Life and Health News

October 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!


New York amended its insurance law relating to accelerated death benefits payments and special surrender values.  The amendment removes a language restriction for life insurers who are also long-term care insurers.     Assembly Bill 7584


New York amended its general business law and now requires telemarketers to disclose that a call is being recorded.     Senate Bill 4361


Tennessee amended its regulation regarding Navigator and Certified Application Counselor registration requirements.     TAC 0780-1-55-.5


New York amended its insurance law regarding education for agents, brokers, and adjusters by adding a new subsection regarding satisfying the continuing education requirements for any biennial licensing period.     Assembly Bill 117


Arkansas issued a bulletin stating that it has experienced difficulties verifying information due to applicants' use of a name other than their legal name. Effective immediately, all applicants for licensure must use their legal name on any documentation submitted to the Department. The legal name is the one on any current state, federal or military identification and if any changes occur during the licensure period, the Department needs at least 30 days written notice.     Bulletin No. 15-2017

Illinois amended its producer license application process regarding felony convictions that would otherwise be grounds to deny, non-renew, or revoke a license and incorporates rehabilitation provisions.     Senate Bill 1688, 215 ILCS 5/500-30, 215 ILCS 5/500-70

Illinois amended provisions concerning financial institutions transacting insurance business to stipulate that producer licensing is not required under specified circumstances.     HB 759; 215 ILCS 5/1403


California enacted legislation to require insurers to return to the owner all funds due for surrendered annuity contracts as expeditiously as possible upon a surrender request, but no later than 45 days from the date of surrender.  The insurer may require specified elements in writing as part of the surrender request and the contract must include language setting forth the requirements for such surrender. This applies to annuities issued on/after January 1, 2019.     Assembly Bill 1398

New York amended its insurance law to specify that the holder may elect to reinvest dividends under individual or group participating income annuities.     Assembly Bill 7152


South Carolina published a bulletin providing the annual adjustment of the maximum benefit for coverage of behavioral therapy. The maximum is increased to $55,600 for the calendar year beginning January 1, 2018.     Bulletin Number 2017-09


Delaware enacted legislation to provide for dormant captive insurance companies, specifying qualifications for the status and requirements applying to it.     House Bill 87


New Mexico issued a bulletin in response to inquiries received by the Company Licensing Bureau. The bulletin interprets the New Mexico Insurance Code for all insurers who have been issued a Certificate of Authority (COA) or are seeking a COA to transact one or more lines of insurance.     Bulletin 2017-011


Delaware amended its Code addressing breaches of security involving personal information and measures to be taken in that event, with differing requirements depending on the specific information compromised.     House Bill 180


New Mexico issued a bulletin pertaining to the adjustment of presumptively acceptable credit life insurance and credit accident and health insurance premium rates.     Bulletin 2017-012


North Carolina amended its law regarding health plan disclosure and notification requirements to no longer exempt stand-alone dental plans.     House Bill 140, 58-3-227


Alabama announced its transition to a new version of State Based Systems (SBS), which was live on September 21, 2017. The revision provides new tools including Lookup, License Manager, Report Generator and SBS for Organizations functions.     SBS Implementation Flyer


Florida published a notice to all health insurers, managed care organizations and other health entities addressing Hurricane Irma, reminding them of their compliance responsibilities relative to Section 252.358, which allows for early prescription refills in the event the Governor has issued an Executive Order declaring a State of Emergency.  The mandate remains in effect until the Executive Order is rescinded or expires.     Notice dated September 5, 2017

Georgia issued a directive encouraging insurers to provide relief to policyholders after Hurricane Irma, including leniency where premium payments may be tardy due to disruption of services after the storm and ensuring that policyholders affected by cancellation or nonrenewal notices or adverse underwriting decisions have sufficient time to address their insurance needs.     Directive 17-EX-7

North Carolina issued a bulletin to remind insurers providing health benefit plans of compliance requirements for obtaining extra prescriptions during a state of emergency or disaster.      Bulletin 17-B-4

Texas issued a bulletin addressing Governor Abbott's proclamation declaring a disaster due to the effects of Hurricane Harvey. The Department encourages carriers to provide relief to those policyholders in counties listed in the governor's proclamations, including suspension of premium payments to allow continuing insurance coverage.     Commissioner's Bulletin B-0009-17

Texas issued a bulletin addressing the possible relocation and other personal hardships of hurricane victims stating that many insureds, enrollees and injured workers should not be without their necessary services, supplies and equipment to maintain their health. The Department's opinion is that all health insurers and HMOs that provide health coverage or cover the payment of medical or other health care services should, throughout the duration of the governor's proclamations, authorize payment for necessary medical equipment, supplies and services regardless of the date they were most recently provided.     Commissioner's Bulletin B-0010-17

Texas issued a bulletin stating that, as a result of the disruptions caused by Hurricane Harvey, it is suspending typical renewal requirements and allowing 150 days for the renewal of a license that expires on or before December 31, 2017. Further, late renewal fees and automatic fines for failing to complete various educational requirements due between August 24 and December 31, will be waived.     Commissioner's Bulletin B-0023-17

Texas issued a bulletin to all health and accident insurers, HMOs, workers' compensation carriers, agents, third party administrator's utilization review agents and MEWAs licensed in the state. All insurers and HMOs providing prescription medication coverage are asked to, through the duration of the governor's proclamations, authorize payment to pharmacies for up to a 90-day supply of prescription medication for hurricane-affected individuals, regardless of the date of the most recent filling of such prescription.     Commissioner's Bulletin B-0014-17


New Jersey enacted legislation prohibiting health insurers from discriminating in providing coverage and services based on gender identity.     Assembly Bill 4568


Illinois amended its law to require every policy of health and accident insurance that provides coverage for prescription drugs to provide for synchronization of prescription drug refills on at least one occasion per insured per year under certain circumstances.     House Bill 2957

Oregon amended its legislation regarding prescription medications for treating opioid or opiate withdrawals, including reimbursements.     House Bill 3440


Illinois enacted legislation regarding electronic delivery of notices and documents by a premium finance company.     215 ILCS 5/513a13

If you have not jumped into the electronic application process, it’s not too late.
Every year First Consulting is helping companies move from a paper application to an electronic application. 
Click here to learn more on how we can help you.


Illinois amended its law to require that individual policies which provide coverage for hospital or medical expenses provide coverage for treatment of serious mental illness and substance use disorders. It adds eating disorders to the definition of serious mental illness for group and individual hospital or medical expense policies.     House Bill 1332, 215 ILCS 5/370c

Illinois amended its regulations to state that a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance market place is not required to provide coverage for dry needling performed by a physical therapist.  It also defines dry needling.     Senate Bill 898

Illinois enacted legislation that creates the Network Adequacy and Transparency Act. The Act applies to individual and group policies with a network plan and is effective January 1, 2019.     House Bill 311

Illinois updated its law for health insurers and HMOs to require coverage for an MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, and if medically necessary as determined by a licensed physician.     Senate Bill 314, 215 ILCS 5/356g, 215 ILCS 125/4-6.1

Maine issued a bulletin that outlines new requirements for carriers offering health plans. Included is a requirement that, beginning January 1, 2018, a carrier must make a website and toll-free telephone number available to enrollees to obtain estimated cost and quality data for comparable health care services obtained from network providers.     Bulletin 424

Massachusetts amended its law pertaining to managed care consumer protections and accreditation of carriers for carriers that offer health care, dental or vision services.     211 CMR 52.02+

Massachusetts issued a bulletin to inform insured health carriers about the use of standard prior authorization forms when reviewing requests for certain medications and imaging services.     Bulletin 17-04

New Jersey enacted legislation requiring health carriers to provide to subscribers written informational materials about organ and tissue donation and registration at each contract renewal.  Materials must be developed or approved by a federally designated organ procurement organization.     Assembly Bill 4230

New York enacted legislation expanding the originating sites at which telehealth services may be delivered to include public, private and charter schools, school age child programs and child day care centers.     Assembly Bill 4703

Ohio amended its law to make it clear that the prior authorization request standards do not apply to a dental benefit that is offered as a part of a policy, contract, certificate, or agreement offered by a health insuring corporation.     1751.72

Oregon enacted legislation requiring health benefit plans to cover among other things, well woman care, counseling and screenings for sexually transmitted infections, and contraceptive drugs or alternatives in certain circumstances.  Legislation also prohibits a health benefit plan from imposing a deductible, coinsurance, copayment or any other cost-sharing requirement for such coverage.     House Bill 3391

Oregon enacted legislation requiring health benefit plans to cover the cost of necessary antitoxins, serums, vaccines, immunizing agents, antibiotics, antidotes and other pharmaceutical agents, medical supplies or other prophylactic measures if the director determines there is a disease outbreak or other condition of public health importance.     House Bill 3276

Rhode Island amended its Insurance Code to include Chapter 18, the Health Care Accessibility and Quality Assurance Act.  Among topics addressed are: certification of network plans; contracts with dental and optometric providers and reporting requirements.     27-18.8+


The Interstate Compact adopted revisions to the Additional Standards for Change of Insured Benefit, effective November 20, 2017.     L-08-LB-I-CoI

The Interstate Compact adopted revisions to the Additional Standards for Graded Death Benefit for Individual Whole Life Insurance Policies, effective November 20, 2017.     L-07-I-4

The Interstate Compact adopted revisions to the Additional Standards for Overloan Protection Benefit, effective November 20, 2017.     L-08-LB-I-OLP Summary

The Interstate Compact adopted revisions to the Additional Standards for Private Placement Plans for Individual Deferred Variable Annuity Contracts, effective November 20, 2017.     AB-03-I-PP

The Interstate Compact adopted revisions to the Additional Standards for Private Placement Plans for Individual Variable Adjustable Life Insurance Policies, to be effective November 20, 2017.     L-06-I-4

The Interstate Compact adopted revisions to the Individual Deferred Paid-Up Non-variable Annuity Contract Standards, effective November 20, 2017.     A-02-I-LONG


Maryland issued a bulletin to provide guidance to carriers and producers regarding the new notice and disclosure for long-term care insurance.     Bulletin 17-08


Kansas adopted by reference the policy and procedure to implement Medicare supplement insurance minimum standards dated May 18, 2017. Adoption is effective September 8, 2017.     Regulation 40-4-35

Massachusetts amended its rules concerning rate manual filing requirements for Medicare supplement insurance.     211 CMR 71.12

New Hampshire re-adopted and amended its minimum standards of coverage and simplification of terms and benefits for Medicare supplement policies.     Ins 1905.01+

Oklahoma issued a bulletin to insurance carriers issuing Medicare supplement policies in the State of Oklahoma advising that they may not charge a premium rate for a disabled person that exceeds the lowest available aged premium rate for such plan.     Bulletin No. LH 2017-02


Texas enacted legislation requiring individual and group health plans that include coverage for mental health or substance use disorder services to provide such coverage in parity with coverage for medical or surgical services relative to both quantitative and nonquantitative treatment limits.     House Bill 10


New York amended its law to allow, upon the superintendent's approval, a domestic mutual life insurance company to offer policyholders alternate methods of voting in an uncontested election of directors.     Senate Bill 2095

North Carolina enacted legislation to adopt the Uniform Power of Attorney Act. It provides the actions the principal's agent is authorized to do when granted general authority with respect to insurance and annuities. It also spells out those actions which must be specifically granted in the power of attorney, for the principal's agent to exercise.     Senate Bill 569, 32C-2-210

Oklahoma amended a regulation applicable to life, accident, and health coverage to clarify that evidence of policyholder acceptance of a coverage change is not required if the change effected by the endorsement is mandated by applicable law.     Regulation 365:10-1-17

Texas published a bulletin to all Life, Accident or Health insurers summarizing, in an attachment to the bulletin, legislation enacted in the 85th legislative session. Part 1 addresses bills that may require action by regulated individuals and entities and Part 2 addresses bills that could require action in particular circumstances.  The summary document cautions that it may not include all bills affecting any particular insurance business.     Commissioner's Bulletin B-0028-17


Georgia issued a directive addressing the Internal Revenue Code's attestation requirement for fixed and hospital indemnity plans.  The previously required attestation that the applicant has minimum essential coverage is replaced with the requirement that such policies display a notice to insureds that the policies do not supply such coverage. The Directive provides the required notice.     Directive 17-EX-5


Colorado issued a bulletin providing templates for notices to be sent by Connect for Health Colorado and/or carriers to provide individual health benefit plan policyholders with information regarding the renewal status of their current plans for the next plan year and the re-determination information for Advanced Premium Tax Credits (APTC), when applicable.     Revised Bulletin No. B-4.79

Compliance staff are challenged to implement, measure and reinforce strategies to protect your company’s reputation and bottom line. 
First Consulting has the expertise to assess your risks.  Click here to learn more.


Illinois amended its law pertaining to the requirements for notice of cancellation, notice of intention not to renew and examination reports for all companies.     House Bill 1954


Illinois amended its law to prohibit a policy of individual or group accident and health insurance from imposing any preexisting condition exclusion, as defined in the Illinois Health Insurance Portability and Accountability Act.     House Bill 2959


Delaware published a bulletin mandating use of the Online Premium Tax for Insurance portal (OPTins) for premium tax form submissions and payments. Users are advised to register at least 30 days prior to January 1, 2018, as the process can take two or more weeks to complete. The Department will not accept paper filings on or after January 1, 2018.     Domestic/Foreign Insurers Bulletin No. 96


Ohio amended its law regarding remitting an application for preneed funeral contracts funded by the purchase of an insurance policy. The agent who sold the policy shall require any payment by the purchaser be in the form of a check, cashier's check, money order, or debit or credit card, payable only to the insurance company.     4717.35


Illinois revised its law related to the rehabilitation, liquidation, conservation, and dissolution of insurance companies.     Senate Bill 683


New York amended its law to provide that the March 2017 version of the NAIC's Accounting Practices and Procedures Manual is to be used in preparing the quarterly statements and the annual statement for 2017, which will be filed in 2018.     11 NYCRR 83.2

North Carolina amended its requirements for filing the annual report to allow the report to be in electronic form or in paper form by the fifteenth day of the fourth month following the close of the corporation's fiscal year.     55-16-22


Texas issued a bulletin providing brief summaries of selected bills enacted by their legislature that affect regulation of solvency and licensing that may be relevant to individuals and entities regulated by the Department of Insurance.     Commissioner's Bulletin B-0030-17


Alaska issued a bulletin to surplus lines brokers addressing the latest line codes for surplus lines transaction reports.     Bulletin B 17-06


Florida's Department of Financial Services/Bureau of Unclaimed Property adopted a rule requiring that, when reporting and remitting property to the Department, holders must follow the procedures in Form DFS-A4-1992.     FAC 69G-20.041


New York issued a circular letter providing direction to insurers authorized to write accident and health insurance, health maintenance organizations and student health plans regarding utilization review requirements for treatment of substance use disorder, coverage of medication-assisted treatment, non-opioid treatment alternatives to pain management, and coverage of opioid treatment programs under insurance policies or contracts.     Circular Letter 2017-14

Rhode Island amended its Insurance Code adding Chapter 18.9, the Benefit Determination and Utilization Review Act.  Among the topics addressed are: certification of review agent; application for review agent; benefit determination procedural requirements; benefit determination notification; appeal procedure requirements; and reporting requirements.     27-18.9+


If you have not jumped into the electronic application process, it’s not too late. Every year First Consulting is helping companies move from a paper application to electronic application.

If you are considering creating an electronic application, a few items that need to be considered are: (1) screen shots of the process; (2) reflexive questions; (3) consent to sign electronic; and, (4) electronic signature process.

You might be asking the following questions on each of the items above: (1) what does this look like; (2) what needs to be included; and (3) what states require a filing as informational or for approval?

First Consulting can help. We are prepared to assist you and your team relating to answering your questions to the items above as well as any concerns related to drafting / filing.

Through First Consulting’s’ innovative Co-Sourcing approach, we can help you and your team with all or part of any project. We are here to help you succeed in getting your projects completed.

Contact me to learn more about how First Consulting can help.

Vickie Goodman


Protecting your Company’s reputation and managing risk is a challenge for compliance staff.  First Consulting has the expertise to help.

•   Assess compliance of claims processing, communications and payments
•   Verify accuracy and completeness of files
•   Determine appropriateness and adequacy of risk controls for specific activities
•   Check workflow processes to help eliminate duplication and redundancy
•   Follow the implementation process of changes to laws for market conduct compliance

Contact me today to start a conversation!

C. J. Rathbun, FLMI, CCEP, HIA, AIRC