Life and Health News
February 2025
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!
ADVERTISING / SALES & MARKETING
Puerto Rico approved Rule No. 109, "Rules on Advertising for Life Insurance and Annuities," which sets minimum standards for advertising life insurance policies and annuity contracts. It specifies requirements for presenting policy benefits, premiums, and changes, and ensures that advertisements clearly identify the insurer and the nature of the policy. Rule CIX s 1
AFFORDABLE CARE ACT
Michigan amended its Insurance Code effective April 2, 2025, by adding a new section to ensure health insurers comply with federal medical loss ratio (MLR) and rebate provisions under the PPACA. The new section requires insurers to issue rebates to policyholders if they fail to meet MLR requirements and report the MLR calculations and rebate details to both the U.S. Department of Health and Human Services and the Michigan Department of Insurance. HB 5825
AGENT / PRODUCER LICENSING AND APPOINTMENT
Oklahoma announced that all Insurance Producer and Adjuster licensing exams, as well as Kaplan Financial exam study manuals, will be available in Spanish. The exams and study materials will be offered in both electronic and printed formats and can be purchased through the Oklahoma Insurance Department's website. Notice Dated 12/23/24
ARTIFICIAL INTELLIGENCE
North Carolina issued a bulletin regarding the Use of Artificial Intelligence Systems in Insurance referencing the NAIC Model Bulletin. Bulletin 24-B-19
CERTIFICATE OF AUTHORITY FILINGS
Nevada announced the start of the 2025 Annual Company Renewal process, requiring insurers to submit payment by March 1, 2025, to continue operations in the state. Insurers must use the Division's Online Service Portal for invoice retrieval, contact updates, and financial filings, with invoices available starting January 3, 2025. Notice Dated 12/16/24
CLAIMS / CLAIMS ISSUES
Nebraska published the interest rate for death claims if a life insurer fails to pay within 30 days of receiving proof of loss. The insurer must pay interest at the rate effective on January 1 of the year the proof of loss is submitted. The judgment interest rate is 6.367% starting October 17, 2024, and 6.282% beginning January 16, 2025. Notice 2025-01
CORPORATE GOVERNANCE
New Jersey adopted new rules concerning the required filing of an annual Corporate Governance Annual Disclosure (CGAD). These rules outline filing procedures, content requirements, and penalties for non-compliance. Insurers must submit a CGAD by June 1 annually, detailing their governance structures, practices, and risk oversight. NJAC 11:1-48.1
CREDIT INSURANCE
Indiana updated its credit life and accident and health insurance rates. The minimum acceptable loss ratio is 55% and discount rates are adjusted, with 3.47% for life and 3.07% for accident and health policies. The DOI also established new prima facie rates, including a 32.5% increase for credit life insurance and a 6.1% decrease for credit accident and health insurance, with the adjusted rates for accident and health insurance to take effect by July 1, 2025. Bulletin 277
Nebraska issued an advisory document outlining requirements for insurers issuing credit life and credit accident and health insurance in the state. Effective April 1, 2025, insurers must file premium rates with the Director, with prima facie rates set at a 45-50 percent loss ratio. Compensation for creditors must not exceed 30 percent of premiums to maintain rate reasonableness. IGD -- A2 Amended
CYBERSECURITY
Alaska issued guidance for compliance with the enacted Insurance Data Security Law. The law establishes standards for data security as well as investigation and notification requirements in the case of a cybersecurity event. The law requires insurers and licensees to assess risks, create information security programs, and develop response plans for cybersecurity incidents. Bulletin B 24-11
DEPARTMENT OF INSURANCE
Illinois announced that the Department of Insurance's Chicago office relocated to 115 South LaSalle Street, 13th Floor. Regulated entities must update all public-facing materials, including forms and disclosure notices, to reflect the new address and ensure third parties conducting business on their behalf do the same. The Department will accept filings with the updated address through SERFF. Bulletin 2025-01
DISASTER / CATASTROPHIC EVENT
California asked the state's health insurers to submit a filing via SERFF within 48 hours of the Governor's declaration of a State of Emergency due to the Palisades Fire and windstorm. The filing should 1) detail the carrier's policies regarding suspending prescription fill or refill limitations and other barriers to access to prescription drugs; 2) plan to provide displaced insureds with access to medically necessary services; 3) plan for replacement of medical equipment and supplies; 4) arrange for in-network or other qualified provider to be available with the patent responsible only for the in-network cost sharing; and 5) plan for communicating with insureds. Notice Dated 1/8/25
California's Department of Managed Health Care (DMHC) issued an All Plan Letter (APL) to guide health plans in ensuring access to essential health services for enrollees affected by the Southern California Fires. Health plans were asked to notify the DMHC within 48 hours about service disruptions and actions taken to support impacted enrollees, including providing access to medical care and prescriptions without standard restrictions, setting up a toll-free number, and allowing access to out-of-network providers at no additional cost. DMHC APL 25-001
Florida issued a notice in response to the State of Emergency declared for the Florida Panhandle, reminding health insurers and related entities of their obligations under section 252.358, Florida Statutes. These entities must waive time restrictions on prescription refills, suspend "refill too soon" edits, and provide at least a 30-day supply of medications for those in affected areas. Notice Dated 1/20/25
FILING REQUIREMENTS / PROCEDURES
California's Department of Managed Health Care (DMHC) issued an All-Plan Letter advising health care service plans to review and update their plan documents to comply with 23 newly enacted bills from the 2024 Legislative Session. Plans must submit a filing by March 21, 2025, detailing their compliance. The letter provides guidance and filing instructions for each bill, covering topics including health care coverage, behavioral health and financial assistance. DMHC APL 24-023
Maryland issued a bulletin outlining the form and rate filing requirements for student health benefit plans for the 2025-2026 school year. The bulletin specifies the filing deadline of February 3, 2025, and highlights requirements for new or revised forms, rates, and compliance with recent law changes on cost-sharing and coverage. Bulletin 25-2
HEALTH CARE EXCHANGE / MARKETPLACE
California's Health Benefit Exchange amends various provisions regarding eligibility, enrollment, and appeals for the Individual Exchange to comply with federal law changes. Key amendments include changes to expand conditions for special enrollment periods and establish clear procedures for eligibility redetermination. T. 10 s 6408 +
Maryland published instructions for submitting individual and small employer form and rate filings for the 2026 plan year. The Department of Insurance provides guidance on essential health benefits, sets filing deadlines, and details requirements for plan forms, rate filings, and compliance with ACA regulations. It also includes specific instructions for stand-alone dental plans and limits on the number of plans per metal level for the Maryland Health Benefit Exchange. Bulletin 25-1
HEALTH INSURANCE / HEALTH RATES
Colorado issued guidance to insurers offering Independent, Non-coordinated Excepted Benefits Coverage. Revised processes were set forth in 89 Fed. Reg. FR 23338-01. Bulletin B-4.143
Connecticut issued amendments to clarify the coordination of benefits between insurers, particularly regarding Medicare coverage. The amendments ensure that both Medicare Part A and B are treated equally under the Medicare carve out and introduce technical changes for clarity. Key updates include refining the definition of "allowable expense" and eliminating terms that could reduce secondary carrier liability, with the goal of ensuring insured individuals receive full coverage from secondary insurers. Regulation 38a-480-3
Delaware revised and reissued their bulletin regarding the Delaware Health Insurance Individual Market Stabilization and Reinsurance Program. The bulletin outlines the procedures for health insurance carriers to pay an assessment by March 1, 2025, to fund the state's reinsurance program. The assessment, set at 2.75% of premiums subject to Delaware's insurance regulations, applies to most health insurance carriers, excluding certain plans like Medicare and Medicaid. Bulletin 113 (REISSUED)
New Hampshire implemented legislative changes to enhance consumer protections against balance billing. The new law aligns with the federal "No Surprises Act" and expands the state’s dispute resolution process to include disputes over emergency care and out-of-network services at in-network facilities. Bulletin INS 25-004-AB
New Hampshire issued guidance on prior authorization reporting following the enactment of SB 561. The law reduces decision time frames for prior authorizations, introduces peer-to-peer reviews, and requires health carriers to collect and submit specific data on authorization decisions. Health carriers must comply with the new timelines and submit annual reports starting in 2026, with interim quarterly reports encouraged for 2025. Bulletin INS 25-001-AB
HOLDING COMPANIES
Maryland adopted amendments to clarify reporting requirements for insurance holding company systems. These regulations specify when an ultimate controlling person must submit an annual group capital calculation, criteria for exemption, and conditions for a limited group capital filing. COMAR 31.04.18.02
LONG-TERM CARE INSURANCE
Colorado issued guidance to long-term care insurance carriers on offering Reduced Benefit Options (RBOs) for policyholders facing premium rate increases. Carriers are encouraged to offer a variety of RBOs, adjusting coverage aspects like elimination period, benefit period, and inflation protection, to help mitigate the financial impact of rate hikes. Carriers must also outline proposed RBOs in policyholder communications and actuarial filings. Bulletin B-4.144
MISCELLANEOUS
Maine adopted regulations to implement the Maine Paid Family and Medical Leave Program, which provides paid leave for family and medical reasons. The program covers employees earning wages in Maine and self-employed individuals who opt for coverage, with eligibility based on wage requirements. It outlines the application process, types of leave, fraud prevention, and employer obligations, including the option to substitute private plans. Employers must comply with reporting, cancellation, and plan approval requirements. 12-702-10-1
MISCELLANEOUS LIFE / ANNUITY
Michigan updated its administrative rules to provide exemptions from certain examination requirements for broker-dealers, agents, investment advisers, and representatives who have been unregistered for between two to five years, provided they participate in the Maintaining Qualifications Program (MQP) and the Investment Adviser Representative Examination Validity Extension Program (IAR EVEP). R 451.4.9
Missouri eliminated registration exemptions for broker-dealers acting as investment advisers and for their agents as investment adviser representatives. However, the amendment to the regulation retains exemptions for solicitors and revises the criteria for private fund adviser exemptions, introducing new registration requirements and fees for affected individuals and firms. Registrants must now pay registration and renewal fees, as well as potential examination costs. 15 CSR 30-51.180
PHARMACY BENEFIT MANAGERS
Alaska enacted a law dealing with Pharmacy Benefit Managers (PBMs). The law includes registration requirements and guidelines for claims, grievances, and appeals. PBMs must use a new registration form for biennial renewals, and those without current registration must apply using this form starting in 2025. Bulletin B 24-12
Arkansas implemented Rule 128 to assess the fairness and reasonableness of pharmacy reimbursement programs by Pharmacy Benefit Managers for health benefit plans. Health plans must report data starting in 2025 to help the Commissioner evaluate if additional dispensing costs are needed. The bulletin covers reporting requirements, standards and procedures. Bulletin 18-2024
New Jersey issued guidance regarding requirements for pharmacy benefits managers (PBMs) and pharmacy services administrative organizations (PSAOs). PBMs must obtain licensure, comply with specific contract requirements, and adhere to regulations for compensation, payment structures, and reporting. Registration for PSAOs is mandated. The deadline for PSAO registrations is set for March 31, 2025. Bulletin 24-18
South Carolina reminds pharmacy benefits managers (PBMs) and pharmacy services administrative organizations (PSAOs) that their conduct and business practices will be examined starting January 1, 2025. Examinations for 2025 are being scheduled, and entities selected will receive a call letter and examination warrant in the coming weeks. Bulletin 2025-01
PREMIUM TAX
Louisiana implemented a new requirement for companies filing premium tax returns, mandating the submission of the Annual Premium Tax Statement (Form 1061) and the Annual Municipal Premium & Tax Report (Form 1076) online through the Industry Access Portal. Companies must also submit additional forms, such as the 2023 Form 1068C for the Investment Tax Credit and others. Notice Dated 12/16/24
REGULATORY REPORTING REQUIREMENTS
Kentucky issued new reporting requirements for pharmacies, now mandating ambulatory pharmacies to report annual cost-of-dispensing data, including labor, medication acquisition, and operational expenses, starting in 2026. Pharmacies may also submit optional prescription-level data. All submitted information will remain confidential and exempt from public disclosure. 201 KAR 2:416
Maryland requires insurers, health organizations, and premium finance companies to submit disaster and continuity of operations contact information by April 15, 2025. Contact details must be updated and "saved" to record that the information was reviewed, even if no change has occurred. The requested information must be submitted via the DOI’s designated link. Bulletin 25-3