Life and Health News
April 2016
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 COMPENSATION
Kentucky issued a new advisory opinion concerning alternative compensation for insurance agents. Advisory Opinion 2016-02
ANNUITIES / ANNUITY CONTRACTS
Connecticut issued a new bulletin concerning required disclosure for indexed-linked annuities. Bulletin S-17
Virginia amended its regulations relating to proceeds and avails of annuity contracts and life insurance policies. SB 640
Virginia amended its regulations relating to the Structured Settlement Protection Act. SB 621
THE DOL RULE IS HERE – LET FIRST CONSULTING HELP
The Department of Labor “Fiduciary Rule” was just released, and over the coming days First Consulting will be reviewing it to help our clients understand what it means and how it affects their business.
Click here to find out more.
AUTISM SPECTRUM DISORDERS
Georgia issued a directive pertaining to autism coverage reporting requirements for all insurers writing comprehensive major medical insurance. Directive 16-EX-1
CLAIMS / CLAIMS ISSUES
New Mexico issued a bulletin setting the interest rate applicable for unpaid claims 45 days after required proof of loss has been furnished for 2016 at 5.25%. Bulletin 2016-003
CORPORATE GOVERNANCE
Iowa adopted rules providing procedural requirements and the required contents of the corporate governance annual disclosure. 191-111.1 dated 10-14-2015
35 STATES WILL ADOPT THE CORPORATE GOVERNANCE MODEL IN 2016
Changes needed to your Board of Director’s documentation can take months, so we advise you act now!
First Consulting’s Corporate Governance Tool Kit can help by providing your company the documentation
needed for compliance under CGAD and the supporting Model Regulation.
CREDIT INSURANCE
Maryland amended the rates for credit life and credit health insurance effective June 1, 2016. 31.13.01.15 dated 12-28-2015
DATA CALLS / REGULATORY REPORTING
Maryland adopted a new regulation relating to annual reporting requirements for private health care payers. 957 CMR 10.01 Dated 12-18-2015
DENTAL INSURANCE
Nebraska issued a bulletin providing for guidance for filers of individual, small group, and stand-alone dental plans seeking to renew or issue plans for Plan Year 2017. Bulletin CB-130
DISCLOSURE REQUIREMENTS
Maine adopted a new rule regarding provider profiling disclosures. Rule Ch. 380 dated 9-3-2015
DRUG / PRESCRIPTION COVERAGE
Colorado amended its insurance law regarding mandatory coverage provision to require coverage for prescription eye drop refill. HB 1095
ESSENTIAL HEALTH BENEFITS
Colorado amended its regulation concerning essential health benefits 3 CCR 702 Reg. 4-2-42 dated 12-28-2015
FILING REQUIREMENTS / PROCEDURES
California amended its regulations regarding document submission and approval procedures for policy forms and other documents. T. 10 s 2201 - 2218.1
Michigan issued a bulletin regarding 2017 form and rate filing requirements for Medical Plans. Bulletin 2016-10-INS
FINANCIAL REGULATION
Colorado amended its regulation regarding the minimum amount of fidelity coverage required to be maintained by the insurers for money or other property that may be lost due to theft or dishonest acts of its officers, directors and employees. 3 CCR 702 Reg. 3-1-1 dated 12-28-2015
GROUP HEALTH
Colorado issued a bulletin regarding credit for deductibles paid when changing group health benefit plans. Bulletin B-4.85 dated 3-10-2016
Illinois issued a bulletin concerning family composite premiums in the Illinois small group market for health benefit plans issued or renewed on or after January 1, 2016 Company Bulletin 2016-2
Oklahoma issued a bulletin regarding the definition of "small group" for health insurance. BULLETIN NO. 2016-01
HEALTH CARE EXCHANGE / MARKETPLACE
Arkansas issued a new bulletin regarding the 2017 Plan Year requirements for qualified health plan certification and associated deadlines. Bulletin 3-2016
Illinois issued a bulletin pertaining to the qualified health plan re-certification for the 2017 plan year. Company Bulletin 2016-1
Nevada issued a bulletin regarding network adequacy standards for certain health benefit plans. Bulletin No. 16-001
New Hampshire published its 2017 plan year guidelines for qualified health plan issuers. Bulletin of March 4, 2016
The Center of Medicare and Medicaid Services issued a notice regarding the final 2017 Letter to Issuers in the Federally-facilitated Marketplaces to offer operational and technical guidance to help them participate in the Marketplace. CMS Notice dated February 29, 2016a
Vermont issued a bulletin relating to seeking a waiver to permit businesses to continue to purchase Exchange health benefit plans directly from insurers. HB 524
HEALTH INSURANCE / HEALTH RATES
Connecticut issued a new notice regarding health insurance rate filing submission guidelines for all insurance companies, fraternal benefit societies, hospital service corporations, medical service corporations and health care centers that deliver or issue individual and group health insurance policies in Connecticut. Notice dated March 7, 2016_1
Florida has enacted a law amending a number of provisions in its health insurance laws and its laws regulating health care providers. HB 221
Louisiana issued a bulletin providing guidance about the extension of transitional relief issued by the Centers for Medicare and Medicaid Services for all health insurance issuers and health maintenance organizations in both the individual market and small group market. Bulletin 2016-01
Michigan issued a bulletin regarding minimum benefit levels for substance abuse minimum coverage under the Michigan Insurance Code. Bulletin 2016-08-INS
Minnesota issued a letter regarding new statutory and certification requirements for health insurance filings offered, sold, issued, or renewed on or after January 1, 2017. 2017 Letter to Issuers
New Mexico changed the effective date for grievance procedures described in 13.10.17.1 to 13.10.17.41 NMAC from January 1, 2016 to January 1, 2017. Bulletin 2016-005
New York enacted legislation amending its law permitting pregnant women to enroll in the state health insurance exchange at any time after a licensed health care provider certifies the individual is pregnant. SB 6429
New York has provided links for guidance, filing instructions, and materials for miscellaneous health filings, including network adequacy and out of network guidance. NY Website
Oregon amended its laws to define “limited benefit coverage” and to create exceptions for limited benefit coverage to provisions otherwise applicable to health insurance benefits. HB 4104
Virginia amended its regulation relating to the sale, renewal, or offer of health benefit plans. SB 562
Wisconsin issued a bulletin providing guidance concerning the U.S. Department of Health and Human Services Extended Transitional Policy. March 16, 2016 Bulletin
HOLDING COMPANIES
Maine amended its rule regarding the Insurance Holding Company System Model in order to incorporate changes to the Maine Holding Company Act and the Model Holding Company regulation promulgated by the NAIC. Rule Ch. 180 dated 8-28-2015
Oregon amended different sections of regulation 836-027 by noting that Forms A, B, C, D, E & F for holding companies can now be found on the Department's website. 836-027-0005, 836-027-0010, 836-027-0012, 836-027-0100, 836-027-0125, 836-027-0140 and 836-027-0160
INSURER INVESTMENTS / SECURITIES
Maine adopted a regulation pertaining to securities, which outlines notice filing and fee requirements for securities offerings made under Tier 2 of federal Regulation A and Section 18(b)(3) of the Securities Act of 1933. 2-32 s 528-1 dated 12-10-2015
INTERNAL AND EXTERNAL REVIEW
Nebraska amended its regulation relating to grievance procedures under the Health Carrier External Review Act. The changes update certain deadlines to conform to timeframes applicable to internal grievance procedures. LB 840
Virginia amended its regulation regarding rules governing internal appeal and external review. 14 VAC 5-216-10 Dated 11-09-2015
LIFE INSURANCE / LIFE CONTRACTS
California issued a notice pertaining to principle-based reserving assessment for the 2015-2016 fiscal year for all insurance companies selling life insurance products. Notice dated February 8, 2016
MISCELLANEOUS
Wyoming amended its regulation regarding direct primary care agreements. SF 49
AT YOUR SERVICE: ADVERTISING COMPLIANCE HELP
How can we help you – agent, IMO, or carrier – maintain compliance in your advertising and
marketing campaigns, staff training and up-to-date knowledge?
Click here to find out more.
MISCELLANEOUS HEALTH / ACCIDENT
New York enacted legislation amended its law by providing exemptions to prohibitions on the renewal of stop loss, catastrophic or reinsurance issued to certain small groups. SB 6694
NOTICE TO INSUREDS
Iowa amended requirements relating to conditions under which notices of insurance cancellations, nonrenewals, or terminations may be delivered electronically. 191-4.24
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Colorado issued a bulletin regarding preventive services covered for carriers who issue individual and small group health benefit plans subject to the Affordable Care Act in the state of Colorado. Bulletin B-4.83
Connecticut issued a new bulletin regarding health insurance coverage for preventative services for all health insurance companies and health care centers authorized to conduct business in Connecticut. Bulletin HC-111
Connecticut issued a new notice regarding filing requirements for individual and small employer group health insurance policies subject to the Affordable Care Act. Notice dated March 7, 2016_2
Oklahoma issued a bulletin advising insurers that existing policies for the Extended Transition to Affordable Care Act Compliant Policies may be renewed for policy years beginning on or before October 1, 2017, provided that all transition policies end by December 31, 2017. Bulletin No. 2016-02
The Center for Medicare and Medicaid Services issued a notice regarding extending the period to transition to Affordable Care Act - Compliant Policies for non-grandfathered small group health policies and non-grandfathered individual health policies. CMS Notice dated February 29, 2016b, and 2016c
The Center of Medicare and Medicaid Services issued a notice regarding application of the market reforms and other provisions of the Affordable Care Act to student health coverage. CMS Notice dated February 5, 2016
PREMIUM TAX
Maine issued an emergency measure pertaining to business taxes for insurance companies. SP 607
REINSURANCE
Colorado amended its regulation regarding reinsurance agreements for life and health. 3 CCR 702 Reg. 3-3-4 dated 12-28-2015
Colorado has amended its regulation regarding assumption reinsurance agreements. 3 CCR 702 Reg. 3-3-1 dated 12-31-2015
RESERVE VALUATION
New York amended its regulation relating to the termination rates and claim reserves of individual and group accident and health insurance. 11 NYCRR 94.3 Dated 10-28-2015
STOP LOSS
Florida amended its regulation regarding stop-loss insurance aggregate attachment points. 627.66997
UTILIZATION REVIEW - HEALTH CARE
Connecticut amended its regulation concerning utilization review, grievances, and external review. 38a-591-1 dated 10-23-2015
Texas amended its requirement regarding utilization review for health care provided under a health benefit plan or health insurance policy. 28 TAC §19.1714
AT YOUR SERVICE: ADVERTISING COMPLIANCE HELP
How can we help you – agent, IMO, or carrier – maintain compliance in your advertising and marketing campaigns, staff training and up-to-date knowledge?
Compliance: Advertising compliance review services for agents, IMOs and companies
Click here
Webinar: Convenient webinar for your company’s lines of business at your convenience
Click here
Seminar: Comprehensive seminar for the industry in all lines of business
Click here
Free: Email update on significant regulatory changes
Click here
NEW! Regular posts on LinkedIn spotlighting advertising laws
Click here
First Consulting expertise is available to help meet your advertising compliance need(s). Don’t wait! Call or email today:
C. J. Rathbun, FLMI, CCEP, HIA, AIRC
816.391.2740
CJ.Rathbun@FirstConsulting.com
THE DOL RULE IS HERE – LET FIRST CONSULTING HELP
The Department of Labor “Fiduciary Rule” was just released, and over the coming days First Consulting will be reviewing it to help our clients understand what it means and how it affects their business.
We have been tracking the rule since its beginning, and have been in constant contact over the past several months with industry leaders, trade groups, carriers, and distribution. This gives First Consulting the unique perspective to understand not only the compliance steps and best practices needed to comply with the rule, but also what your competition and distribution partners are thinking about fiduciary compliance and where the industry may be headed.
Call us today for a free, no-obligation discussion on the DOL “Fiduciary Rule” and how First Consulting can help you take steps toward compliance.
Kevin W. Mechtley
816.886-3272
Kevin.Mechtley@FirstConsulting.com
