Life and Health News

September 2018

Welcome to our latest newsletter!  As a thought leader in the Insurance Industry for over 49 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!


Arkansas released a bulletin stating that based on advice from the Center for Consumer Information and Insurance Oversight, the deadline for issuers to comply with all ACA reforms on transitional policies in the non-grandfathered individual and small group markets has been extended from the end of 2018 until December 31, 2019.     Bulletin 6-2018


The Colorado Department of Regulatory Agencies adopted an emergency regulation to establish that insurance producers who sell health care insurance shall disclose to the person purchasing the policy that the insurance producer will receive a commission, establish the required disclosure of the standard compensation schedule of the producer to the consumer, and to establish the conditions and notice that must be provided to a consumer if a producer intends to charge a fee for the sale of an individual health benefit plan.     Emergency Regulation 18-E-03

The Colorado Department of Regulatory Agencies adopted an emergency regulation to implement rules prohibiting producers from charging certain fees for which they are already compensated through commissions and to clarify which fees may be charged.     Emergency Regulation 18-E-02


Oregon aligned insurance code and securities licensing requirements for the sale of variable annuities.     OAR 836-071-0185


New Hampshire adopted rules to set forth procedures for filing and the required contents of the Corporate Governance Annual Disclosure.     Ins 4502


New Mexico amended its regulation concerning credit for reinsurance requirements. NMAC - NMAC


New Jersey's governor issued an Executive Order declaring a state of emergency for several flood-impacted counties and asking officials and agencies to waive, suspend, or modify any existing rule when it could be detrimental to the public welfare during the emergency.     Executive Order 2018-33

New Mexico issued Executive Orders relating to declarations of a state of emergency in response to a monsoonal storm system and flooding.     Executive Orders 2018-041 & 2018-042

New York's governor issued an Executive Order declaring a State Disaster Emergency for various counties due to severe storms producing heavy rainfall and flooding.     Executive Order No. 186

Texas' governor extended the disaster declaration for 60 counties affected by Hurricane Harvey.  Any regulatory statute prescribing the procedures for conduct of state business or any order or rule of a state agency that would in any way prevent, hinder or delay necessary action in coping with this disaster shall still be suspended.     Disaster Proclamation dated 8/7/18


Illinois has approved legislation that expands the definition of a patient to ensure impartial access to substance abuse treatment. Patients shall have impartial service without regard to sexual orientation, gender identity, marital status, or disability. This change is effective 01/01/19.     20 ILCS 301/30-5(d)

New York issued a circular letter concerning discrimination based on sexual orientation, gender identity and/or gender dysphoria. The circular letter reminds health insurers that, regardless of protections at the federal level, New York has its own state requirements related to non-discrimination protections.     Circular Letter 2018-9


New Hampshire amended its regulation regarding coverage for prescription contraceptive drugs, prescription contraceptive devices and contraceptive services, effective January 1, 2019.     415:6-W; 415:18-I; 420-A:2; 420-A:17-c


Louisiana eliminated the requirement that insurers file a certificate of compliance confirming that advertisements for life insurance producers in a given year complied with existing laws and administrative rules.     LAC 37:XIII.4117


Connecticut issued a bulletin to clarify the content of the federal rule that allows for a group or an association of employers to act as a single sponsor of an association health plan in conjunction with Connecticut law. The bulletin confirms that small employers with a fully insured health plan will continue to be rated as a small employer.     Bulletin HC-122

Maryland issued a bulletin to address the DOL Rule ("Final Rule") in light of Maryland's existing statutory requirements with respect to an Association Health Plan.     Bulletin 18-15


Alaska issued a bulletin stating that effective October 1, 2018, an insurer may not deliver a policy or contract to a policy or contract owner unless the Guaranty Association notice attached to the bulletin is provided at the time of delivery of the policy or contract. This document must also be made available upon the request of a policy owner.     Bulletin B18-12


Delaware adopted a new regulation regarding compensation for chiropractic services.  This new regulation prohibits insurance carriers from including in any insurance policy, contract or certificate any provision that unreasonably discriminates against access to chiropractic care or services. It also prohibits carriers or TPAs from discriminating against or unreasonably denying a doctor of chiropractic compensation for a chiropractic service rendered by that doctor of chiropractic if the carrier would otherwise compensate a provider who is not licensed as a doctor of chiropractic but who is otherwise licensed to perform that same or substantially similar service.     Regulation 1318

Kansas issued a bulletin stating that if mammograms or pap smears are covered, reimbursement or indemnification shall not be denied. Furthermore, a policy may apply to mammograms or pap smears the same deductibles, coinsurance and other limitations as apply to other covered services. The bulletin also revises definition of mammogram to include 3D mammograms.     Bulletin 2018-02

New Hampshire adopted a regulation related to ancillary health minimum standards, including disclosure requirements and outline of coverage requirements.     Ins 6201.01 - 6201.07

New Hampshire amended its regulation concerning health and dental benefit plan network adequacy, effective August 1, 2018.     Ins 2701.01 - 2701.14


New Mexico amended its regulation concerning requirements for insurance holding companies for domestic insurers doing business in New Mexico. NMAC - NMAC


The Interstate Compact posted a weekly tip regarding using realistic data on the specifications page. Policy and rider standards include a requirement for the filed specifications page to be “completed with hypothetical data that is realistic and consistent with the other contents of the policy and any required actuarial memorandum.”     Weekly Tip dated 7/27/18


Maryland amended its regulations to address an issue with the DOI not being able to reach Medical Directors and Private Review Agents with inquiries and requires a medical director/private review agent to provide the contact information of one person who can respond to inquiries. Any change in contact info must be submitted to the DOI in writing within 30 days.     Regulatory Activity COMAR

New Jersey amended its regulation relating to insurance groups and reinsurers by expanding the conditions for foreign and alien life and health insurers under which waivers may be granted; updating the website where DOI maintains a current list of accredited reinsurers; updating the location and email address for reinsurer’s certification application procedures; and updating the information for filing withdrawals.     NJAC 11:2-1.4;  11:2-18.1; 11:2-18.4; 11:2-18.5; 11:2-28.4; 11:2-28.7B; 11:2-29.3


Alaska enacted legislation requiring health care providers and facilities to provide an annual list of ten of the most common services they perform with brief, plain language descriptions. It also requires they provide good faith estimates of charges for non-emergency care within ten business days of a request.     SB 105; 18.23.400

Connecticut issued a bulletin clarifying requirements for short-term limited-duration health insurance policies. These policies must provide coverage for essential health benefits and, if lasting longer than six months, must cover preexisting health conditions.     Bulletin HC-121


New York amended its regulation regarding Suitability and Best Interests in Life Insurance and Annuity Transactions. Duties and obligations of insurers and producers are clarified to help ensure that a transaction is in the best interest of the consumer.     11 NYCRR 224.0 - 224.9


New Mexico amended its regulation regarding the mortality table for life insurance and annuities. NMAC; NMAC; NMAC; NMAC; NMAC


North Carolina made various changes to insurance laws. Changes include revisions concerning the Life and Health Insurance Guaranty Association, surplus lines insurance, automatic lapse of nonresident licenses where the licensee no longer has a license in good standing from their home state, and PPOs.     HB 382; 58‑44A‑10; 58‑36‑30; 58-36-30; 58‑68‑25(b); 58‑50‑56(a)(2)


Puerto Rico issued a circular letter that requires all domestic insurers, health service organizations, producers, authorized representatives, adjusters, general agents, managers, surplus lines brokers, attorneys-in-fact, and insurance consultants to make compulsory use of the "Online Services Portal" to file the Annual Business Report and Annual Report of Direct Jobs Generated in Puerto Rico.     Circular Letter CC-2018-1928-ES


Connecticut issued a bulletin that combines provisions for four bulletins issued in 2014 and 2015. The bulletin expands the scope of previous bulletins to include retiree health products.     Bulletin HC-120

Oklahoma issued a bulletin that supersedes the Oklahoma Insurance Department's (OID) Bulletin LH 2013-03/PC 2013-11 (11/25/13).  All companies writing casualty and accident and health stop loss coverage must file their policy forms with the OID for prior approval.  They are not a form of reinsurance, so they are not exempt from approval.  Requirements are given in the bulletin for the coverage to be considered a stop loss policy.     Bulletin No. LH 2018-02 & PC 2018-02