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.
ADVERTISING / SALES & MARKETING
Arizona enacted legislation to exempt certain items from classification as advertising/sales material requiring filing. House Bill 2386; 20-1110
Nevada issued a bulletin advising that certain insurers are allowed to provide to an insured or prospective insured prizes and gifts, goods, wares, merchandise, gift certificates, charitable donations, raffle entries, meals, event tickets and other items not to exceed $100 in a calendar year. It provides notice of the withdrawal of Bulletin 10-005A. Bulletin 17-003-W
AFFORDABLE CARE ACT
Colorado adopted an Emergency Regulation concerning premium rate setting for non-grandfathered individual, small and large group health benefit plans issued on or after January 1, 2018. Emergency Regulation 17-E-02
Colorado adopted an Emergency Regulation to address enrollment periods for individual and group health benefit plans in accordance with Colorado statutes and the Affordable Care Act. Emergency Regulation 17-E-01
Colorado revised a bulletin to provide templates for notices to be sent by Connect for Health Colorado and/or carriers to provide individual health benefit plan policyholders information regarding renewal status of their current plans for the next plan year and redetermination information for Advanced Premium Tax Credits, as applicable. Revised Bulletin No. B-4.79
Texas enacted legislation prohibiting a qualified health plan offered through a health benefit exchange from providing coverage for elective abortion unless such coverage is provided separately from other health benefit plan coverage offered by the issuer and premium for such coverage is paid separately from and in addition to the premium for other health benefit plan coverage. Further, the enrollee must provide a signature for the coverage separate and distinct from the one for other health benefit plan coverage. House Bill 214; 1696.001+; 1218.001+
AGENT / PRODUCER LICENSING AND APPOINTMENT
Connecticut published a notice to all Certified Insurance Consultants (CICs) stating that renewal notifications were emailed to all active licensees the last week of July. If a licensee did not receive the notification, they may email the Department at firstname.lastname@example.org to request a copy. Other instructions are noted as well. Notice dated August 1, 2017
New Mexico issued a bulletin to all resident and non-resident license applicants. All applicants are now required to apply using the National Insurance Producer Registry (NIPR) online application process. Paper application may only be used by applicants who are unable to apply online. Bulletin 2017-010
AUTISM SPECTRUM DISORDERS
North Carolina amended its regulation regarding the requirements to determine whether a treatment is considered adaptive behavior treatment. 58-3-192
CERTIFICATE OF AUTHORITY FILINGS
New Hampshire enacted legislation establishing procedures for reinstatement of certificate of authority for foreign corporations. Senate Bill 18, 293-A:15.31
CLAIMS / CLAIMS ISSUES
Tennessee promulgated a new regulation addressing Unfair Claims Settlement Practices. 0780-01-05-.01+
Delaware enacted legislation to expand its Code to include Chapter 85, the "Corporate Governance Annual Disclosure Act." The first filing of the CGAD will be in 2018. Senate Bill 40; Chapter 85
CREDIT FOR REINSURANCE
Mississippi revised its regulation regarding credit for reinsurance. 19-1-22.07+
South Carolina issued a bulletin with notice of tentative credit accident and health insurance rates for 2018. The Department proposes no change to the single premium rates per $100 of initial indebtedness; however, it proposes a 20% decrease in premiums for open-ended monthly outstanding balance policies. Bulletin Number 2017-07
South Carolina published a bulletin to provide notice of tentative 2018 rates for 3-day retro credit accident and health insurance. The Department proposes no changes to the rates, keeping them at $.28 per year per $5.00 unit of monthly indemnity. Bulletin Number 2017-08
Wisconsin issued a bulletin with revised prima facie credit life and credit accident and sickness insurance rates. Bulletin dated July 21, 2017
DISASTER / CATASTROPHIC EVENT
Illinois required all insurers to withdraw any cancellation or nonrenewal notice issued on or after July 12, 2017 for insureds affected by flooding in Cook, Lake, Kane and McHenry counties until September 30, 2017. Insurers are to grant an extension of 60 days to affected insureds for insurance related time periods and to post on their websites all actions taken to implement the requirements of this bulletin. Company Bulletin 2017-3
DRUG / PRESCRIPTION COVERAGE
Hawaii enacted legislation allowing pharmacists to prescribe and dispense prescription contraceptive supplies, noting that insurance coverage for such supplies, required under Section 431:10A-116.6, must extend to such prescription and dispensation. Senate Bill 513
New York amended its rules relating to required contraceptive coverage. 11 NYCRR 52.17, 11 NYCRR 52.18
Rhode Island enacted legislation to clarify that an insurer must provide adversely affected members at least 30 days notice prior to removing a prescription drug from its formulary or making changes in the preferred or tiered cost-sharing status of a covered prescription drug. House Bill 6322
FILING REQUIREMENTS / PROCEDURES
California issued a notice to all insurers that corporate applications and similar filings needing Department approval by year-end 2017 must be submitted no later than September 15, or, in the case of a holding company application, no later than October 20, 2017. Only "perfected" applications (those filed electronically via Oasis or in duplicate to the Corporate Affairs Bureau with specified inclusions) will receive expedited review. Notice of Year-End Review Procedures dated August 10, 2017
2017 CSO MORTALITY TABLE CHANGES
First Consulting is actively working with 2017 CSO changes now.
Put our experience to work for you, and we can do it on Your SERFF Instance!
Click here to learn more.
Florida promulgated a rule adopting the National Association of Insurance Commissioners Financial Condition Examiners Handbooks 2017 and 2016, incorporating them by reference. FAC 69O-138.001
California enacted legislation pertaining to funds received by any person acting as a licensed insurance producer, an administrator or a surplus line broker to revise fiduciary fund maintenance requirements. Existing law is amended to allow funds to be maintained in a trust account in a bank or savings and loan association. Assembly Bill 1460; 1734 and 1734.5
Kansas amended its audited financial statements filing requirements regulation, adopting by reference the NAIC Model dated November 30, 2016. Regulation 40-1-37
FRATERNAL BENEFIT SOCIETIES
California issued a notice announcing the adoption of section 50.19 to Title 11 of the Code of Regulations Article 19 promulgating a revised bond required of organizers of fraternal benefit societies. Notice dated June 16, 2017
HEALTH INSURANCE - COMPREHENSIVE
Colorado issued a bulletin to provide carriers with the most recent "USPSTF A and B Recommendations," published by the United States Preventative Services Task Force (USPSTF); the Health Services Administration (HRSA) women's preventative services guidelines; the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and the preventative service mandates required by Colorado law, along with guidance about when the recommendations must be implemented. Bulletin No. B-4.83
Connecticut amended its law to require provider directories to include information about whether the provider is accepting new patients. Senate Bill 546; 38a-477h
Connecticut enacted legislation prohibiting insurers and other entities providing coverage for prescription drugs from requiring the use of step therapy protocols for drugs prescribed to treat insureds who have been diagnosed with stage IV metastatic cancer. House Bill 7023
Hawaii amended its statutes addressing health benefit plan network access and adequacy, requiring that health carriers providing a network plan maintain a network that is sufficient in numbers and appropriate types of providers to assure that all covered benefits will be accessible without unreasonable travel or delay and covered persons have access to emergency services 24 hours per day, 7 days per week. Senate Bill 387
Massachusetts adopted a rule that requires insurers to provide certain notice to mothers regarding their inpatient and outpatient rights during specified maternal/newborn service. 105 CMR 130.662
New York provided a circular letter to all insurers authorized to write accident and health insurance. It provides guidance regarding the requirements relating to family leave benefits coverage. Circular Letter 2017-11
Rhode Island amended its laws to require a health care entity or health plan to issue a decision regarding the credentialing of a health care provider within 45 calendar days of receiving a complete credentialing application. Such entities must establish a written standard defining a complete application and provide applicants with regular status updates. Senate Bill 145; 27-18-83
Rhode Island enacted legislation amending its mandated coverage for treatment of mental health and substance use disorders. The amendments prohibit unfair discrimination and require patients to have access to evidence-based non-opioid treatment for pain, including medically necessary chiropractic care and osteopathic manipulative treatment. Senate Bill 789; 27-38.2-1
HEALTH INSURANCE / HEALTH RATES
Arkansas issued a bulletin addressing the All Payer Claims Database submission and privacy regulations related to substance use disorder. The Department notified all APCD data suppliers that it is a lawful holder of such claim data; therefore, data suppliers do not need to suppress any part 2 data prior to submitting to its vendor for processing. Bulletin 11-2017
Arkansas published a bulletin announcing a revised version of the Data Submission Guide for the Healthcare Transparency Initiative. It is available at: www.insurance.arkansas.gov and https://www.arkansasapcd.net/Home/. Bulletin 12-2017
Illinois enacted legislation requiring a group or individual policy of accident and health insurance, a managed care plan or a HMO to provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobulin therapy. House Bill 2721, 215 ILCS 5/356z.25
Louisiana issued a notice advising that the annual HIPAA assessment rate has been determined by the Department of Insurance to be .00015 percent. Notice dated June 20, 2017
Michigan Centers for Medicare & Medicaid Services issued an order regarding individual health market product discontinuation notices for plan year 2018. Order No. 17-038-M
Missouri revised its law to require certain health insurance policies to provide coverage for services performed in an ambulatory surgical center or abortion facility under certain circumstances. Senate Bill 5, 197.240
New Hampshire amended its law for health benefit plans that cover substance use disorder services to not require a renewal of authorization or approval of medication-assisted treatment more frequently than once every 12 months. 420-J:18
New Jersey enacted legislation to require carriers offering heath benefit plans to cover health care services provided through telemedicine and telehealth. Senate Bill 291, 26:2S-29
New Mexico issued a bulletin that interprets the requirements for health insurance carriers offering emergency care coverage. Bulletin 2017-009
New York amended its regulation pertaining to hospital, surgical, or medical expense coverage to not subject medically necessary abortions to copayments, coinsurance, or annual deductibles, unless the policy is a high deductible health plan. It provides the circumstances under which a religious employer may exclude coverage for medically necessary abortions and defines religious employer. 11 NYCRR 52.2, 11 NYCRR 52.16
New York amended its regulations to add a definition for worksite disability policies and made changes regarding claim reserves for health insurance policies. 11 NYCRR 94.3, 11 NYCRR 94.4
HEALTH MAINTENANCE ORGANIZATIONS
New York amended its law regarding health maintenance organizations to provide that if the contract between the HMO and a hospital is not renewed or is terminated, the parties shall continue to abide by the terms of the contract, including reimbursement terms, for a period of two months from the effective date of termination or, in the case of a non-renewal, from the end of the contract period. This extends from July 1, 2017 to July 1, 2019. Pub. Health s 4406-c
The Virgin Islands enacted "The Virgin Islands Insurance Holding Company System Regulatory Act" to meet accreditation standards of the National Association of Insurance Commissioners and place the laws of the Territory on par with other United States jurisdictions. House Bill 42
INCLUDE FIRST CONSULTING IN YOUR 2018 BUDGET
Including First Consulting in your 2018 Compliance budget will allow you to accomplish more!
Click here to see just a few ways that First Consulting can help.
LONG-TERM CARE INSURANCE
Florida amended its rule regarding long term care replacement reporting requirements, to have the report submitted electronically. FAC 69O-157.111
Hawaii enacted legislation providing the Insurance Commissioner with express prior approval authority over long-term care insurance rates, requiring, among other things, that filings be submitted at least 60 days prior to notifying policyholders. Senate Bill 952; 431:10H
Louisiana renumbered and amended its regulations pertaining to long-term care insurance. Among other things, it adds a definition of benefit trigger and revises the policy definitions of adult daycare, home health care and skilled nursing. LAC 37:XIII.1901+
MARKET CONDUCT EXAMINATIONS
Missouri enacted legislation stating that if an insurance company is required to pay interest on any claims, refunds, penalties, or payments under a market conduct examination, or any other legal or remedial action and the interest rate is not provided for by law, interest will be at the annual adjusted prime rate of interest, but under no circumstance shall such interest rate exceed 9% per annum. House Bill 292, 374.191
Pennsylvania issued a notice providing the new per diem charges for market conduct examinations of insurance companies. Notice 2017-08
MARRIAGE EQUALITY / CIVIL UNIONS / DOMESTIC PARTNERS
Rhode Island amended its law entitled "Unfair Competition and Practices" by adding a definition of domestic partnership. The amendments prohibit treating domestic partners differently than marriage partners for purposes of premiums, policy fees or rates charged for policies of accident and sickness insurance. House Bill 5951A; 27-29-2, 27-29-4
Michigan rescinded its regulation regarding maximum amounts of group life insurance available to members of a discretionary group. R 500.616
New York issued a circular letter to all insurers regarding the insurance industry's position to influence the economic effects of climate change. It urges all insurers to complete the annual Climate Risk Disclosure Survey and provides examples of day-to-day operations that can have a positive effect on the environment. Circular Letter 2017-9
MISCELLANEOUS HEALTH / ACCIDENT
Arizona enacted legislation to exclude "disability income" from the requirement that a disability insurance policy provide coverage for services by providers regardless of the provider's family relationship to the insured. House Bill 2189; 20-1376.09; 20-1406.09
California enacted legislation requiring that all large group, individual and small group health insurance policies provide all covered mental health and substance use disorder benefits in compliance with the provisions of federal law governing mental health parity. Senate Bill 374
Colorado has withdrawn seven health plan-related bulletins: B-4.47 (Prior Approval and File/Use Rate Filings); B-4.51 (Actuarial Equivalent Services for Certain Essential Health Benefits); B-4.61 (Individual Market Renewal Notices); B-4.90 (Network Adequacy Standards/Reporting); B-4.91 (Network Access Plan Standards/Reporting); B-4.92 (Standards/Reporting for Provider Directories); and B-4.93 (Continuity of Care Requirements). Notice dated August 15, 2017
Connecticut enacted legislation to require reimbursement of covered services rendered in the state by an out-of-network provider for the diagnosis or treatment of a substance use disorder to be paid under the individual's health insurance policy directly to the provider if the provider is otherwise eligible for reimbursement of such services. House Bill 5140; 38a-488a
Florida adopted a rule addressing withdrawal from the individual market, which requires an electronic filing. FAC 69O-154.114
NOTICE TO INSUREDS
Missouri issued a bulletin to respond to and address inquiries received with regard to annual Gramm Leach Bliley privacy notices currently required and how those have been impacted by recent federal legislative changes. Bulletin 17-08
Michigan amended its law regarding valuation of annuities and pure endowment contracts and continuing education requirements for insurance producers. House Bill 4325, 500.835a, 500.1204c
Alaska issued a regulatory order requiring use of OPTins for reporting and payment of premium tax, effective with the 2017 reporting year (due March 1, 2018). Regulatory Order No. R 17-05
Missouri issued a bulletin to all health carriers writing health insurance or health benefit plan coverage regarding the publication of proposed health insurance rates for 2018. Bulletin 17-07
REGULATORY REPORTING REQUIREMENTS
Massachusetts adopted regulation that governs the reporting requirements regarding health care data and information that health care payers must submit in connection with the All Payer Claims Database (APCD) . 957 CMR 8.01+
REPORTS - DATA CALLS & OTHER REPORTS
Florida adopted updates to its rule for reporting on Multiple Employer Welfare Arrangements (MEWAs), to incorporate an electronic process. FAC 69O-192.058
Oregon readopted its rules pertaining to the all-payer healthcare claims data reporting program and revised the definition section. OAR 409-025-0100+
Texas issued a data call for calendar year 2016 reporting on Credit Life and Credit Accident and Health insurance. Submissions are due by the close of business on October 31, 2017. Commissioner's Bulletin B-0008-17
STANDARD VALUATION LAW
New York amended its regulation regarding specific standards for morbidity, interest and mortality for individual contract health insurance benefits. 11 NYCRR 94.10
THIRD PARTY ADMINISTRATORS
New Hampshire provided clarification of persons or entities that are required to submit an annual exception from licensing form. Ins 2301.03
TPA LICENSING AND RENEWALS
Did you know that you have a choice of TPA Licensing and Renewals?
With First Consulting you do. Click here to learn more.
Nevada enacted legislation making the charging of certain fees a deceptive trade practice and revising provisions governing deceptive trade practices relating to gift certificates or gift cards. Assembly Bill 361
Connecticut enacted legislation regulating the offer and dissemination of travel insurance, defining terms and specifying fees for licensing, among other details. House Bill 7024
Arkansas amended its Code to clarify that, for purposes of the Unclaimed Life Insurance Benefits Act, an Annuity or Life policy used to fund a funeral or related expense or a prepaid funeral benefits contract is not included with the definition of "contract" or "policy." 23-81-903
North Carolina amended its law regarding the notice requirements and penalties for the disposition of abandoned property. House Bill 294, 116B-59
UTILIZATION REVIEW - HEALTH CARE
Ohio amended its insurance code regarding prior authorization request standards for health insurance. Among other things, this includes standards for electronic submission and time frames for responding. 3923.041
The new 2017 CSO Mortality Table is resulting in revised premiums and policy values that means new life insurance policy forms changes and changes to the actuarial support documents with or without new schedule pages.
The result? Overload for the Forms Filing staff.
First Consulting is actively working with these 2017 CSO changes now. Put our experience to work for you, and we can do it on Your SERFF Instance!
Contact me or any First Consulting Associate to discuss this further.
It’s hard to believe that next year’s budget process is already upon us. However, including First Consulting in your 2018 Compliance budget will allow you to accomplish more!
Here are just a few ways that First Consulting can help:
• New Product Development & State Variation Drafting – utilize our expertise to make developing a new product stress-free.
• Product Filing – overload assistance when in-house staff are stretched to the max, and we can use Your SERFF Instance!
• Research – get that research/survey project off your desk, and allow First Consulting to complete that work anonymously with each state.
• Compliance Monitoring/Oversight - Staying current on state and federal compliance updates can be difficult and time consuming. We track, analyze, summarize and forward these updates to your staff. We can also recommend any necessary changes.
• Certificate of Authority – admission in a new jurisdiction, name change, assumption, and more.
• ERM/ORSA & Corporate Governance – Our turnkey tool kits simplify the ORSA and Corporate Governance reporting.
• Compliance Risk Management – Our hands on approach can identify “gaps” in operational compliance with a review of current procedures; assess priorities for a plan of action; and provide proven alternatives and best practices.
• Anti-Fraud, AML, OFAC and Privacy Training – our online training satisfies the state requirements for underwriters, call center personnel, claims handlers and other integral personnel. Plus this research was recently updated for 2018.
Contact me for a no obligation proposal and cost estimate.