Life and Health News
January 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!
AGENT / PRODUCER LICENSING AND APPOINTMENT
New Mexico will implement amendments to several provisions in the state’s insurance licensing rules, effective April 1, 2025. These updates include changes to rules for resident and nonresident agents, surplus lines brokers, and adjusters, with notable clarifications such as removing provisions for pharmacy benefit managers and adjusting continuing education requirements. Additionally, the amendments address licensing criteria for insurance producers, business entities, and fraternal benefit producers. 13.4.2.1 NMAC
Pennsylvania replaced its existing insurance producer rule with a new one based on the Producer Licensing Model Act. The new rule streamlines the application process and offers greater transparency and efficiency. 31 PA. CODE CH. 37a
Rhode Island updated its regulations on licensing and renewal fees for insurance producers, third party administrators and others. The changes include the repeal of the annual contracted producer report, introduction of a new electronic appointment fee of $15 and updated fee schedule for business entity licensees. The regulation also streamlines the procedures for electronic filing of insurance producer appointments, renewals, and terminations through the National Insurance Producer Registry (NIPR). 230-RICR-20-50-5.1
ARTIFICIAL INTELLIGENCE
Massachusetts issued a Bulletin to insurers licensed to do business in Massachusetts regarding the use of Artificial Intelligence (AI). Insurers using AI systems must comply with applicable insurance laws, including those on unfair trade practices, corporate governance annual disclosure, insurance rate requirements and market conduct examinations. The guidance mandates that insurers develop written AI System programs to mitigate risks and ensure fairness, with oversight from the DOI. Bulletin 2024-10
AUTISM SPECTRUM DISORDERS
Illinois reminds insurers writing accident and health insurance and managed care plans, they cannot deny or refuse to otherwise provide covered services solely because of the location where the clinically appropriate services are provided. The bulletin specifically applies to treatments for autism spectrum disorder, including applied behavior analysis, and covers non-traditional settings. The DOI advised insurers to work with providers to avoid claim rejections or delays. Bulletin 2024-17
ELECTRONIC TRANSACTIONS
Puerto Rico amended its insurance regulation regarding electronic transactions effective January 10, 2025. The amendment establishes electronic delivery of policy contracts and related documents as the default method, with the option for insured parties to request physical copies. Key changes include renumbering the regulation from Rule 102 to Rule 110, revising procedures for electronic delivery, and clarifying conditions for online business practices. Rule CX Section 1+
Utah updated the required Dental Claim Billing Standard for electronic health insurance transactions. The amendment replaces the reference to the ADA Dental Claim Form J340 with the updated American Dental Association Dental Claim Form J43024. Rule R590-164-5
FILING REQUIREMENTS / PROCEDURES
Nevada Division of Insurance launched the 2025 Annual Company Renewal process. The Department provided information on how to obtain the renewal invoice on-line as invoices will not be mailed. Insurers are encouraged to keep contact information current. For companies required to submit financial filings, use the Financial Filing Submission Portal. The last day to pay invoices is March 1, 2025. Notice Dated December 26, 2024
FRAUD / ANTI-FRAUD
Federal Financial Crimes Enforcement Network (FinCEN) issued an alert warning financial institutions about scams involving the misuse of FinCEN's name and authority, including fraudulent schemes related to beneficial ownership reporting and misuse of FinCEN's Money Services business (MSB) registration tool. FinCEN requests these scams be reported through Suspicious Activity Reports (SARs). It clarifies that it does not charge fees for beneficial ownership filings or request payments in investigations. Financial institutions are urged to remain vigilant. FIN-2024-Alert 005 December 18, 2024
HEALTH INSURANCE
Colorado revised its guidance on the medical inflation trend calculation for premium rate reductions on the Colorado Option Standardized Health Benefit Plans. This updated Bulletin provides carriers with instructions to comply with premium rate reduction requirements under Colorado Insurance Regulation 4–2-85, applicable to small group and individual health plans. Amended Bulletin B-4.121
Federal Centers for Medicare & Medicaid Services (CMS) published FAQs to clarify the Good Faith Estimate (GFE) requirements for uninsured and self-pay individuals under the Consolidated Appropriations Act of 2021. It explains the obligation of health care providers and facilities to offer GFEs to individuals without health coverage, including those with alternative insurance plans, and expands the requirement to include dental and vision providers, among other FAQs. CMS Notice Dated 12/13/24
New York amended its Insurance Law to require health insurance plans to provide coverage for at least two medically necessary epinephrine auto-injector devices for individuals at risk of life-threatening allergic reactions. The law caps the insured's annual out-of-pocket cost for these devices at $100, with exceptions for high deductible health plans. SB 7114
New York enacted the "Dyslexia Diagnosis Access Act," which requires all policies providing coverage for physician services or comprehensive medical coverage to include coverage for neuropsychological exams to diagnose dyslexia. These policies must cover testing, diagnosis, and treatment for dyslexia, including comprehensive exams to evaluate the individual’s psychological, emotional, and educational needs and is effective for policies issued, renewed, or amended on or after January 1, 2025. AB 2898
HIV
Illinois reminds carriers that effective January 1, 2024, all individual and group health insurance policies, HMO plans, and voluntary health services plans must cover all FDA-approved HIV Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) drugs without cost-sharing. This includes coverage for off-label use, mandates the inclusion of these drugs in formularies, and applies preventive care guidelines for high-deductible health plans. Bulletin 2024-18
MANAGED CARE PLANS / HMOS
California's Department of Managed Health Care (DMHC) and the Department of Health Care Access and Information (HCAI) issued an All-Plan Letter encouraging health care service plans to integrate Certified Wellness Coaches into their services. This initiative, under AB 133, aims to provide prevention and early intervention behavioral health services to children, youth, and their families. Health plans are advised to consider using Wellness Coaches to reduce the demand on clinical resources while supporting behavioral health care for their members. DMHC APL 24-022
MEDICARE SUPPLEMENT INSURANCE
Maine reminded insurers of their obligations under Rule Chapter 275 regarding guaranteed issue rights for consumers whose Medicare Advantage Plans are discontinued in the Service Area. Affected consumers have a 90-day window to enroll in any Medicare Supplement plan of their choice, with no underwriting or pre-existing condition exclusions. Bulletin 481
Oklahoma reissued a bulletin concerning Medicare supplement regulations. The state requires Medicare Supplement issuers to offer new policies with the same or lesser benefits to policyholders who have not had a coverage gap greater than 90 days. Issuers must also provide a 60-day open enrollment period and waive medical underwriting for these new policies. Additionally, issuers must notify individuals under 65 with disabilities about open enrollment when they turn 65. Bulletin 2023-10 (Revised 12/13/24)
MENTAL HEALTH PARITY
Colorado amended its insurance rules to enhance parity between mental health and substance use disorder (MH/SUD) benefits and medical/surgical benefits in health plans. The regulation expands coverage for preventive care, prohibits stricter treatment limitations for MH/SUD benefits, and mandates new reporting requirements for insurance carriers. 3 CCR 702-4-2-64
Georgia directs health insurers to comply with the state's Mental Health Parity Act by submitting an annual Comparative Analysis Report (CAR) detailing mental health parity data. Insurers must submit the CAR by January 1 each year, with exemptions for companies that have filed an approved Attestation for Annual Reporting and received the DOI's approval. Bulletin 24-EX-9
MISCELLANEOUS
Colorado's Department of Labor and Employment adopted new regulations under the Paid Family and Medical Leave Insurance Act (FAMLI Act). The regulations amend definitions, clarify the coordination of FAMLI benefits with other benefits such as Workers' Compensation and Unemployment Insurance, and outline employer responsibilities, including maintaining health care benefits and handling overpayments. 7 CCR 1107-4
Maine's Department of Labor adopted regulations for the Maine Paid Family and Medical Leave Program. The program provides paid leave for family and medical reasons, covering employees earning wages in the state and self-employed individuals who opt for coverage. It outlines eligibility criteria, the application process, various types of leave, and premium payment requirements. Employers can substitute the state plan with equivalent private plans, subject to specific approval and reporting requirements. Rule 12-702 Section 1+
PHARMACY BENEFIT MANAGERS
Arkansas amended its PBM regulation to strengthen oversight of pharmacy benefits managers. The amendments expand the Commissioner’s authority over PBM licensing, introduce new reporting obligations for PBMs, including annual disclosures on rebates and cost savings, and establish a process for Maximum Allowable Cost (MAC) appeals. Rule 118
Virginia Bureau of Insurance announced updates to the pharmacy benefits management rebate reporting requirements under Insurance Code section 38.2-3468. Updated forms, instructions, and guidance will be released by January 17, 2025, for the 2024 rebate reports, which are due by March 31, 2025. The Bureau encourages entities to review the materials and sign up for notifications on the Virginia State Corporation Commission website for updates. Memorandum dated December 5, 2024
PREMIUM TAX
California announced the launch of the new Premium Tax Processing System (PTPS) portal, effective January 31, 2025. The system will streamline the filing of Insurance (Premium) Tax Returns for Admitted Insurers and Surplus Line Brokers. While filings for the 2023 tax year and earlier will still be accepted by email, all new filings must be submitted through the PTPS starting in 2025. Notice Dated 12/2/24
REPORTS - ANNUAL / QUARTERLY STATEMENT
North Dakota announced a change in the process for submitting and publishing the Company Abstract of Statement. Insurance companies are now required to submit their annual statement abstracts directly to the North Dakota Newspaper Association via a Self-Service Portal, instead of through the DOI. Carriers must ensure publication in the newspaper with the highest circulation in each judicial district in which they operate in North Dakota. Companies must also submit proof of publication to the DOI within four months of filing their annual statement. Bulletin 2024-1
REPORTS - DATA CALLS & OTHER REPORTS
Indiana adopted provisions under Rule 83, requiring health payers, including insurers and third-party administrators, to submit healthcare claims data to the state's all payer claims database. The regulation defines key terms, outline submission requirements, and set penalties for non-compliance, including daily fines. Health payers must register annually, submit monthly data in specific formats, and address any errors in submissions, with exemptions for smaller entities. 760 IAC 1-83
Massachusetts Division of Insurance advised domestic insurers, including health maintenance organizations and dental service corporations, to integrate climate risk management into their operations. Insurers must incorporate climate risks into their governance, financial risk management, and disclosure practices, ensuring board oversight and adherence to the NAIC's ORSA Guidance Manual. Full implementation is expected by July 1, 2025. Bulletin 2024-11
RESERVE VALUATION
Texas adopted the updated National Association of Insurance Commissioners (NAIC) valuation manual dated August 15, 2024. 28 TAC 3.9901
SUITABILITY
Utah's Insurance Commissioner issued a bulletin to life insurance and annuity licensees giving guidance regarding the Suitability in Annuity Transactions rule. The Commissioner highlights factors a producer should consider such as financial implications, surrender charges, and prior annuity exchanges required under the best interest standard. Non-compliance could potentially lead to penalties under Utah law. Bulletin 2024-12
TRADE PRACTICES
Federal Trade Commission (FTC) amended the Telemarketing Sales Rule effective January 9, 2025, to include inbound telemarketing calls made by consumers in response to an advertisement through any medium or direct mail solicitation in which technical support products or services are offered for sale. 16 CFR 310.2
UTILIZATION REVIEW - HEALTH CARE
Mississippi adopted permanent rules for utilization review agents, implementing SB 2140, the Prior Authorization Act. The rules establish standards for certification, timely reviews, appeals, and prior authorization procedures for health insurers and review agents. They emphasize transparency, requiring insurers to publish prior authorization statistics, ensure access to clinical personnel, and report data annually. The rules also include provisions for standardizing electronic prior authorization systems by 2027. 19-3-19.01