Life and Health News

November 2017

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!


California amended its Insurance Code section 1725.5, which requires insurance licensees to prominently feature their license numbers on business cards, written price quotations and print advertisements distributed exclusively in the state.  The section now requires the word "insurance" to be featured in type at least as large as the smallest telephone number or 12-point type, whichever is larger.     Ins s 1725.5


California amended its Insurance Code to require health insurers to file with the department all required rate information for nongrandfathered individual health policies on the earlier of 100 days before October 15 of the preceding policy year or the date specified in the federal guidance. The section also specifies information to be disclosed in the filing. The change is effective January 1, 2018.     10181.3

California enacted legislation addressing annual open enrollment periods for on-exchange and off-exchange health plans for policy years beginning on or after January 1, 2019.     Assembly Bill 156

The Centers for Medicare and Medicaid Services, Center for Consumer Information and Insurance Oversight issued a notice addressing 2017 hurricane disasters and special enrollment periods, termination of coverage and grace period flexibilities provided to those affected by the qualifying events.     CMS Notice dated September 28, 2017

The Centers for Medicare and Medicaid Services, Center for Consumer Information and Insurance Oversight issued a notice addressing the Hyde Amendment, which prohibits taxpayer funding for abortion (with limited exceptions).  Qualified Health Plan issuers are required to take specific steps to prevent use of certain funds. Failure to adhere to requirements could result in decertification or civil monetary penalties.     CMS Notice dated October 6, 2017


New Jersey readopted its laws regarding insurance-related activities that require licensure as an insurance producer and producers' standards of conduct.     NJAC 11:17A-1.1+; NJAC 11:17A-2.1


California enacted legislation to revise the Knox-Keene Act, to require a qualified autism service professional or a qualified autism service paraprofessional to be supervised by a qualified autism service provider for purposes of providing behavioral health treatment.     Assembly Bill 1074; 10144.51


California clarified its Insurance Code section 396 regarding persons to receive notice of lapse, termination, expiration, nonrenewal or cancellation of a policy for nonpayment.     Ins s 396


Tennessee amended its regulations regarding financial and reporting requirements the Commissioner deems necessary for the regulation of captive insurance companies. The changes are effective December 21, 2017.     0780-1-41.01+

Tennessee published a bulletin to provide guidance to its captive insurance industry in light of Accounting Standards Update 2015-09 issued by the Financial Accounting Standards Board (FASB). The FASB update addresses disclosures about short-duration contracts as defined in Topic 944, Financial Service - Insurance.     Bulletin 17-01


California amended its insurance code to address redomestication of insurers to the state, to require admitted insurers to retain all financial condition records for the current year plus 5 previous years, and to add a section requiring insertion of a license number (with specified text size) into any business cards, written price quotations and print advertisements distributed exclusively in the state for insurance products, among other changes.     Assembly Bill 1696


Delaware issued a bulletin addressing data breaches of confidential consumer information. The Department requests that companies which experience an unauthorized release of information notify the Department within 24 hours.  Further, it recommends that companies use closed-faced envelopes to mail information to consumers, as windowed envelopes may expose personal information.     Universally Applicable Bulletin 3


South Dakota amended its regulations addressing credit for reinsurance, adding sections on trusts, investment companies, own risk and solvency assessments, letters of credit, and reinsurance agreements, among other topics.     20:06:31


South Carolina’s Director issued an order approving 2018 rates for credit accident and health insurance sold in conjunction with loans subject to the South Carolina Consumer Protection Code. Insurers must notify the Department by December 1st of each year of their intention to use rates higher than those promulgated.     Order 17-02; Order 17-03


Alabama's governor proclaimed a state of emergency due to threat of Tropical Storm Nate.  It allows for extension of emergency refills of prescription medication from a 72-hour supply to a 30-day supply and for pharmacists covered by section 34-23-40 of the Alabama Code to use their good judgment in refilling prescriptions for non-controlled substances where prescription documentation cannot be supplied.  Refill of controlled substances requires prescriptions or other documentation.     Proclamation 10-05-17

Florida issued an emergency order due to the effects of Hurricane Irma.  The order addresses grace periods and temporary postponement of cancellations or nonrenewals.     Emergency Order 214271-17-EO

New York issued a circular letter to all domiciled insurers that issue insurance policies that may be impacted by Hurricanes Maria and Irma in Puerto Rico, the U.S. Virgin Islands and other affected areas. Among other things, carriers should work towards fair and speedy resolutions of claims and recognize that affected policyholders may be delayed in paying premiums.     Circular Letter No. 17 (2017)

The Financial Crimes Enforcement Network (FinCEN) issued a notice that financial institutions affected by Hurricanes Harvey, Irma and Maria should contact FinCEN and their functional regulator as soon as practicable to discuss any delays in their ability to file required Bank Secrecy Act reports.  Further, they are encouraged to keep FinCEN and their functional regulators informed as their circumstances change.     FinCEN Notice dated October 3. 2017


Delaware enacted legislation prohibiting health insurance policies from limiting or excluding coverage for treatment of stage 4 metastatic cancer using an approved FDA drug by mandating that the insured first fail to respond to other drugs. However, use of such drugs must be consistent with best practices and supported by peer reviewed medical literature.     House Bill 120; 18 s 3338B


South Carolina published a bulletin to notify insurers and producers transacting business in the state of legislative changes addressing electronic delivery of insurance policies. Participation by consumers is strictly voluntary and must be provided at no cost to the consumer. Further, insurers may not cancel, refuse to issue or refuse to renew a policy because a consumer refuses to agree to receiving mailings electronically.     Bulletin 2017-11


California enacted legislation amending the Insurance Code to reflect the fees currently charged by the Department of Insurance. Updated fees include (among others): registration filing fee; purchasing group registration filing fee; application for amendment of certificate of authority filing fee; certificate of compliance filing fee; application for broker certificate fee; agent licensing fees; broker licensing fees; appointment fee; adjuster licensing fee and annual statement filing fees.     Assembly Bill 1699


Massachusetts provided revised filing guidance for health insurance carriers regarding rate filings, for rates to be effective beginning January 1, 2018 for coverage issued or renewed to merged market (individual/small group) members.     HC Filing Guidance Notice 2017-D (Revised)


New York amended definitions related to financial risk transfers between insurers and accountable care organizations.     11 NYCRR 101.3


California amended its Insurance Code to require that group health insurance covering hospital, medical or surgical expenses provide coverage for preventive care for children age 18 or younger to include screening for blood lead levels for children who are at risk for lead poisoning, as determined by a health care provider in accordance with applicable California regulations.     Assembly Bill 1316

Vermont published a bulletin to provide clarification on the statutory interpretation of 8 V.S.A sections 4080(5), 4514a and 4594, which address group health insurance offered to part-time employees. Insurers are required to offer employers the option of covering employees working 17.5 or more hours weekly and employers can decide whether to cover such employees.     Bulletin 196


New Jersey adopted new rules to identify a peer-reviewed and evidenced-based clinical tool to be utilized by certain health insurers in reviewing medical necessity for the treatment of substance use disorders in the context of determining insurance benefit coverage.     10:163-1.1

New York issued a circular letter to all insurers that write accident and health insurance to provide further direction regarding health insurance coverage for naloxone.     Circular Letter 2017-16

Did you know that in addition to TPA licensing, we also assist with licensing other specialized market operations such as Limited Health Service Organizations and Warranty Service Providers to expand into new jurisdictions?  Click here to learn more.


Delaware enacted legislation to track the National Association of Insurance Commissioner's Model Holding Company Act with respect to the Commissioner's power to examine insurers and have access to books and records of insurers in order to ensure compliance with the Holding Company Act.     House Bill 81


Delaware enacted legislation to adopt the NAIC Model Viatical Settlements Act, to establish strong consumer protections while protecting policyholder rights.     Senate Bill 66


Rhode Island amended its regulations regarding unfair competition and practices as respects domestic partnerships.     SB 432


Texas published a bulletin with Medicare marketing guidelines and agent licensing requirements related to certain Medicare plans and prescription drug plans.     Bulletin B-0036-17

Virginia amended its rules regarding minimum standards for Medicare supplement policies.     14 VAC 5-170-30


Maryland amended its law pertaining to the circumstances under which an insurance producer may commingle premium monies from multiple carriers into one or more premium accounts.     COMAR, COMAR (eff. 1-1-2018)+


Rhode Island enacted legislation providing that patients with substance use disorders shall have access to evidence-based non-opioid treatment for pain, and  coverage shall apply to medically necessary chiropractic care, and osteopathic manipulative treatment.     House Bill 6124

South Carolina issued a bulletin addressing Code Section 38-71-380 which prohibits use of the optional intoxicants and narcotics exclusion found in 38-71-370(9) for medical expense policies.  The prohibition does not apply to all accident and health insurance policies, but to certain types listed in the bulletin.     Bulletin 17-12

Vermont published a bulletin addressing callback screening mammograms. The Department states that screening mammograms, required to be covered at 100%, include any mammograms and qualified physician's interpretation of the results as well as any additional views and interpretations as needed.     Bulletin 195


New York adopted regulations to establish standards for the determination and any readjustment of non-guaranteed elements that may vary at the insurer's discretion for life insurance policies and annuity contracts.     11 NYCRR 48.0, 11 NYCRR 48.1, 11 NYCRR 48.2, 11 NYCRR 48.3

Has your marketing or sales department ever had an idea to provide additional value added services that might seem like rebating at first glance? You might be surprised that these services are allowed in many states and First Consulting is here to help. 
Click here to learn more.


California amended its Insurance Code to require a health care service plan to include notice of the process to obtain continuity of care in its disclosure form and any evidence of coverage issued after January 1, 2018. The plan is to provide a written copy of the information to its contracting providers and provider groups and a copy to enrollees upon request. Also, it must provide such information in a notice to accompany any termination of coverage notice sent under specified circumstances.     Senate Bill 133


South Dakota amended its regulations to adopt the Own Risk Solvency Assessment Guidance Manual, 2014 edition, from the National Association of Insurance Commissioners.     20:06:09


Maryland issued a bulletin relating to payment of insurance premiums with a credit card.  Payments are allowed so long as they are accepted from all insureds, discounts are not given to other forms of payment, no collateral is required, and insureds who pay with a credit card are not given different rates from those with similar risk characteristics.     Bulletin 17-10


Montana adopted a regulation regarding requirements for filing annual reports online.     Regulation 44.5.301, 44.2.302


Washington posted a message on SERFF stating that it would begin using the new functionality allowing it to flag filings for deletion. Users will be given access to download copies of their filings in an easier fashion, so they can maintain copies of the files that are flagged. The OIC will start with the oldest records, but this purge will not affect users who have a data hoster or use Oracle Insurance Compliance Tracker.     SERFF Message 10-09-2017


Connecticut issued a bulletin to inform limited lines travel insurance producers of the changes related to licensing requirements effective October 1, 2017.     Bulletin L-22


New Jersey enacted new legislation that requires life insurers to use the federal death master file to identify potential matches.     Assembly Bill 2511


Has your marketing or sales department ever had an idea to provide additional value added services that might seem like rebating at first glance?

Value added services like:

   ·   Weight Management
   ·   Travel Assistance
   ·   Wellness Program
   ·   Will Preparation
   ·   Gym Member Discounts
   ·   and more….

You might be surprised that these services and more are allowed in many states and First Consulting is here to help:

   ·   determine if the value added service is allowed in each state;
   ·   draft any forms; and,
   ·   file with each state. We’re even able to use your SERFF instance!

Call us today to discuss the Value Added Services your Company is considering, and how First Consulting can keep your new initiatives on track.

Scott Sheffer

Vickie Goodman


You might know that First Consulting & Administration, Inc. assists many insurers and other types of organizations in obtaining and renewing Third Party Administrator (TPA) licensing.

But did you know that we also assist with licensing other specialized market operations such as Limited Health Service Organizations and Warranty Service Providers to expand into new jurisdictions?

We are experienced with each licensing process and with the various state-specific requirements. We’ll advise what materials are needed for each filing, assemble and submit the filings to each jurisdiction, and follow up to secure approval.  Click here to learn more.

Contact me for a no obligation proposal and cost estimate.

John Palmer


The Department of Labor has concluded its regulatory review of the proposed 18 month delay and filed a rule with the Office of Management and Budget. While limited information is currently available, it’s expected that there will be an 18 month extension of the transition period and delay of applicability dates. First Consulting continues to monitor the DOL Fiduciary Rule and can keep you up to date on the latest developments. Contact me if you have questions about the delay and how it will impact your business or if you would like to receive future updates on the DOL Fiduciary Rule.

Jason Robbins