Life and Health News
February 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.
ADVERTISING / SALES & MARKETING
North Dakota amended its regulations pertaining to advertising rules for life insurance. Insurers are required to establish and maintain a system of control over advertisements used by its agents. 45-04-10-02 Dated 06-12-2015
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AGENT / PRODUCER COMPENSATION
Kentucky has issued a new advisory opinion to clarify questions about agent commission payments for insurers authorized to offer health benefits in the state. Advisory Opinion 2016-01
Washington adopted a regulation to provide guidance to insurance producers regarding the sharing of commissions with non-licensed persons. 284-17-805 Dated 08-25-2015
AGENT / PRODUCER CONTINUING EDUCATION
Delaware has amended its regulation pertaining to continuing education of agents, brokers, surplus lines brokers and consultants to clarify requirements and for individuals who have been continuously licensed for 25 years. 504 s 8.0 Dated 09-29-2015
Ohio amended its rule regarding agent continuing education, including carrying over of excess continuing education credits to the next renewal period. Rule 3901-5-01 Dated 10-28-2015
AGENT / PRODUCER LICENSING AND APPOINTMENT
Alabama published a bulletin noting that all individual applicants for both resident and non-resident professional licenses are required to submit proof of citizenship before the license will be issued or renewed. It provided a list of items acceptable as proof. Submission of proof for renewals is effective for all licenses set to expire as of February 29, 2016. Bulletin 2015-07
Kansas has amended its regulations regarding registration procedures for broker-dealers and agents. 81-3-1
Wisconsin issued a bulletin regarding insurance agent appointments. Bulletin dated December 16, 2015 (A)
ANNUITIES / ANNUITY CONTRACTS
Oregon adopted new rules regarding surrender charges for individual deferred annuities. OAR 836-051-0150 Dated 11-01-2015
Rhode Island amended its law regarding the annuity mortality table for use in determining reserve liabilities for annuities. R27-94-006
AUTISM SPECTRUM DISORDERS
South Carolina issued an opinion saying the proposed amendments expanding state mandated coverage for autism spectrum disorder care to individual and small group markets would be considered a new state-mandated benefit in addition to essential health benefit. Opinion of December 18, 2015
CANCELLATION / NON-RENEWAL / PREMIUM OR COVERAGE CHANGES
Illinois issued a disaster-related moratorium on all insurance policy cancellations, nonrenewals, and premium payments. Company Bulletin 2015-13
CAPTIVES
Hawaii issued a memorandum regarding annual filing requirements for captive insurance companies. Memorandum 2015-4C
CLAIMS / CLAIMS ISSUES
Arkansas has amended its rules and regulations regarding insurance claim settlement practices for all insurers, HMOs and risk retention groups. Rule and Regulation 43 Dated 08-24-2015
Iowa amended requirements regarding prompt payment of certain health claims. The major change removed long-term care from list of insurance products exempt from the rule. 191-15.32
CONFIDENTIALITY
Oregon amended its regulation regarding the Collaborative Dispute Resolution Model rules relating to confidentiality and inadmissibility of communications by adding definitions and clarifications. OAR 137-005-0050 Dated 10-01-2015
CORPORATE GOVERNANCE
Louisiana has adopted a new rule regarding filing requirements for the Corporate Governance Annual Disclosure, which an insurer or the insurance group of which the insurer is a member, is required to file no later than June 1 of each calendar year. LAC 37:XIII.201 dated 9-20-2015
Corporate Governance Tool Kit
First Consulting’s new Corporate Governance Tool Kit provides your insurance company, in any line of business, the documentation needed for compliance readiness under the NAIC Corporate Governance Annual Disclosure Model Act (CGAD) and supporting Model Regulation.
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CREDIT FOR REINSURANCE
North Dakota amended its credit for reinsurance model regulation to add new provisions for the certification of reinsurers. 45-03-07.1-01 Dated 06-12-2015
CREDIT INSURANCE
Colorado has amended its regulations regarding credit insurance. 3 CCR 702 Reg. 4-9-2 dated 10-30-2015
Montana has amended its regulation regarding credit insurance, expanding the scope to apply to loss-of-income insurance. 2.59.303 dated 10-15-2015
DATA CALLS / REGULATORY REPORTING
Colorado has issued an amended bulletin to provide additional guidance for Colorado Health Cost reporting requirements. Bulletin B-4.58 dated 1-5-2016
DEPENDENT COVERAGE
Ohio rescinded its rule which extended health coverage of an older age child to age 28. Rule 3901-8-13 Dated 10-27-2015
DISCRETIONARY GROUPS
Oregon issued a new bulletin clarifying the division's position regarding approval of life discretionary groups. Bulletin 2015-2
DRUG / PRESCRIPTION COVERAGE
Colorado has issued a new bulletin that provided guidance for consumers and carriers regarding coverage of FDA-Approved contraceptive measures for women. Bulletin No. B-4.84
Iowa adopted a new regulation regarding prior authorization of prescription drug benefits. 191-79.1
Massachusetts has issued a bulletin to health insurers and HMOs offering or renewing insured health products in the state regarding federal requirements that carriers cover certain contraceptives without consumer cost sharing. Bulletin 16-03
Massachusetts has issued a bulletin to health insurers and HMOs offering or renewing insured health products in the state regarding federal requirements that carriers cover certain tobacco cessation products without consumer cost sharing. Bulletin 16-01
Nevada adopted a new regulation relating to health benefit plans that cover prescription drugs and use the department's approved formularies. Companies are prohibited from removing a drug from its approved formulary, subject to specific exceptions. NAC 689A (LCB File No. R074-14) dated 5-14-2014
ESSENTIAL HEALTH BENEFITS
Delaware has issued a new bulletin reminding insurance carriers that they are required to contract at least 30% of Essential Community Providers. Domestic-Foreign Insurers Bulletin 83
FILING REQUIREMENTS / PROCEDURES
Illinois amended regulations regarding required procedures for filing and securing approval of policy forms. Among the changes are requirements that forms be submitted in a searchable text PDF format, that replacement form filings include redlines, and that a combination form be submitted in two separate filings. Each filing must be identified with a unique company tracking number and must have an accurate TOI and Sub-TOI selected. 50 Ill. Adm. Code 916
Puerto Rico issued a circular letter regarding general guidelines and requirements for forms submissions for insurers that write life, annuity, consumer credit, disability, accident and health insurance. Circular Letter CC-2015-1869-AV-AS
Washington has adopted a new regulation regarding filing requirements for health plans, stand-alone dental plans and stand-alone vision plans. 284-43-6500 Dated 10-20-2015
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FINANCIAL REGULATION
Arizona issued an order designating the NAIC as the department's repository for electronic filing of annual statements and supplemental filings by authorized domestic insurers. This eliminates the requirement for domestic insurers to send a separate paper filing to the department. Regulatory Activity Order of December 8, 2015
Illinois amended requirements relating to financial reporting for accident and health insurance policies to include reference to several editions of the NAIC's Accounting Practices and Procedures Manual. Different editions are applicable depending on the date a policy is issued and the date a claim is incurred. 50 Ill. Adm. Code 2004.10
North Dakota updated its rules regarding accounting practices and procedures. The Department now requires use of the March 2015 version of the NAIC Accounting Practices and Procedures Manual. 45-03-15-01 Dated 06-12-2015
Virginia has amended its regulations regarding annual financial reporting. 14 VAC 5-270-40 Dated 10-19-2015
FRATERNAL BENEFIT SOCIETIES
Pennsylvania has amended the Valuation Filing Instructions for domestic fraternal benefit societies required filings. 2015 Valuation Filing Frat Ben Soc
HEALTH CARE EXCHANGE / MARKETPLACE
California has issued an Emergency measure to implement new California Code of Regulations under Title 10--Investment, Chapter 12--California Health Benefit Exchange. Emergency T. 10 s 6408 Dated 12-14-2015
Maryland has issued a bulletin providing guidance on small group health composite premiums for multiple plans, which is applicable to new and renewing nongrandfathered small group plans on or after April 1, 2016. Bulletin 15-34
New York enacted legislation amending its insurance law related to permitting pregnant women to enroll in the state health insurance exchange at any time. SB 5972
HEALTH INSURANCE / HEALTH RATES
Colorado has amended its bulletin concerning guidelines for the filing of rates and forms for certain limited benefit plans. Bulletin B-4.80 dated 1-4-2016
Indiana has issued a new bulletin concerning credit life and accident/health rates. Bulletin 222
Ohio amended its rule defining "eligible dependent" for health care coverage. Rule 145-4-09 Dated 09-29-2015
Oregon adopted and amended temporary rules regarding health benefit plans, including changes to increases and decreases in services, permitting insurers to make certain modifications in coverage at time of renewal. It also allows that any health benefit plan, beginning on 1-1-17, must be updated to comply with state and federal law as well as changes to definitions. Temporary OAR 836-010-0155 Dated 12-17-2015
Virginia has amended its regulation regarding requirements for student health insurance coverage. 14 VAC 5-130-40 Dated 11-16-2015
HEALTH PLAN BENEFITS
Oregon adopted regulations relating to carriers and TPA responsibilities with regards to "Enrollee Confidential Communication Request" form, standards for acknowledging and responding to requests, and information to be submitted to DOI. OAR 836-053-0600 Dated 10-01-2015
HOLDING COMPANIES
Arkansas has amended its rule and regulations regarding insurance holding company systems and enterprise risk reporting forms and instructions. Rule and Regulation 15 Dated 9-30-2015
Delaware has amended its regulations regarding registration of insurance holding companies. 1801 s 1.0 Dated 11-01-2015
Michigan has issued a new order regarding filing requirements for insurers under the Holding Company Act. Order No. 2015-061-M
Michigan has made several revisions to regulations related to insurance holding companies, which are based on the NAIC's Insurance Holding Company System Regulatory Act (Model 440). SB 177
Missouri has issued an emergency measure regarding the Insurance Holding Company System Model Regulation with Reporting Forms and Instructions, which is an accreditation standard as of January 1, 2016. Emergency 20 CSR 200-11.101 dated 1-1-2016
North Dakota amended regulations regarding insurance holding companies and enterprise risk reports. The Department adopted two new reporting forms; Form E, pre-acquisition notification form, and Form F, enterprise risk report. 45-03-05-04 Dated 06-12-2015, 45-03-05+
Tennessee amended its regulation regarding filing and reporting requirements for insurance companies in the insurance holding company systems. 0780-1-67 Dated 08-18-2015
INSURER INVESTMENTS / SECURITIES
Alaska amended its regulations regarding registration and notice of securities. Regulatory Activity 3 AAC 08.011 Dated 09-10-2015
Colorado has amended its regulations regarding securities act. 3 CCR 704-1 Ch. 3 dated 10-30-2015
Florida has adopted new registration/notice-filing rules for entities required to be registered or notice-filed under Florida's Securities Transaction statutes. FAC Rule 69W-600.0012 Dated 07-14-2015
Florida has amended its registration of securities rule requiring an applicant to file forms and fees electronically on the Office of Financial Regulation website. FAC Rule 69W-700.001 Dated 07-14-2015
Kansas has amended its regulations regarding Kansas Uniform Securities Act. 81-1-1 dated 09-17-15
INTERNAL AND EXTERNAL REVIEW
Colorado has amended its regulation regarding informal investigations by independent contractors of all authorized and unauthorized insurers and producers transacting insurance business in Colorado. 3 CCR 702 Reg. 6-3-2 dated 10-30-2015
Texas has amended its regulations regarding examination expenses and assessments that must be paid by domestic and foreign insurers, including HMOs. 28 TAC s 7.1001 Dated 11-02-2015
LIFE INSURANCE / LIFE CONTRACTS
Kansas has issued a bulletin concerning temporary life insurance. Reminds life insurers that they are required to provide temporary life insurance to individual policyholders, along with a written receipt for premium, when an application and initial payment, or authorization for payment, are received. BULLETIN 2015-4
Pennsylvania has amended the Valuation Filing Instructions for Domestic Life Insurance Company. 2015 Valuation Filing Life Ins Cos
LIMITED BENEFIT CONTRACTS
Ohio enacted legislation making changes to the health coverage benefit limits and coverage exclusions for life and health insurance guaranty associations. In addition, amendments have been made to the law relating to reinsurance contracts, to update prompt payment requirements, and make changes to the effective date of a provision regarding subrogation. SB 223
LONG-TERM CARE INSURANCE
Michigan has issued a new bulletin which pertains to the Long-Term Care Partnership Program. Bulletin No. 2016-01-INS
FIRST CONSULTING’S CO-SOURCING APPROACH
A new year means new projects and quick deadlines. Have you ever said:
“I wish we had more people on this project?”
“How are we going to get this all done on time?”
“I wish we had someone that could research that subject?”
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MANAGED CARE PLANS / HMOS
California has amended its regulation regarding conflict of interest code for the Department of Managed Health Care. T. 28 s 1000 Dated 05-22-2015
Colorado has issued a new bulletin relating to continuity of care requirement when consumers are transitioning between managed care and/or health benefit plans. Bulletin B-4.86
MEDICARE SUPPLEMENT INSURANCE
New Hampshire reinstated expired rules regarding Medicare supplement policies. The rules expired on 2/1/2014 and were adopted again without change. Ins 1902.01 Dated 09-17-2015
Oregon amended its regulation regarding Medicare Supplement insurance guaranteed issue for eligible persons. OAR 836-052-0142 Dated 11-01-2015
Puerto Rico has issued a circular letter regarding clarification of the definition of group that is applicable in Puerto Rico for health care other than Medicare Advantage or Medicare Supplement plans. Circular Letter CC-2015-1868-D
West Virginia has issued a new informational letter pertaining to the time frame for writing Medicare Supplement application on an individual. Informational Letter 109-B
MISCELLANEOUS
Colorado has amended its regulation regarding the limited service licensed provider networks. 3 CCR 702 Reg. 2-1-9 dated 10-30-2015
MISCELLANEOUS HEALTH / ACCIDENT
Colorado has amended its definition of the term "complications of pregnancy" for all companies and entities marketing or selling accident and sickness policies providing disability coverage due to sickness and companies or entities marketing or selling individual or group services or indemnity contracts. 3 CCR 702 Reg. 4-2-6 dated 10-30-2015
MISCELLANEOUS LIFE
New York enacted legislation amending its insurance law regarding distribution of dividends by domestic stock life insurers. SB 1380
New York enacted legislation amending its insurance law regarding standards relating to the board of directors of domestic life insurance companies. SB 3012
MORTALITY TABLES
Delaware has amended its regulations regarding the new annuity mortality table for use in determining reserve liabilities for annuities. 1208 s 2.0 Dated 09-29-2015
Florida has revised its morbidity tables for long-term disability policies and revised regulations regarding minimum reserve standards for individual and group health insurance contracts. FAC Rule 69O-154.202 Dated 10-12-2015
Rhode Island has amended its regulations regarding annuity mortality table for use in determining reserve liabilities for annuities. R27-94-002 Dated 09-29-2015
ORSA: OWN RISK AND SOLVENCY ASSESSMENT
Michigan has enacted regulations relating to risk management and own risk and solvency assessment (ORSA) reporting requirements. SB 178
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Arkansas has issued a new bulletin regarding the definition of small employer under the Affordable Care Act and medical loss ratio allowances. Bulletin 15A-2015
Colorado has amended its bulletin regarding short-term limited duration health insurance policies and special enrollment periods. Bulletin B-4.76 dated 1-4-2016
Indiana has issued an emergency rule temporarily adding provisions to conform the definition of "small employer" to federal law under the Affordable Care Act. Emergency 760 s 1 (LSA 15-428)) Dated 12-09-2015
Maryland has issued a new bulletin providing guidance to health insurers, nonprofit health service plans, dental plan organizations, and HMOs on the Affordable Care Act requirements for individual and small employer form and rate filings for 2017. Bulletin 15-33
Massachusetts has amended its regulation regarding utilization review criteria to clarify that plan members, prospective plan members, and their health care providers may obtain medical necessity information, including proprietary criteria from their health plans. 958 CMR 3.101 Dated 06-19-2015
Massachusetts has amended its regulations which sets forth the waiver process for consumers seeking to buy non-group insurance outside of the open enrollment periods complying with eligibility rules that have not been changed in the Affordable Care Act and the related state law. 958 CMR 4.020 Dated 06-19-2015
The Department of the Treasury has amended its regulations relating to grandfathered health plans, preexisting condition exclusions, lifetime and annual benefit limits, rescissions, dependent coverage until age 26, internal and external review and appeal procedures, and patient protections under the ACA. 26 CFR 54.9801-2 Dated 11-18-2015
PREMIUM TAX
Arkansas has amended its regulation regarding filing and paying insurance premium taxes for any insurer, HMO, or other entity that is required to report and pay premium taxes via use of OPTins. Bulletin 19-2015
On November 13, 2015, New Mexico issued Bulletin 2015-031 related to health insurance and premium tax surcharges. Enforcement of that is suspended. Bulletin 2015-032
Tennessee issued an emergency measure amending its regulation relating to the timely filing of premium tax returns. Emergency 0780-1-50 Dated 1-12-2016
PRE-NEED CONTRACTS
Alabama has amended its regulation regarding limited care facilities. 410-2-4-.04
Arkansas has amended its rule and regulation regarding the fees for transfer or cancellation of a prepaid funeral benefits contract. Rule and Regulation 110 Dated 8-7-2015
California has enacted a regulation regarding security for limited liability companies certified as a cemetery authority. AB 180
REGULATORY REPORTING REQUIREMENTS
Illinois amended instructions for viatical settlement provider and broker reporting. 50 Ill. Adm. Code 5701
REINSURANCE
Washington has amended its regulations relating to certification of reinsurers. 284-13-500 Dated 10-16-2015
Arkansas has amended its regulations pertaining to credit for reinsurance. Rule and Regulation 65 Dated 9-30-2015
New York enacted legislation amending its law regarding exemptions for stop loss, catastrophic or reinsurance coverage issued to certain small groups. SB 5928 and SB 6004
Pennsylvania has issued a notice regarding qualified jurisdictions for certified reinsurers. Notice of January 9, 2016
SERFF FILINGS
Puerto Rico issued circular letter which provides general SERFF instructions for form and rate submissions. Circular Letter CC-2015-1870-AV-AS
SMALL EMPLOYER GROUPS
Colorado has issued a new bulletin that provides guidance to consumers and carriers regarding credit for deductibles paid when changing small group health benefit plans. Bulletin No. B-4.85
Delaware has amended its domestic-foreign insurers bulletin for all health insurance carriers, health service corporations, and HMOs doing business in Delaware regarding mini-cobra small employer group health policies. Domestic-Foreign Insurers Bulletin 51 (Amended)
Indiana has issued a new bulletin concerning the definition of "small employer" in health insurance plans. Bulletin 221
EASE YOUR STATE FILING NEEDS
Trust First Consulting to ease your State Filing needs!
Our Efficient Filing Process
Over the past 46 years First Consulting has refined and improved our filing process to maximize speed and efficiencies. First Consulting will complete required transmittals and certifications, perform Flesch scores, complete forms Checklists, handle forms Objections, and we update our website daily with any Status Updates so that you always know exactly where each state filing is at.
Analysts are for Analyzing, Not Filing
Using First Consulting’s filing experts is not only affordable, but it also allows your analyst to focus on those tasks that require their expertise, not the routine filing work.
Contact me today to find out how our clients gain an advantage by utilizing First Consulting for their state filing work.
Sean Cox
Sean.Cox@FirstConsulting.com
816.391.2737
FIRST CONSULTING’S CO-SOURCING APPROACH
A new year means there are new projects that need to be completed and quick deadlines in which to complete those projects.
Have you ever said:
- “I wish we had more people on this project?”
- “How are we going to get this all done on time?”
- “I wish we had someone that could research that subject?”
Our Co-Sourcing approach is what you need. Through this approach you can be involved in your project as much or as little as you see fit.
At First Consulting, we understand that each client and each project are unique. With you we will develop a specific approach to your project that fits your needs and expectations.
Click the following links to learn more about First Consulting Services or Co-Sourcing approach, or contact me today to discuss how we can help.
We are here to help you get your projects completed this year.
Vickie Goodman
816.391.2735
Vickie.Goodman@FirstConsulting.com
