Life and Health News
December 2024
Welcome to our latest newsletter! As a thought leader in the Insurance Industry for over 50 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!
ACTUARIAL
New York issued guidelines for insurance companies regarding the submission of the Actuarial Opinion and Memorandum (AOM) and Risk-Based Capital Checklist due by March 1, 2025. Actuarial Opinion Checklist dated November 20, 2024
AGENT / PRODUCER LICENSING AND APPOINTMENT
Kansas Department of Insurance set the following application fees for insurance professionals: $15 for resident agents and $50 for nonresident agents for calendar year 2025. Notice of Application Fee Amounts
Ohio updated regulations governing agent pre-licensing and continuing education, including requirements for CE courses, providers, and violations. Rule 3901-5-01
Pennsylvania removed the pre-examination education requirements for insurance producer licensing and replaced them with new continuing education mandates. Insurance producers will be required to complete three credits in ethics for most licensees. The law takes effect on April 29, 2025. SB 1241
Wisconsin announced that all company appointments for resident and nonresident agents must be processed electronically through the National Insurance Producer Registry (NIPR) for the 2025 renewal period. The renewal period begins on January 5, 2025, and ends on March 15, 2025. Companies must pay renewal invoices electronically by March 15, and failure to do so will result in termination of agent appointments. Bulletin dated November 14, 2024
ANNUITIES / ANNUITY CONTRACTS
Nevada amended a regulation on annuity suitability. NAC 686A.526
ARTIFICIAL INTELLIGENCE
Iowa issued guidance for insurers regarding the use of Artificial Intelligence (AI) systems, emphasizing compliance with insurance laws, including those against unfair trade practices and discrimination. Insurers must establish an AI Systems (AIS) Program for responsible AI use, ensure the prevention of errors and bias, and be prepared to provide documentation if the use of AI is investigated or examined by the DOI. Bulletin 24-04
Oklahoma's Insurance Commissioner reminded insurers that decisions or actions supported by advanced technologies, including Artificial Intelligence (AI), must comply with all relevant insurance laws and regulations, ensuring fairness and preventing discrimination. Insurers must establish an AI Systems Program (AIS Program) with governance and risk management protocols, among other requirements. Bulletin 2024-11
CAPTIVES
Ohio amended regulations governing captive insurance companies, focusing on modifications to applications, capital and surplus requirements, and financial condition reporting. Rule 3901-11-01
CYBERSECURITY
New York's Department of Financial Services issued a cybersecurity advisory highlighting deceptive practices used by North Korean IT workers, such as fake identities and VPNs, to infiltrate U.S. companies for cyber espionage and illicit financial gain. Carriers are urged to remain on heightened vigilance regarding background checks, identity verification, and technical measures to monitor suspicious activity. Industry Letter dated November 1, 2024
DISCRIMINATION
Delaware updated the definition of “sexual orientation” in its state code to include asexuality and pansexuality alongside heterosexuality, homosexuality, and bisexuality. It also revises the Delaware Insurance Code to prohibit unfair discrimination in the insurance industry based on sexual orientation, including the newly added categories. HB 275
DRUG / PRESCRIPTION COVERAGE
Texas requires issuers of health benefit plans to provide prescription drug information to enrollees or prescribing providers through a standard application programming interface (API) in real time, if requested. Issuers with fewer than 10,000 enrollees can apply for a 12-month extension. Bulletin B-0018-24
ESSENTIAL HEALTH BENEFITS
Alaska announced updates to the Essential Health Benefits benchmark plan, effective January 1, 2026, expanding coverage to include hearing aids, massage therapy, nutritional counseling, chiropractic care, and treatment for TMJ disorders. Notice Dated November 15, 2024
EXCEPTED BENEFITS
New Mexico extended the effective date for compliance with the regulation adopted under the Short-Term Health Plan and Excepted Benefit Act from January 1, 2025, to July 1, 2025. Bulletin 2024-24
FEE SCHEDULES
Hawaii published its comprehensive schedule of fees, taxes, and deposits for insurers, covering areas such as admission fees, service charges, and premium taxes across various insurance classes. Notice dated November 1, 2024
HEALTH INSURANCE / HEALTH RATES
Delaware now requires all group, blanket, and individual health insurance policies to cover prostate cancer screenings for men at risk, including those aged 50 (average risk), 45 (high risk), and 40 (higher risk). Delaware also expanded the definition of "prostate screening" to include methods such as the digital rectal exam and PSA test, while repealing the previous mandate for PSA tests for men aged 50 and older. HB 302
Delaware now requires insurers to provide coverage for speech therapy to treat children diagnosed with certain speech-language disorders, including conditions like expressive language disorder and phonological disorder. The coverage requirements apply to individual, group, and blanket policies issued or renewed after December 31, 2024. HB 273
New Jersey passed two laws requiring medical insurance carriers to cover hearing aids and cochlear implants, and to provide cost sharing caps for diabetes treatment, epinephrine auto-injector devices and prescription asthma inhalers. Bulletin 24-16
Oregon mandated that health insurance policies cover an updated list of prosthetic and orthotic devices. OAR 836-052-1000
HOLDING COMPANIES
Colorado readopted amendments to the "Holding Company System Regulation" to strengthen procedural and reporting requirements for insurance holding company systems. This includes new provisions for the group capital calculation which outlines the criteria for exemption from filing the annual group calculation. 3 CCR 702-3-4
New Mexico promulgated amendments to regulations under the Insurance Holding Company Law. The amendments update definitions, revise provisions related to transactions requiring prior notice, outline new notification requirements and transparency measures for cost-sharing and management services agreements, among other changes. 13.2.2.1 NMAC
INTERNAL AND EXTERNAL REVIEW
New Mexico amended grievance procedures for health care insurers. Changes include expanding the internal panel review period from 5 to 15 days and exempting "limited scope dental" and "limited scope vision" from some grievance procedures. Additionally, the timeline for reviewing administrative grievances by the Superintendent has been extended from 45 to 60 days. 13.10.17.2 NMAC
MISCELLANEOUS HEALTH / ACCIDENT
Colorado amended regulations to strengthen continuity of care requirements for ACA-compliant health plans, excluding short-term policies, ensuring that enrollees maintain access to necessary medical services when providers leave a network or when transitioning between plans. These amendments clarify carrier responsibilities, including notification requirements for network changes and provisions for continuing care with out-of-network providers during active treatment or transitions. 3 CCR 702-4-2-56
Colorado's Department of Labor and Employment updated regulations to ensure private plans for family and medical leave provide benefits and protections equivalent to the state plan. The amendments streamline procedures for approval, maintenance, and compliance of private plans, including the introduction of annual fees, clearer application requirements, and penalties for non-compliance. 7 CCR 1107-5
New Jersey's Insurance Commissioner advised carriers they must update their policies to comply with the federal final rules on Mental Health Parity and Addiction Equity Act and state regulations. Carriers must also file a new state annual report demonstrating compliance by March 1 each year. Bulletin 24-14
PHARMACY BENEFIT MANAGERS
Idaho issued guidance requiring all health insurers that undertake Pharmacy Benefit Manager (PBM) activities to officially register as PBMs. This guidance goes on to outline the compliance obligations for PBMs, effective January 1, 2025. Bulletin 24-05
New Hampshire published guidance on reporting receipt of pharmaceutical rebates by insurers and pharmacy benefits managers. Bulletin INS 24-067 AB
New York promulgated new regulations and amended existing regulations for pharmacy benefit managers (PBMs). 11 NYCRR 450.7+
UTILIZATION REVIEW - HEALTH CARE
Wyoming established requirements for prior authorization processes in health insurance, in line with the "Ensuring Transparency in Prior Authorization Act." These requirements mandate that health insurers and contracted utilization review entities submit and publicly post regular reports on prior authorization statistics, retain compliance records for five years, and file an annual report with the insurance commissioner. Regulation Chapter 72