Life and Health News
October 2023
Welcome to our latest newsletter! As a thought leader in the Insurance Industry for over 50 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
The Federal Department of Labor, Health and Human Services and Treasury issued FAQs on September 27, 2023, regarding transparency in coverage under the Affordable Care Act. FAQs About Affordable Care Act Implementation Part 61
AGENT / PRODUCER LICENSING AND APPOINTMENT
California enacted legislation requiring agent examinations be provided in additional, specified languages. The Commissioner will be required to report annually on the number of applicants taking the exam in each language and the pass rate. AB 451
The Texas Insurance Department amended a regulation regarding offenses and criteria to consider when licensing an individual with a criminal background. 28 TAC s 1502
CONFIDENTIALITY / PRIVACY
California enacted an amended privacy law allowing for an abbreviated privacy notice when certain conditions are met. SB 793
Delaware adopted the Delaware Personal Data Privacy Act. New protections include, among other things, the right of the consumer to confirm whether or not a business is processing the consumer's personal data, to correct or delete data, to obtain a copy or summary of the data and to delete data. The law establishes duties for companies. The law also includes an opt-out right. HB 154
CREDIT INSURANCE
Wisconsin Insurance Commissioner announced new prima facie credit life and credit accident and health rates effective for a three-year period beginning January 1, 2024. Bulletin dated September 28, 2023
DISASTER / CATASTROPHIC EVENT
Oregon's Insurance Commissioner issued a bulletin specifying expectations of health insurers with regard to medical claim payments for insureds affected by wildfires and other declared emergencies in Oregon going forward. Bulletin DFR 2023-2
DISCRIMINATION
Colorado adopted a regulation requiring all life insurers utilizing external consumer data and information sources (ECDIS), algorithms and predictive models using ECDIS, to adopt a risk-based governance and a risk management framework designed to determine whether the use of these tools results in unfair discrimination based on race and to remediate if discrimination occurs. 3 CCR 702-10; Regulation 10-1-1
FILING REQUIREMENTS / PROCEDURES
Delaware amended its regulations pertaining to rate and form filings, including adding a requirement that filings be submitted to the department no less than 60 days prior to the proposed effective date. The commissioner may extend the review up to 90 days by giving notice within 45 days of receipt of the filing, and the filing will not become effective until the later of department approval or the expiration of the extended time period. HB 228
Illinois issued a bulletin reminding Accident and Health and Managed Care providers of the requirements of filing annual network adequacy filings. The bulletin further reminds carriers of the importance of the accuracy of their provider directories. Bulletin 2023-10
FRAUD / ANTI-FRAUD
California enacted an amendment relating to false and fraudulent insurance claims. The amendment requires the insurer to provide the fraud warning on a form used when the person applies for a policy, seeks to amend insurance coverage, or furnishes information relating to underwriting criteria affecting premium or eligibility for coverage, under an existing policy, instead of when that person applies for a policy or seeks to make a change to an existing policy. SB 743
HEALTH CARE EXCHANGE / MARKETPLACE
Rhode Island issued state-specific requirements for carrier notices of renewal and discontinuance in the Rhode Island Individual and Small Group Markets. Bulletin 2023-03
HEALTH INSURANCE - COMPREHENSIVE
Maryland's Insurance Administration informed carriers that the CARES Act requires coverage for COVID-19 vaccines, without cost-sharing, from an in-network provider no later than October 3, 2023. Bulletin 23-13
Nevada's Insurance Commissioner issued a bulletin reminding insurance companies of their obligation to provide COVID-19 vaccine coverage, including mRNA COVID-19 vaccine without cost-sharing obtained from a network provider. This is effective beginning October 3, 2023. Bulletin 23-002
MARKETING
Illinois adopted the Consumer Fraud and Deceptive Business Practices Act, which prohibits a business from sending a letter or postcard if the letter or postcard does not include the proper disclosures. All disclosures and disclaimers appearing on a postcard or letter must be conspicuously located at the top of the postcard or letter, be easily readable in clear and unambiguous language, and be printed in at least 14-point bold-face font in a black-outlined box. SB 1440
MEDICARE SUPPLEMENT INSURANCE
Oklahoma amended its Medicare Supplement regulations to create new enrollment opportunities for Medicare Supplement policyholders. Bulletin 10-2023
MENTAL HEALTH PARITY
Oklahoma made changes to its mental health parity law. The changes deal with denials of mental health and substance use disorder claims. Bulletin 11-2023; Senate Bill 557
MISCELLANEOUS
Kentucky adopted regulations establishing standards of conduct for agents and broker-dealers and describing a number of acts which will be considered unacceptable conduct or practices. 808 KAR 10:440
Maryland amended its regulations pertaining to the Prescription Drug Affordability Board. Amendments are intended to methods for paying the assessment, requesting an exemption from the assessment, address reconsideration of an exemption request and to clarify that health benefit plans are subject to the assessment. 14.01.02
New York revised its general business law to raise the maximum fine for persons violating the law regulating telemarketing to $20,000 for each violation. AB 4456
The U.S. Department of Treasury's Financial Crimes Enforcement Network (FinCEN) published a Small Entity Compliance Guide. This guide helps businesses determine if they are required to report their beneficial ownership information to FinCEN. FinCEN Notice dated September 18, 2023
PHARMACY BENEFIT MANAGERS
South Carolina amended its laws relating to Pharmacy Benefit Managers (PBM) and Pharmacy Services Administrative Organizations (PSAO). PSAOs must be licensed by January 1, 2024, in order to do business in the state. PBMs are prohibited from committing several additional acts included in Section 38-71-2230. Bulletin 2023-06; Section 38-71-2230
Tennessee's Department of Commerce and Insurance addressed concerns regarding the submission of wholesaler information by a pharmacy or pharmacy benefit manager (PBM) as part of the pharmacy's claim for reimbursement. Bulletin 23-05
REINSURANCE
New Jersey's Department of Insurance, Office of Solvency Regulation published a list of qualified accredited reinsurers. Notice dated September 1, 2023
REPORTS - DATA CALLS & OTHER REPORTS
Montana revised its regulation pertaining to Small Insurer Health Carriers to eliminate certain data reporting requirements. ARM 6.6.5050
RESERVE VALUATION
Kentucky adopted regulations pertaining to the valuation of life insurance and annuity reserves. The regulation sets out the framework for valuation standards and conditions under which the department actuary may verify insurance company reserves. 806 KAR 6:072
New York issued a Special Considerations Letter relating to December 31, 2023, reserves and other solvency issues. Special Considerations Letter dated September 8, 2023