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
Colorado amended it regulation regarding life and annuity insurance advertising, which among other things, expanded its list of terms that cannot be included in advertising and amended its disclosure requirements. 3 CCR 702 Reg. 4-1-2
AGENT / PRODUCER CONTINUING EDUCATION
Massachusetts has amended its statutes regarding continuing education requirements for insurance producers. It changes initial education requirements previously due within 36 months, to "prior to the initial renewal date of such license," and requires completion of the equivalent of at least 45 hours of instruction between renewals, including 3 hours of ethics education. HB 880
AGENT / PRODUCER LICENSING AND APPOINTMENT; FEES
Oklahoma issued a bulletin regarding the requirements of 36 O.S. § 1435.41. Statute 36 O.S. § 1435.41 previously required an insurer to recognize a policyholder’s request to have information regarding a life insurance policy provided to the producer that originally wrote the coverage, has been amended and broadened. It now applies to health, as well as life, insurance. In addition, the statute has been amended to require the carrier to honor the request even if a new agent of record has been appointed. Bulletin No. LH 2014-02
AUTISM SPECTRUM DISORDERS
Hawaii enacted legislation that requires the Insurance Commissioner to contract for the performance of an actuarial analysis by a licensed actuary who is a member in good standing with the American Academy of Actuaries of the projected costs of providing insurance coverage for screening, diagnosis, and treatment of autism spectrum disorders. Senate Bill 2054
CANCELLATION/NON-RENEWAL/PREMIUM OR COVERAGE CHANGES
Hawaii enacted legislation prohibiting rescission of coverage for an individual after the individual is covered under the plan, unless the individual or person seeking coverage on behalf of the individual performs an act, practice or omission that constitutes fraud, the individual makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage, or the individual fails to timely pay required premiums or contributions toward the cost of coverage (provided that the rescission complies with federal regulations). SB 2820
South Carolina amended several of its statutes related to captive insurance companies. It allows the DOI to declare a captive inactive under certain conditions, allows protected cells to be incorporated or not, revises or adds definitions and revises reporting requirements as well as other changes. SB 909
Delaware published a bulletin to point out to all health insurers that the Delaware Code does not require either the insurer or the non-network provider of emergency services request arbitration pursuant to Section 7.1 of Regulation 1301 as a precondition to receiving payments from insurers within 30 days of the insurer's receipt of a clean claim. So, a health insurer must pay the amount specified by the policy to the non-network provider within 30 days of receipt of each claim for each emergency care service, regardless of a pending arbitration request. DOMESTIC/FOREIGN INSURERS BULLETIN NO. 71
DEFERRAL OF CASH SURRENDER BENEFITS
Idaho published a bulletin regarding the rate of interest on deferred payment of cash surrender benefits, specifying a minimum of 5.125%. Bulletin 14-04
North Carolina released a bulletin to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster. Bulletin 14-B-7
DRUG / PRESCRIPTION COVERAGE
New Hampshire amended its accident and health and health benefit plan insurance requirements for a 90-Day supply of covered prescription drugs. Covered persons must be allowed to purchase their 90-day supply of covered prescription drugs at a pharmacy of their choice within the insurer’s network. Clarification was provided that a retail pharmacy dispensing the supply must comply with any specified terms, conditions, and reimbursement rate the plan may require for mail order pharmacies that fill 90-day prescriptions. 415:6-aa, 420-J:7-b
New Hampshire amended its prescription drug coverage requirements pertaining to off-label drugs under accident and health insurance. Senate Bill 91
California enacted omnibus healthcare legislation addressing, among other topics, confidentiality of medical information and the California Major Risk Medical Insurance Program. SB 857
Delaware issued a bulletin to inform all insurance companies that write health insurance in the state that the Preliminary Justifications Parts I and II are required for all health premium filings including rates for plans both on and off the Marketplace. DOMESTIC/FOREIGN INSURERS BULLETIN NO. 70
Hawaii amended its statutes to require that reimbursement for telehealth services be equivalent to that for the same services provided via face-to-face contact between a health care provider and patient. SB 2469
Hawaii has amended its statutes to include organ donation in the definition of "disability," as it relates to benefits payable under Section 392-21. HB 2400
Hawaii required reimbursement for services provided through telehealth be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient for individual accident and sickness and HMO policies. 431:10A-116.3, 432D-23.5
Hawaii revised its mental health and drug/alcohol abuse treatment insurance benefit requirements, which among other things, expands its requirements to apply to policies issued by fraternal benefit societies and removes limits of treatment visits and episodes. 431M-4
Louisiana issued a bulletin to health insurance issuers and health maintenance organizations to bring provisions of law to the attention of all issuers so that issuers can be prepared, after receiving objections from LDI staff, to expeditiously correct policy forms and rate filings that were due in the individual and small group markets (nongrandfathered) on June 27, 2014. Bulletin 2014-05
North Carolina amended its statutes to prohibit insurers and health benefit plans from limiting or fixing the fee an optometrist may charge patients for services or materials unless the services or materials are covered by reimbursement under the plan or insurer contract with the optometrist. SB 477
South Dakota published a bulletin regarding audiology services for insureds under 19 years of age who are on qualified plans. Medically necessary services rendered by duly licensed professionals are to be subject to the same cost sharing as other covered benefits in the policy; however, there is no mandate for coverage of hearing aids or other devices or equipment. Bulletin 14-04
HEALTH INSURANCE - COMPREHENSIVE
California enacted legislation that requires health plans to provide certain mental health and substance abuse benefits by January 1, 2015. H & S s 1374.76
New York enacted legislation for every policy that provides hospital, major medical or similar comprehensive coverage regarding requirements for inpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services. Ins. Law s 3216
HEALTH INSURANCE/HEALTH RATES
Louisiana amended its health insurance rate review requirements, which among other things, provides for the frequency of rate increase and limitations for all health benefit plans, limited benefit plans, and excepted benefit plans. It provides clarification that a health insurance issuer includes an HMO. Senate Bill 554
LIFE INSURANCE/ LIFE CONTRACTS
Hawaii revised its legislation, which among other things, revised standard valuation law requirements for policies and contracts issued prior to, on, or after, the operative date of the valuation manual. It revised standard nonforfeiture law by providing new requirements for the valuation manual for use in determining the minimum nonforfeiture standard. Senate Bill 2821
MANAGED CARE PLANS / HMOS
Nevada published a bulletin declaring 2015 a "transitional year" relative to compliance with NRS
687B.490, which vests with the Insurance Commissioner the authority to determine network adequacy. The bulletin includes Network Adequacy Standards to be used in 2015, as the Commissioner will not be requiring carriers to become retroactively compliant with the still-pending regulation once it is written. Bulletin 14-005
MARRIAGE EQUALITY/CIVIL UNIONS / DOMESTIC PARTNERS
New Hampshire clarified statutes governing recognition of civil unions and marriages entered into by same-sex couples. The bill also provides that gender-specific terms related to marital or familial relationships shall be construed to be gender-neutral for all purposes. Senate Bill 394
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Colorado issued a bulletin providing carriers with information about the actuarial equivalent service limits for certain essential health benefits in order for a plan to be considered for approval as a qualified health plan for sale both on and off the Exchange. This bulletin revises the actuarial equivalent services limits that were established for plan year 2014 and updates them for use in plans issued on or after January 1, 2015. Revised Bulletin No. B-4.51
Colorado issued a bulletin to inform insurance carriers that short-term, limited duration health benefit plans (“short-term health plans”) do not qualify as the minimum essential coverage required under the Affordable Care Act (ACA). The loss or termination of a short-term health plan does not trigger a special enrollment period that would allow a consumer to purchase an ACA-compliant health benefit plan outside of an open enrollment period. Bulletin B-4.76
Colorado issued a revised bulletin pertaining to the bulletin initially issued on May 5, 2014. It is being reissued due to the addition of SERFF Filing Instruction codes for HMOs. The bulletin informs carriers that they may elect to continue non-grandfathered health benefit plans that do not comply with the requirements of the Patient Protection and Affordable Care Act (ACA) that were last renewed prior to January1, 2014. Revised Bulletin No. B-4.73
Colorado published a bulletin to provide carriers with notices to be delivered to consumers with non-compliant non-grandfathered health benefit plans that a carrier has elected to continue into 2015. Carriers are under no obligation to continue such plans, but, if they choose to do so, the notices included in the bulletin need to be used. Bulletin B-4.75 dated 6-30-2014
Georgia issued a directive regarding interplay between the Patient Protection and Affordable Care Act and the Georgia Prompt Pay Law. Directive 14-EX-4
New Mexico published a bulletin to clarify the calculation of premium tax payments. Effective July 1. 2014, payments will be rounded to the nearest hundredths. Samples were provided. Bulletin 2014-010
Delaware enacted legislation adding chapter 50C, Safe Destruction of Records Containing Personal Identifying Information to Title 6. It requires that a commercial entity which seeks to permanently dispose of records containing consumers' personal identifying information within its custody or control, take reasonable steps to destroy or arrange for the destruction of each record by shredding, erasing or otherwise destroying or modifying the information in the records to make it unreadable or indecipherable. Does not apply to certain banks and financial institutions or health insurers/health care facilities subject to HIPAA standards. HB 295
Florida enacted its Information Protection Act of 2014. Requires notice to affected customers and the Department of Legal Affairs within 30 days of a breach (with some exceptions). Requires customer records, regardless of format, to be disposed of by shredding, erasing or otherwise altering to render the information unreadable or indecipherable through any means. SB 1524
Hawaii amended its statutes regarding mental health and addiction confidentially of records, inserting references to HIPAA requirements. SB 2869
REGULATORY REPORTING REQUIREMENTS
Washington required insurers to file their required financial statements electronically with the National Association of Insurance Commissioners (NAIC) or the Insurance Commissioner. Rule 2013-25
RESERVE VALUATION AND NONFORFEITURE RATES
Rhode Island amended its standard nonforfeiture law for life insurance to specify that the nonforfeiture interest rate for certain policies may not be less than 4%. House Bill 7715
Wisconsin amended reserve and reporting requirements for life and fraternal insurers. Ins 2.80, Ins 50.79
New York amended its section 1322 regarding risk-based capital for life and health insurance companies, to include certain corporations and HMOs. It changes the total adjusted capital formula for what qualifies as a company-level event for a domestic insurer and notes dates for filing the RBC report. SB 7764
THIRD PARTY ADMINISTRATORS
Delaware published a Memorandum to Third Party Administrators and Reinsurance Intermediaries notifying them that, on or before August 29, 2014, all TPA and RI original licenses must be returned to the Department. An Affidavit of Lost License may be submitted, if applicable. Effective September 30, 2014, all TPAs and Ris will be issued new license numbers, to enable access to the SBS and NIPR database to generate licenses and certificates. Memo dated July 1, 2014
New Jersey readopted and amended NJAC 11:23 dated 08-05-2013 regarding third party administrators of health benefits and third party billing services. NJAC 11:23
Rhode Island enacted the Unclaimed Life Insurance Benefits Act effective January 1, 2016. It requires the complete and proper disclosure, transparency and accountability relating to any method of payment for life insurance death benefits regulated by the state. Also it provides requirements for life insurers to identify potential matches of its insureds to the Social Security Administration death master files. House Bill 7031
UTILIZATION REVIEW - HEALTH CARE
Connecticut issued a bulletin that identifies the new provisions and compliance requirements pertaining to utilization review, grievance and appeal statutes. Bulletin HC -98
Connecticut issued a bulletin that supersedes Bulletin HC-86-13 (REVISED) dated July 16, 2013. It defines existing requirements for licensure of utilization review companies. Bulletin HC-86-14
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