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.
AGENT / PRODUCER CONTINUING EDUCATION
Mississippi issued a bulletin regarding its adoption of a "Suitability in Annuity Transactions" regulation and insurance producer training required. The grace period for training expires on September 1, 2014 and only the producers completing the training by that time will be allowed to solicit the sale of an annuity product. Bulletin 2014-7
AGENT / PRODUCER LICENSING AND APPOINTMENT; FEES
Texas issued a bulletin regarding Medicare marketing guidelines and agent licensing requirements related to specified Medicare-related and Prescription Drug plans. Commissioner's Bulletin #B-0019-14
CANCELLATION / NON-RENEWAL / PREMIUM OR COVERAGE CHANGES
Delaware amended its statutes to require written notice of cancellation due to nonpayment of premium. Requires that notice be delivered to the policyholder or mailed to their last known address. If mailed, proof of mailing must be retained for at least 1 year. HB 161
CLAIMS / CLAIMS ISSUES
Connecticut issued a bulletin repealing and replacing FS-27 issued September 10, 2013, requiring that any issuer offering a Qualified Health Plan providing for certain non-excepted abortion services as defined in the Affordable Care Act must segregate the funds associated with that coverage. Bulletin MC-21
Connecticut issued a bulletin to all insurers, licensees and interested parties stating its position regarding the processing of claims and related matters for insured disaster victims throughout the duration of the Governor's declaration in a weather-related event or other disaster. Bulletin IC-31
Puerto Rico issued a Ruling Letter announcing Administrative Order 327 from the Department of Health, which requires clinical laboratories and health providers or institutions to take blood samples for the detection of the Chikungunya virus from all patients who meet the definition of an acute stage case and deliver the sample to the Department of Health for testing. The Ruling Letter mandates that this test be covered by insurers the same as any other blood test. Ruling Letter: CN-2014-182-D
Rhode Island adopted final amendments to Regulation 48, addressing coordination of benefits. Changes are effective August 12, 2014. Regulation 48
Rhode Island amended its statutes requiring post-payment audits to be completed no later than 18 months after claims payment. The included definition of "health care provider" was revised to include mental health service providers and facilities. SB 2536
South Carolina issued a bulletin providing notice of tentative credit accident and health insurance rates and the opportunity to request a hearing for any insurer feeling aggrieved by any of the rates promulgated. Bulletin 2014-11
DEPARTMENT OF INSURANCE
Colorado issued a bulletin regarding inspection, copying and procurement of public records at the Division of Insurance. It specifies hours available, provides information about obtaining copies, specifies fees and charges for various services, and lists categories of information the Division maintains. Bulletin B-1.6
Missouri announced its upcoming Department of Insurance Director's Regulatory Summit which takes place on October 15, 2014. Their website (http://insurance.mo.gov/summit/) has more information. DOI Website announcement
DISASTER / CATASTROPHIC EVENT
Connecticut issued a bulletin providing direction for handling individual and group health insurance claims for disaster victims and evacuees in case of a weather-related event or other disaster for which the Governor declares a state of emergency. Bulletin IC-34
New Jersey has published a bulletin providing guidance to insurers regarding pre- and post-disaster regulatory activity, including, but not limited to, issuance of bulletins and/or orders under the Commissioner's emergency powers. Bulletin 14-08
Connecticut issued a bulletin addressing gender identity non-discrimination requirements. Bulletin IC-37
Illinois issued a bulletin providing guidance regarding compliance with the nondiscrimination provisions applicable to transgender persons found in the Affordable Care Act, the Illinois Human Rights Act, and the Illinois Mental Health Parity Act. Company bulletin 2014-10
North Carolina issued a bulletin communicating certain reporting requirements of the Annual Financial Reporting Law. It specifies deadlines for various reports coming due between October 1, 2014 and August 1, 2015, provides useful information and hyperlinks. Bulletin 14-B-08
FRATERNAL BENEFIT SOCIETIES
Illinois revised its statutes regarding fraternal benefit societies, their boards of directors, society laws, annual self-audits, maintenance of solvency and voluntary dissolution. SB 646
Louisiana issued a directive regarding public universities' purchasing of health insurance coverage for enrolled student athletes and third-party premium payments. Directive 207
HEALTH INSURANCE - COMPREHENSIVE
Massachusetts enacted legislation to address long-term substance abuse recovery by expanding the definition of "substance abuse treatment," among other terms and providing for various types of treatment. SB 2142
New Hampshire enacted legislation to provide for surrogate health care decision making by a family member or friend on behalf of an adult who lacks health care decision making capacity. HB 1434
Delaware revised its statutes to more closely follow the NAIC Model Law - Insurance Holding Company System Regulatory Act, including requiring an Enterprise Risk report annually. HB 257
LIFE INSURANCE / LIFE CONTRACTS
Louisiana issued an advisory letter regarding the new law requiring 30 days notice of the end of a term policy conversion option effective August 1, 2014. Advisory Letter 2014-03
LIFE INSURANCE AND ANNUITY SOLICITATION
Oklahoma issued an update to Bulletin 2011-04, regarding information requests from terminated producers who remain as the agent of record on a policy and have the policyholder's consent for information release. An exception is stated for the referenced law: it does not apply to any policy sold or serviced by a producer while associated with an insurer's captive distribution system. Bulletin LH 2011-04 (update) and LH 2014-02
MANAGED CARE PLANS / HMOS
Illinois updated its Health Maintenance Organization Act by adding to the definitions of "Provider" and "Health Care Provider" long-term care facilities as defined in the Nursing Home Care Act. SB 3048
Connecticut issued a bulletin rescinding and replacing Bulletin HC-96, from April 22, 2014, addressing coverage for autism spectrum disorders and early intervention services in relation to changes under the Affordable Care Act. The Department requests that all carriers remove dollar limits to their Applied Behavioral Analysis benefits. Bulletin HC-99
New Hampshire has enacted legislation to require that insurers issuing or renewing policies pursuant to PPACA shall not charge copayments, coinsurance or office deductibles for chiropractors and physical therapists that are greater than such amounts charged for services of a primary care physician. HB 1281
New Jersey issued a bulletin regarding federal guidance on compliance with mandated infertility benefits. Bulletin 14-09
New York enacted legislation regarding the provision of maternal depression education, screening guidelines and referrals for treatment as well as insurance coverage for the condition. SB 7234
MARRIAGE EQUALITY / CIVIL UNIONS / DOMESTIC PARTNERS
Oregon promulgated a rule requiring entities regulated by the Department of Consumer and Business Services to treat same-sex marriages validly performed the same as any marriage of heterosexual couples validly performed. OAR 836-010-0150
MEDICARE SUPPLEMENT INSURANCE
Texas issued a bulletin reminding concerned parties that the marketing of Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Medicare Prescription Drug Plans and 1876 Cost Plans is subject to the Medicare Marketing Guidelines from the Centers for Medicare and Medicaid Services (CMS). Bulletin B-0019-14
MISCELLANEOUS HEALTH & ACCIDENT
Rhode Island amended its statutes to disallow companies supplying such coverage to require that eye care providers provide services or materials to its subscribers at a fee set by the insurer or vision plan unless the insurer or vision plan compensates the provider for the provision of such services or materials to the patient. It also prohibits nominal reimbursement in order to claim that services and materials are covered services. SB 2516
ORSA: OWN RISK AND SOLVENCY ASSESSMENT
Illinois has amended its statutes regarding Own Risk and Solvency Assessment, revising the Purpose and Scope statement, changing some reporting deadlines, adding definitions of some terms, addressing confidentiality of information shared and specifying penalties for certain delays, among other changes. HB 4725
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Alabama issued a bulletin to revise Bulletin 2014-01, to clarify regulation 482-1-116 regarding the Alabama Small Employer Allocation Program and to provide guidance to companies in view of dual regulation between the State and US Department of Health and Human Services. Bulletin No. 2014-03
Connecticut issued a bulletin regarding the Affordable Health Care Act (ACA) and the state's health insurance exchange. It reminds entities licensed by the Department that appropriate action will be taken against anyone using misleading or false advertising involving provisions of the ACA. The same applies to anyone using misleading sales methods. Bulletin IC-33
Mississippi has issued a bulletin regarding compliance with the Center for Medicare and Medicaid Services' "Final Rule on the Exchange and Insurance Market Standards for 2015 and Beyond," which includes new conditions for hospital or other fixed indemnity insurance to be considered an excepted benefit. Bulletin 2014-8
Rhode Island has enacted legislation amending requirements of the Confidentiality of Health Care Communications and Information Act to allow reporting, without usual consent, of confidential health information to law enforcement or division of elderly affairs of suspected abuse, neglect or exploitation of an elder person. HB 7091 / SB 2094
SMALL EMPLOYER GROUPS
Georgia issued a bulletin for use in preparing 2015 Small Group health rates. Bulletin 14-L&H-1
UTILIZATION REVIEW - HEALTH CARE
Missouri has amended its statutes to require that health carriers make initial determinations within 36 hours, including one working day, of obtaining all necessary information regarding a proposed admission, procedure or service requiring a review determination. SB 716
First Consulting can help with UCAA filings
If your Company is planning action such as a name change, re-domestication, acquisition, merger, or adding of a new jurisdiction or line of business, these actions will require a change in your certificate of authority. Preparing and making the filings can be a time consuming task.
Our experienced staff can help with the Uniform Certificate of Authority Application (UCAA) developed by the NAIC and we are familiar with the various state-specific requirements that exist. First Consulting can handle these services and free your staff for other functions and projects.
Click here for information on how we can assist with obtaining additional state licenses or authority and with corporate changes such as name changes.
Or, you can call or email Scott Sheffer or Jerry Wickersham today to get more details about our services.
Are you ready for ORSA?
The fall state legislative season will soon be heating up and we anticipate a rush to get new laws proposed and approved by the end of 2014 or early 2015 in order to meet the NAIC effective date.
NAIC made the adoption of the ORSA Model part of a Solvency Modernization Initiative (SMI) putting serious pressure on states to adopt this model expeditiously. Most states are telling companies the filing of the ORSA Report (required for companies with over $500 million in premium) will have a third quarter 2015 deadline. Even if your company does not have to file the ORSA report, implementation of the Enterprise Risk Management (ERM) framework is something you will want to consider since the rating agencies have begun asking to see this documentation.
First Consulting can help your company with ORSA readiness. The ERM Starter Kit and ERM Tool Kit contain template policies, procedures, committee charters and reports. Remember even if you have an ERM program today, you might need to revise your current Board of Directors risk committee charter, risk policy and other key documents for ORSA.
Check out the full description of our ERM/ORSA Comprehensive Consulting services here:
Please feel free to contact me to discuss any of these services.