. Bulletin of March 27, 2017
Oregon revised its due dates for small group and individual health rates for Plan Year 2018. Rates are now due on May 15, 2017. Announcement dated April 18, 2017
Puerto Rico issued a Ruling Letter extending transitional health insurance renewals to September 30, 2018. Ruling Letter CN-2017-217-AS
South Carolina published a bulletin adopting the federal extension of the transitional policy through calendar year 2018 for health insurers with non-grandfathered health insurance in the individual or small group markets. Bulletin 2017-02 (Addendum D to Bulletin 2013-12)
South Dakota published a bulletin establishing submission deadlines for On- and Off-Exchange Individual and Small Group ACA-compliant health insurance plans. Issuers intending to market or renew such products after January 1, 2018, must comply the the filing deadlines for rates, forms, access plans and binder filings. Bulletin 17-02
Utah issued a bulletin with 2018 plan year requirements for health benefit plans and stand-alone dental plans. Bulletin 2017-1(a)
AGENT / PRODUCER COMPENSATION
New Mexico enacted legislation to allow for payment of insurance agent and broker commissions and other compensation to deceased agents' and brokers' estates. House Bill 80
Tennessee enacted legislation to allow an insurance producer to charge fees for services related to an individual's purchase of an individual major medical policy when the insurer is not paying commission to the producer. The fees must be based on a qualified written agreement signed by the party to be charged in advance of the performance of the services under the agreement. House Bill 428
ANNUITIES / ANNUITY CONTRACTS
Missouri issued a bulletin that provides information on how the annuity illustration standards may apply to participating income annuity illustrations. Bulletin 17-01
IS IT TIME TO UPDATE YOUR ANNUITY PRODUCT LINE?
Whether you’re in need of minor revisions, or it's time to launch brand new products,
or maybe you’re still sorting through issues related to the DOL Fiduciary Rule.
Regardless of the reason, now is the time to contact First Consulting to discuss how we can help.
Click here to learn more.
AUTISM SPECTRUM DISORDERS
Iowa amended its law to require certain health insurance policies to provide coverage for applied behavior analysis for the treatment of autism spectrum disorder. House File 215
Arkansas enacted legislation to revise provisions of its Insurance Code related to formation and operation of captive insurance companies. House Bill 1476
CLAIMS / CLAIMS ISSUES
Kentucky amended its law to provide exceptions to autopsy confidentiality guidelines and criteria for processing an insurance claim under certain circumstances. House Bill 67
Maine amended its law regarding the health care claims data set filing description requirements by exempting TPAs and carriers acting as TPAs for self-funded employee benefit plans regulated by ERISA to submit data for members. Maine also amended certain exclusions and submission requirements. 90-590 s 243-2, 90-590 s 243-3
New Mexico amended its insurance Code to provide for electronic claims payment if requested by a claimant. House Bill 127
CONFIDENTIALITY / PRIVACY
Utah enacted legislation to define the term "identifying information" and to prohibit its dissemination without authorization. Senate Bill 227
Virginia enacted legislation stating that an insurance agent or institution that provides nonpublic personal information to nonaffiliated third parties only in accordance with section 38.2-613, and has not changed its policies and practices regarding such disclosure from the policies and practices disclosed in its most recent notice, is not required to provide an annual notice. House Bill 2422
Idaho enacted legislation creating Chapter 64 of its Code, addressing Corporate Governance Annual Disclosure. House Bill 102
CORPORATE GOVERNANCE ANSWERS? WE’VE GOT THEM!
Want help with CGAD, ORSA and other reporting readiness?
First Consulting has answers! Click here to learn more.
CREDIT FOR REINSURANCE
Idaho enacted legislation amending its insurance code to add a new section and revise provisions regarding credit for reinsurance. House Bill 101; 41-514+
Michigan issued a bulletin providing 2018 form and rate filing requirements for stand-alone dental plans on and off marketplace. Bulletin No. 2017-06-INS
Utah enacted legislation prohibiting a dental insurer from setting fees for dental services that are not covered services under its insurance policy. Senate Bill 44
New Jersey issued a bulletin requesting contact information relating to disaster preparation plans for all insurers authorized or admitted to transact business in the state and noting that any change to such information should be reported, via the address information supplied, within 30 days of such change. Bulletin 17-04
New York issued a circular letter to all authorized life insurance companies, fraternal benefit societies, accident and health insurance companies and health maintenance organizations. The circular letter sets forth the standards expected of insurance companies in planning and preparing for, and responding to, disasters affecting the people of New York State. This circular letter repeals and replaces Circular Letter No. 4 (2015) and Circular Letter No. 5 (2015). Circular Letter 2017-5
DRUG / PRESCRIPTION COVERAGE
Montana amended its law to provide requirements for health insurance issuers if using a maximum allowable cost list or using reference pricing for prescriptions. House Bill 276, 33-22-172
FILING REQUIREMENTS / PROCEDURES
New Hampshire amended its Rule 401 addressing standards and procedures for filing of life, accident and health insurance forms. Among the changes is revision of grace periods from 30 to 31 days, for purposes of consistency across rules. 401.01+
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First Consulting can help! We have a wealth of knowledge on all lines of business
and we have the capacity to handle all sized projects, quickly and efficiently.
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FRAUD / ANTI-FRAUD
Colorado enacted legislation to amend its definition of insurance fraud. House Bill 1048
Delaware amended its Bulletin 15 by updating the link through which the Model Uniform Suspected Insurance Fraud Reporting Form and completion instructions may be accessed by carriers to fulfill their fraud reporting obligations. Insurers opting to use the NAIC Online Fraud Reporting System are encouraged to continue doing so; this update is for those not using the OFRS. Domestic/Foreign Insurers Bulletin No. 15 (revised)
Kentucky amended it law relating to securities fraud by revising the list of violations that are considered to be a Class D felony. House Bill 329
HEALTH INSURANCE - COMPREHENSIVE
Arkansas enacted legislation to add breast ultrasound to the definition of mammography as an essential health benefit for coverage. However, while ultrasound may not be subject to deductible provisions of the policy, it may be subject to copayment provisions. House Bill 2022
Arkansas enacted legislation to require parity in health benefit plan coverage between orally administered anticancer medication and intravenously administered anticancer medication. House Bill 1592
Delaware published a bulletin to clarify that its Admin Code Section 1317, addressing network disclosure and transparency, and the underlying statute do not apply to the dispensing activities of pharmacies operating outside a facility-based setting. Insurers Bulletin No. 95
Minnesota established the Minnesota Premium Security Plan (MPSP) to provide reinsurance to eligible carriers in the individual health insurance market. It requires that in counties where a health carrier actively markets an individual health plan, the health carrier must offer, in those same counties, at least one individual health plan with a provider network that includes in-network access to more than a single health care provider system. HF 5, 62K.10
Montana amended its law pertaining to coverage for telemedicine services. Senate Bill 129, 33-22-138
New York issued a circular letter regarding health insurance coverage for breast tomosynthesis (3-D mammograms) and whether or not prohibitions against annual deductibles and coinsurance for mammography screenings and diagnostic imaging for the detection of breast cancer includes copayments. Circular Letter 2016-2 Supplement 1
New York published a circular letter, to insurers authorized to write accident and health insurance in the state, to clarify coverage for legal dispensation of medical marijuana. If office visits are covered under the insurance policy, the issuer may not deny coverage for the office visit solely on the basis that the visit also resulted in receipt of a medical marijuana certification; however, the insurance law does not require coverage of office visits solely for the purpose of obtaining a certification. Insurance Circular Letter No. 6 (2017)
Virginia enacted legislation to provide that, when there is no amount actually paid or payable to the provider by the insurer, health services plan or HMO for the services provided, the insurer (or other organization) shall use such insurer's (organization's) pre-established allowed amount to calculate the amount payable by the insured for such services. House Bill 2037
West Virginia amended its Code to add new sections addressing step therapy protocols in health benefit plans which provide prescription drug benefits. House Bill 2300
HEALTH INSURANCE / HEALTH RATES
Delaware published a bulletin updating the online address for the application required to be completed in order to rescind a health insurance policy. Domestic Foreign Insurers Bulletin No. 43 (REVISED)
Kentucky enacted legislation regarding health insurance coverage requirements for tobacco cessation medications and services under certain circumstances. Senate Bill 89
Kentucky enacted legislation regarding the use of experimental treatments for terminal illnesses. It states it will not require health insurers to expand their coverage or provide coverage for experimental treatments, although such treatments may be offered. Senate Bill 21
IIPRC / INTERSTATE COMPACT
The Insurance Compact announced an update to the Member State Filing Fee Chart, which is available on the Compact website (http://www.insurancecompact.org/) on the Insurer Resources page. Notice to Filers dated 04-18-2017
LIMITED BENEFIT CONTRACTS
South Carolina issued a bulletin addressing requirements applicable to Hospital Indemnity or other Fixed Indemnity policies sold in the state, withdrawing Bulletin 2014-14 and the previous requirement of attestation to having "minimum essential coverage". Bulletin 2017-01
First Consulting’s experienced staff recently helped our clients
draft and file a number of different Limited Benefit products.
Contact Us today to learn how we can help you!
MANAGED CARE PLANS / HMOS
Vermont published a bulletin stating that each Managed Care Organization subject to Part 5 of Rule H-2009-03 is to annually attest to the Commissioner, on or before July 15, that it is in compliance with requirements of Part 5 and to post electronically a current and accurate provider directory consistent with applicable law. Each MCO subject to Part 6 is to annually file (using the same deadline) a report showing network availability and opportunities for improvement. Insurance Bulletin 192
Arkansas enacted its "Physician Order for Life-Sustaining Treatment Act." The POLST complements an advance directive and converts the individual's intentions into a medical order. Such a document is prohibited from being required as a condition of being insured or receiving healthcare services and rates or fees for insurance coverage or healthcare services cannot be based upon whether it has been executed. Senate Bill 356; 20-6-201+
Delaware issued a bulletin to notify all domestic/foreign insurers that bulletins will appear on the Department's Laws, Regulations and Bulletins page instead of the home page. Bulletin No. 11
Kansas amended its law regarding agreements that may be made among insurers with respect to the equitable apportionment among them of insurance which may be afforded applicants who are in good faith, entitled to but who are unable to procure such insurance through ordinary methods. 40-2101
MISCELLANEOUS HEALTH / ACCIDENT
Arizona promulgated regulation that any policies issued on or after July 1, 2017, providing coverage by a disability or group or blanket disability insurer must provide coverage for lawful health services provided by a health care provider to an insured regardless of the familial relationship of the provider to the insured. Coverage may be limited to those providers who are members of the insurer's provider network. 20-1376.09 and 20-1406.09
MISCELLANEOUS LIFE / ANNUITY
North Dakota amended its Code regarding insurable interest in personal insurance. House Bill 1286
NOTICE TO INSUREDS
Idaho enacted legislation to require that an individual life policy may not be issued or delivered in the state until the applicant is provided the option of designating a person, in addition to the applicant, to receive notice of lapse or termination of the policy for nonpayment of premium. It further requires annual notification of the policy owner of the right to make or change such designation and that a lapse may not be processed until at least 14 days after a notice has been sent to the policy owner and the designee, if designation has been made. House Bill 244
Louisiana amended its emergency regulation regarding the privacy notice requirements under the FAST Act. LAC 37:XIII.9953
Montana amended its laws to, among other things, allow captive insurance mergers, clarify insurers security deposit requirements, amend laws pertaining to insurance exchange continuing education and not allow a life insurer to sell, solicit, or negotiate life insurance, except stand-alone funeral insurance, through a funeral director, mortician, undertaker, or any employee of a mortuary or undertaker. House Bill 137
ORSA: OWN RISK AND SOLVENCY ASSESSMENT
Idaho enacted legislation to adopt ORSA requirements, adding new Chapter 63 to its insurance code. House Bill 100
Kentucky issued a bulletin providing information regarding changes to the annual reconciliation filing requirements, procedures and various tax rates imposed by local governments on premium receipts. Bulletin 2017-1
REPLACEMENT - LIFE & ANNUITY
Missouri amended its regulation of the activities of insurers, agents and brokers with respect to the replacement of existing life insurance and annuities. 20 CSR 400-5.400
Kansas amended the effective date of the risk-based capital instructions promulgated by the NAIC to December 31, 2016. Senate Bill 15
STANDARD VALUATION LAW
Wyoming enacted legislation to adopt the Standard Valuation Law. House Bill 6
New Mexico amended its Insurance Code to remove Stop Loss insurance from the list of Accident and Health insurance products and authorize certain insurers to write Stop Loss liability insurance. House Bill 336; 59A-7-3
Virginia published an Administrative Letter addressing revisions to the rules governing suitability in annuity transactions. Administrative Letter 2017-1
It’s the beginning of the second quarter and you have multiple projects and priorities competing. If this sounds familiar and you find yourself needing additional resources, First Consulting has experienced staff with a breadth of knowledge. Several of our staff members have extensive home office experience and understand your situation.
Some of the more popular excepted benefits products we’ve been working on recently include:
• Hospital Indemnity
• Critical Illness
• Disability Income Insurance
Whether you’re in need of minor revisions or it's time to launch brand new products, it’s time to contact First Consulting to discuss our Product Drafting and Filing Services. First Consulting’s experienced drafting and filing teams can get your products to market in quick and efficient manner! And did you know that Frist Consulting can make SERFF filings on your company’s SERFF instance?
If you aren’t ready for product changes because you’re still sorting through DOL Fiduciary Rule compliance issues, let First Consulting’s DOL Consulting Services help prepare you for the upcoming applicability dates. While many parts of the DOL Fiduciary Rule were delayed until January 1, 2018, there are several key provisions that go into effect in less than a month. Now’s the time to assess your DOL Fiduciary Rule preparedness!
Make First Consulting your first call for annuity product development! Contact me for more information about how we can help or to learn more about Co-Sourcing.