Life and Health News

May 2018

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

Kentucky repealed its regulation regarding Kentucky Health Benefit Exchange eligibility and enrollment in a qualified health plan as these administrative regulations were rendered obsolete with the promulgation of 900 KAR 10:200, Kentucky State Based Exchange on the Federal Platform.     900 KAR 10:030


AGENT / PRODUCER CONTINUING EDUCATION

Alabama amended its law regarding producer and service representative continuing education requirements. The changes are effective January 1, 2019.     27-8A-1 and 27-8A-2

Nebraska amended its law to eliminate prelicensing education requirements.     Legislative Bill 743, 44-4053, 44-4056


AGENT / PRODUCER LICENSING AND APPOINTMENT

Florida amended several regulations regarding agent licensing, renewal and education requirements for agents who are members of the military or military veterans effective July 1, 2018.     HB 29; 497.453; 497.466; 517.12; 626.171; 626.732; 626.7851; 626.8311; 626.927

Indiana amended its law which provides that when an individual who applies for an insurance producer license in Indiana was previously licensed for the same lines of authority in another state, the individual is not required to complete any prelicensing education or examination.     27-1-15.6-9

New Mexico approved a new regulation regarding appointments of insurance producers, continuation of appointments and termination of producer contracts.     13.4.2.29 NMAC

New Mexico enacted legislation with regard to obtaining a temporary insurance producer license.  The regulation provides conditions and limitations pertaining to such a license.     13.4.2.25 NMAC

Oklahoma published a notice that beginning May 1, 2018, Prometric will administer the examinations for insurance licenses.  Oklahoma is not changing exams or exam content outlines.     Special Notice 04 06 18 New Exam Vendor

Texas posted a notice on their website stating that the expiration date for producer and adjuster licenses has changed to the last day of the person's birth month beginning April 17, 2018. The notice is on the Agent and Adjuster Licensing Notices page.     Texas Department of Insurance Website


ANNUITIES / ANNUITY CONTRACTS

Rhode Island issued a bulletin providing the form for use in compliance with Life Annuity Mortality Table for use in Determining Reserve Liabilities for Annuities.     Bulletin 2018-4


AUTISM SPECTRUM DISORDERS

Idaho issued a bulletin regarding coverage of treatments for autism spectrum disorder.     Bulletin 18-02

Kentucky amended its law to require health benefit plans to provide coverage for the diagnosis and treatment of autism spectrum disorders. Coverage must not be subject to any maximum annual benefit limit, including any limits on the number of visits an individual may make to an autism services provider.     House Bill 218; 304.17A-142


BENEFICIARY

Iowa amended its law to provide that a beneficiary of a life insurance contract who has been convicted of one of the listed felonies that was perpetrated against the insured, in the six months prior to the insured's death, is not entitled to any benefit under the policy or contract.     Senate File  467; Section 633.535


CLAIMS / CLAIMS ISSUES

Idaho amended its regulation relating to civil action regarding claims for damages.     SB 1277; 12-120;  7-1503


CORPORATE GOVERNANCE

Wyoming enacted legislation to create the Insurance Corporate Governance Annual Disclosure Act effective July 1, 2019.  No insurer or insurance group will be required to file the disclosure required by this act until 2020.     SF0007; 26-29-239;  26-54-101 - 26-54-108


IMPORTANT CGAD ALERT!
Is your state requiring your Corporate Governance Annual Disclosure (CGAD) report for the first time in 2018? Click here to learn more!


CYBERSECURITY

Michigan amended provisions regarding cybersecurity incidents and cybersecurity plans.     House Bill 4973; 15.232;  15.243

Oregon amended its law to revise the definition of personal information to include information or combinations of information that a person reasonably knows or should know would permit access to a consumer’s financial account, provides notice requirements upon a breach of security, and provides technical safeguards when disposing of personal information.     Senate Bill 1551; 646A.602; 646A.604; 646A.606; 646A.608; 646A.610; 646A.622


DENTAL INSURANCE

Michigan issued a bulletin regarding 2019 form and rate filing requirements for stand-alone dental plans on and off the marketplace.     Bulletin No. 2018-08-INS


DISCRIMINATION

Idaho enacted legislation to prohibit discrimination against living organ donors in the offering, issuance, cancellation, price or conditions of a life insurance policy, disability insurance policy or long-term care insurance policy, or in the amount of coverage provided under such policy.     SB 1302; 41-1852


DRUG / PRESCRIPTION COVERAGE

Florida amended its regulation regarding the prescription drug monitoring program and prescribing and dispensing certain controlled substances.     HB 21; 465.0155; 465.0276; 921.0022; 893.055

Ohio issued a bulletin regarding certain pharmacy benefit prohibited practices, effective April 3, 2018.     Bulletin 2018-02

Virginia amended its regulation relating to prescription drug coverage and synchronization of medications.     HB 234; 38.2-3407.9:04


FILING REQUIREMENTS / PROCEDURES

New Mexico adopted a rule applicable to all life and health insurers issuing life or health insurance policies sitused in New Mexico to clarify the use of forms previously filed and approved on a matrix basis for New Mexico-sitused group policyholders or for individual policies issued to New Mexico residents.     13.6.1.1 NMAC dated 12-26-17, 13.6.1.5 NMAC+

Oregon enacted legislation to require insurers to file all schedules and tables of premium rates for life and health insurance to be used on risks, and file any amendments to or corrections of such schedules and tables.  Insurers must also include information regarding drug reimbursement under certain circumstances.     House Bill 4005, 743.018


FILINGS: HEALTH

Michigan issued a bulletin pertaining to 2019 form and rate filing requirements for medical plans on and off the marketplace.     Bulletin No. 2018-07-INS

Montana issued a memorandum regarding 2019 requirements for health plan form and rate filings. This memorandum provides instructions for on and off-exchange health plans. New templates for 2019 must be filed even if no changes were made to the underlying policy forms.     Advisory Memorandum of April 2, 2018


DISCLOSURE STATEMENTS FOR INDEMNITY PLANS – WILL YOU BE FIRST OR LAST?
As a result of the Tax Cuts and Jobs Act of 2017, the disclaimer language, required for fixed indemnity and hospital indemnity plans, no longer includes information regarding the individual mandate penalty. Click here to learn how First Consulting can help you to re-file.


FRATERNAL BENEFIT SOCIETIES

Indiana amended its law concerning the annual statement filed by a fraternal benefit society.     27-11-8-2


FRAUD / ANTI-FRAUD

Delaware issued a bulletin regarding the insurance fraud reporting form.     Bulletin No. 15 (revised)

Iowa amended its law relating to the receipt of pecuniary damages by insurers as victims of insurance fraud.  It clarifies the definitions of "pecuniary damages" and "victim" to provide that an insurer paying a victim’s insurance claim is not a victim and does not have a right of subrogation.  However an insurer may be a victim if insurance fraud has been perpetrated against the insurer.     House File 2238; Section 910.1

Virginia amended its Consumer Protection Act regarding certain fraud crimes.     HB 304; 59.1-200


GROUP HEALTH

Iowa amended its regulation for carriers offering group health insurance coverage by making a technical update to remove reference to "organized delivery systems".     191-35.24; 191-35.27


SUMMER OVERLOAD – ARE YOU READY?
The summer months can often be difficult for managers trying to balance letting staff take time off while still getting all the work completed.  Click here to learn how First Consulting can help.


GUARANTY ASSOCIATION

Idaho amended the long-term care and health benefit provisions of the Idaho Life and Health Guaranty Association Act .     HB 548; 41-4303; 41-4308; 41-4309


HEALTH CARE EXCHANGE / MARKETPLACE

Arkansas issued a bulletin regarding 2019 plan year requirements for qualified health plans, stand-alone dental plan certification, and ACA-Compliant and off-marketplace health plan requirements.     Bulletin No. 4-2018


HEALTH INSURANCE / HEALTH RATES

Alabama issued a bulletin regarding extension of transitional relief to all health insurance issuers, health care service plans and health maintenance organizations. Transitional relief in both the individual market and small group market may be continued consistent with guidance from the Department of Health & Human Services dated April 9, 2018.     Bulletin No. 2018-01

Florida amended its code regarding coverage requirements for services by nonparticipating providers.     627.64194

Florida amended its regulation regarding coverage for midwife and nurse-midwife care.     627.6406; 627.6574

Florida enacted new legislation relating to direct primary care agreements, effective July 1, 2018.     HB 37; 624.27

Indiana enacted legislation to provide prior authorization requirements that a health plan must comply with under certain circumstances.     House Bill 1143, 27-1-37.5-1+

Iowa enacted legislation regarding health care services delivered by telehealth. A contract or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.  It also specifics certain classes of third-party payment providers and excludes certain types of coverage.     House File 2305; 514C.32

Kentucky amended its law relating to child support enforcement of health care coverage to provide that health care coverage includes the fee for service, health maintenance organization, preferred provider organization, and other types of private health insurance and public health care coverage under which medical services could be provided to a dependent child.     Senate Bill 108; 403.211

Kentucky amended its regulation that establishes guidelines for coordination of benefits by group health insurance contracts.     806 KAR 18:030

Kentucky enacted legislation providing clarification to health insurers of requirements relating to traumatic brain injury treatment for veterans.     House Bill 64, Uncodified HB 64 s 1 (2018)+

Kentucky repealed its regulation regarding minimum standards for treatment of alcoholism within group health plans.     806 KAR 18:010

Maine amended its law regarding coverage requirements for preventive services provided by health plans.     HP1015, 24-A s 4320-A

Maine enacted legislation requiring health insurance coverage for certain services provided by naturopathic doctors. Includes provisions regarding limits, deductible, copayment, coinsurance and network participation.     24-A MRSA §4320-K, SP0337

Oregon amended its code requiring health benefit plans to reimburse the cost of bilateral cochlear implants to also include coverage for programming and reprogramming cochlear implants if medically appropriate for the treatment of hearing loss. An insurer must also contract with pediatric audiologists in sufficient numbers and geographic locations.     House Bill 4104, 743A.140, 743A.141

Oregon amended its insurance code to require an insurer offering a health benefit plan and a health care service contractor to reimburse an out-of-network provider for emergency services or other covered inpatient or outpatient services provided at an in-network health care facility.     Senate Bill 1549; 743B.287

Oregon enacted legislation that requires an insurer that offers a health benefit plan that reimburses the cost of an osteopathic manipulative treatment provided by an osteopathic physician to reimburse the cost of the evaluation conducted by the osteopathic physician that resulted in the osteopathic manipulative treatment.     House Bill 4107, Uncodified HB 4107 s 2 (2018)

Puerto Rico published a ruling pertaining to the extension of the transition policies applicable to certain health insurance in the individual and small group market.     Ruling CN-2018-238-AS


HEALTH MAINTENANCE ORGANIZATIONS

Florida amended its regulation regarding liability for health services for health maintenance organizations, effective July 1, 2018.     641.3154

Florida amended its regulation regarding time limit on contract delivery for health maintenance organizations.     HB 465; 641.3107


INDUCEMENTS

Arizona amended its regulation regarding prohibited inducements by increasing the maximum aggregate value to $100 (had been $25).     HB 2098; 20-452


ADVERTISING COMPLIANCE EVENT and SOCIAL MEDIA MINI-BOOTCAMP
Has your team attended the premier advertising compliance conference? This seminar will share advertising and social media compliance expertise and insight to help you maintain regulatory and ethical compliance. Click here to learn more!


LONG-TERM CARE INSURANCE

Colorado amended several regulations concerning dementia disease and related disabilities.     HB 18-1091; 10-16-102; 10-16-413.5; 10-19-103; 10-19-107

Illinois amended its regulation pertaining to long-term care insurance.  It provided annual rate certification requirements, premium rate schedule increases for policies subject to loss ratio limits related to original filings and amended the initial filing requirements.     50 Ill. Adm. Code 2012.30+

Iowa amended its regulation for long-term care insurance by amending the notice of internal appeal decision to revise the address the request must be sent to and removing the $25 filing fee.     Regulation 191-39.45; 191-39.46


MEDICARE SUPPLEMENT INSURANCE

Iowa amended its regulation regarding creditable coverage for Medicare supplement benefits by making a technical update to remove reference to "organized delivery systems".     191-37.3

Montana amended its regulation applicable to Medicare supplement benefit plan standards for 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020.     6.6.507F


MISCELLANEOUS

Alabama approved a bill regarding chiropractic agreement requirements. These agreements are not considered to be insurance under state law.     SB 234; Uncodified SB 234 s 2 (2018)

Colorado amended regulations concerning modernizing terminology related to behavioral health.     SB 18-091; 10-16-102; 13-21-103; 13-21-117; 25-1-801; 25-1-802; 25-49-102

Florida amended its regulation relating to consumer report security freezes, effective July 1, 2018.     HB 953; 501.0051

Idaho amended its regulation regarding dividends and other distributions to shareholders.     HB 454; 41-3812

Idaho amended its regulation relating to authorization for out-of-state insurers pertaining to interstate insurance sales.     SB 1288; 41-306

Idaho amended its regulation relating to fees for a security freeze, effective July 1, 2018.     SB 1265; 28-52-106

Oregon amended its law to prohibit insurers from requiring that a person appoint, or refrain from appointing, a health care representative as a condition for insurance.     House Bill 4135, 127.565

Virginia amended its code regarding reimbursement for services rendered during pendency of physician's credentialing application, effective July 1, 2018.     HB 139; 38.2-3407.10:1

Virginia amended its law regarding home hospice programs and disposal of drugs, effective July 1, 2018.     HB 501; 32.1-162.5:1

Virginia amended its regulation relating to security freezes on credit reports.     HB 1027


CORPORATE CHANGE?  SAVE YOUR TIME!
Training staff to handle UCAA filings may be a one-time event and the experience gained may not be used again for several years, if at all. Take advantage of First Consulting’s experienced staff as you plan for these events. Click here to learn more.


OMNIBUS LEGISLATION

Indiana enacted legislation which among other things, pertains to genetic testing results of an insured without the consent of the insured, standard valuation law requirements and an appeal of a health maintenance organization's grievance resolution.     Senate Bill 6, 34-30-2-77.9, 27-1-12.8-23

Iowa amended its law pertaining to unfair methods of competition and unfair or deceptive acts or practices to remove the exclusion for long-term care insurance.  It also repeals the requirement that the DOI establish an information clearinghouse where Iowans can obtain information about health care coverage that is available.     House File 2237, 507B.4, 505.32

Utah amended several regulations concerning health insurance coverage.  Among many other things, this includes modifications to definitions and requirements for filing a binder for health/dental policy; allows an insurer to terminate coverage of a spouse of an insured under an accident and health insurance policy in the event of legal separation; prohibits an insured from charging any additional amount for electing to extend group coverage, and repeals certain sections.     HB 39; 17B-2a-818.5; 31A-1-301; 31A-22-612; 31A-22-722


PREMIUM TAX

Kentucky issued a bulletin to provide the current position of the Kentucky Department of Insurance regarding local government premium tax.     Bulletin 2018-01

Oklahoma enacted legislation regarding taxable income of an insurance company and imposed limits on deductions.     House Bill 1011; 68 s 2358


PRE-NEED CONTRACTS

Michigan issued a bulletin that supersedes Bulletin 2017-04-INS, dated April 21, 2017. It allows a life insurer to write a life insurance policy or annuity contract which is subject to an assignment of the proceeds of the insurance policy or annuity contract as payment for cemetery or funeral services or goods.  Accordingly, the new cemetery or funeral maximum assignment value, effective June 1, 2018 through May 31, 2019, is $10,770.     Bulletin No. 2018-06-INS

Tennessee amended its regulation relating to travel protection services for pre-need insurance.  Any contract excluded from the definition of "pre-need funeral contract" is not a contract of insurance.     Title 56 and Title 62, Chapter 5, Part 4


PUBLIC RECORDS

Idaho amended its regulation regarding public records exempt from disclosure.     SB 1274; 74-106


REPLACEMENT - LIFE & ANNUITY

Rhode Island amended its regulation regarding replacement of existing life insurance and annuities.     230-RICR-20-25-4


REPORTS - ANNUAL / QUARTERLY STATEMENT

Indiana companies required to file an annual statement with the department shall submit the company's statement on the Annual Statement Blank prepared in accordance with NAIC Annual Statement Instructions, and following practices and procedures prescribed by the Accounting Practices and Procedures Manual.     27-1-3-13

New Hampshire issued a bulletin to health insurance companies, health maintenance organizations, fraternal benefit societies and third party administrators addressing the annual statement supplemental reporting requirement with respect to health insurance coverage. Carriers and TPAs must submit data summarizing the carrier’s business from the immediately preceding calendar year by June 30, 2018.      Bulletin INS-18-015-AB of March 30, 2018

New Jersey issued a bulletin to advise all domestic insurers, health maintenance organizations, dental service corporations and dental plan organizations of how the Department will handle all requests under the Open Public Records Act, or common law rights of access to government records, for production of the annual financial statements supplemental compensation exhibits.     Bulletin 18-03


RISK-BASED CAPITAL

Indiana amended its insurance code regarding risk based capital requirements by amending the definition of health insurer and the requirements for filing risk-based capital reports.     27-1-36-9.3

Kansas amended its law relating to risk-based capital instructions to amend the definition of “RBC instructions” to reference the version of the instructions promulgated by the NAIC that became effective on December 31, 2017.     40-2c01


UNCLAIMED PROPERTY

Indiana amended its Unclaimed Property Act so that a time deposit that is automatically renewable is considered matured upon the expiration of its initial period except for under certain circumstances.     Senate Bill 376; 32-34-1-20

Virginia amended its regulation regarding abandoned property, financial organizations, bank deposits and other funds.     55-210.3:01


UTILIZATION REVIEW - HEALTH CARE

Alaska issued a bulletin regarding utilization review and benefit determinations, grievance procedures and external review regulations for health care insurers.     Bulletin B 18-05


DISCLOSURE STATEMENTS FOR INDEMNITY PLANS – WILL YOU BE FIRST OR LAST?

As a result of the Tax Cuts and Jobs Act of 2017, the disclaimer language, required for fixed indemnity and hospital indemnity plans, no longer includes information regarding the individual mandate penalty for policies issued after January 1, 2019.

Michigan has released Bulletin 2018-04-INS and additional states are sure to release information too.

Get ahead of the curve and get your forms refiled.

First Consulting’s experienced team can quickly update your forms and get them filed with each state……and we can do it on your SERFF instance.

Contact me today to learn more on how we can help with all of your drafting and filing needs.

Vickie Goodman
816.391.2735
Vickie.Goodman@FirstConsulting.com


CERTIFICATE OF AUTHORITY SERVICES

Is there a change on the horizon for your Company?

If a corporate change (e.g., control, merger, name), or an expansion into additional jurisdictions, or product lines is in your Company's future, let First Consulting assist with the Uniform Certificate of Authority Application (UCAA) process.

Our experienced staff can assist you with this process. Don’t waste time training your staff on this process when it may not be needed again for years, if at all.

Click here for information on how First Consulting can assist you with UCAA filings.

John Palmer
816.391.2744
John.Palmer@FirstConsulting.com


SUMMER OVERLOAD – THE COMPLIANCE HELP YOU NEED

The summer months can often be difficult for managers trying to balance letting staff take time off while still getting all the work completed. Have you figured out how you are going to accomplish this?

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!

Sean Cox
816.391.2737
Sean.Cox@FirstConsulting.com