Life and Health News
July 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
Utah adopted a rule effective June 15, 2016, relating to annual accounting reports of commission compensation that producers, consultants, and affiliates of producers will be required to provide to certain large customers in connection with insurance sales. Rule R590-272
AGENT / PRODUCER CONTINUING EDUCATION
Louisiana amended its licensing and education requirements. A producer is required to take the examination prior to filing an application for a license and must receive a passing score of at least 70%. Licensing fees and continuing education requirements for holders of combination (life/health insurance) producer licenses and (life/ health) consultant licenses also have changed. House Bill 746, House Bill 865
Mississippi revised its continuing education requirements for the renewal of a producer license. Senate Bill SB 2193, 83-17-415
New Hampshire enacted legislation that requires certain insurance producers to complete certain education requirements every 2 years. House Bill 1340, 402-J:7-a
AGENT / PRODUCER LICENSING AND APPOINTMENT
Georgia adopted rule changes to allow for issuance of a Limited Health Counselor license in lieu of the previous Limited Group Health Counselor license, which will provide for counseling services regarding both group and individual insurance products. 120-2-3-.06
Nebraska amended its regulations regarding license and appointment requirements for a viatical settlement broker. 210 NAC Ch. 76 s 003, 210 NAC Ch. 76 s 004
South Carolina amended its insurance laws relating to address requirements for insurance producer license applicants. House Bill 4817
ANNUITIES / ANNUITY CONTRACTS
Indiana readopted its annual report requirements for securities issuers, requiring that an annual report be filed within 90 days of the close of the fiscal year. The requirement for quarterly financial statements also has been readopted and must be filed within 45 days after the close of each calendar quarter. Regulation 710:4-5-1, 710:4-5-2
Maryland amended its rule pertaining to the filing of annuity forms for approval to require filing mathematical outlines for certain annuity contracts. COMAR 31.04.17.03
Got the DOL Fiduciary Rule Implementation Blues?
Now that the final DOL “Fiduciary Rule” has been out for a few months, you may be finding that you have more questions than answers when it comes to implementation. Click here to find out how First Consulting can help!
BENEFICIARY
Connecticut enacted legislation to prevent someone found not guilty by reason of mental disease or defect, either as principal or accessory, from receiving benefits of life insurance issued on the life of a homicide victim or inheriting property from the victim. Senate Bill 213
CORPORATE GOVERNANCE
Connecticut enacted legislation addressing Corporate Governance Annual Disclosures (CGAD) and regulation of Risk Retention Groups (RRGs). Effective June 17, 2017 and annually thereafter, each domestic insurer or its insurance group, is to submit a CGAD. Effective Oct 1, 2016, RRGs are to provide specified information at the time of filing for a license. Senate Bill 436
CREDIT FOR REINSURANCE
New Hampshire amended its law to provide that a credit shall not be allowed to any ceding insurer for reinsurance unless the contract specifies how the reinsurance will be paid in the event of the insolvency of the ceding insurer. House Bill 1403, 405:47
DRUG / PRESCRIPTION COVERAGE
Louisiana enacted legislation requiring insurers that provide medical and surgical benefits covering topical ophthalmic prescriptions to not deny refills under certain circumstances. Senate Bill 258
FILING REQUIREMENTS / PROCEDURES
Nebraska issued a notice eliminating the requirement that policy forms be refiled when the only reason for refiling is a change in company officers. Notice of June 6, 2016
Staff Vacations Limiting Your Output?
Holidays and Summertime can often become difficult for managers to balance workloads
and letting their staff take vacations. First Consulting can help! Drafting, Filing, Research
FILINGS: HEALTH
Maryland amended its regulations to no longer allow Individual health benefit plan applications to be filed under the file and use method. COMAR 31.04.19.05
Pennsylvania revised notice 2016-01 as to the filing of rates for small group excepted benefit policies. Notice 2016-01 - Revised
GROUP HEALTH
New Hampshire amended its law regarding actions to recover on a policy by increasing the statute of limitations to three years from the expiration of the time within which proof of loss is required by the policy for group health and group blanket carriers. HB 1409
HEALTH CARE EXCHANGE / MARKETPLACE
New Hampshire enacted legislation applicable to health insurers and health maintenance organizations to provide administration simplification in the prior authorization process for prescription drugs and to encourage the use of electronic prior authorization technology. House Bill 1608
New Mexico issued a bulletin advising that effective July 1, 2016, and on the 15th of each month moving forward, all insurance carriers offering qualified health plans through New Mexico's Health Insurance Marketplace (BeWellNM) are required to submit their health plan provider contracted network lists in a specified format. Bulletin 2016-014
New Mexico issued a bulletin recommending that certain health insurers create 2017 plan year contingency policy form language, pending the outcome of a court case on cost-sharing reductions. The bulletin provides sample policy form language. Bulletin 2016-013
HEALTH INSURANCE - COMPREHENSIVE
Alaska enacted legislation to require a health insurer that offers, issues for delivery, or renews group or individual health insurance that provides mental health benefits shall provide coverage for mental health services provided through telehealth by a health care provider licensed in the state. The carrier may not require that prior in-person contact occur between a health care provider and a patient before payment is made for covered services. House Bill 234
Colorado enacted legislation to require health insurance coverage for severe protein allergic conditions, including specified disorders and gastrointestinal tract conditions. House Bill 1387
Colorado published a bulletin to provide consumers and carriers with the standards and requirements for ensuring continuity of care for health benefit plans. Bulletin B-4.93
Connecticut amended its statutes to require a health carrier to post on its website any clinical review criteria it uses and links to any rule, guideline, protocol or other similar criterion it relies upon to make an adverse determination. A copy of the specific rule, guideline protocol or similar criterion will be provided to the covered person without charge upon request. Senate Bill 372
Connecticut enacted legislation addressing standards and requirements for health carriers' provider networks and contracts between carriers and participating providers. Carriers are required to maintain networks with sufficient numbers and appropriate types of participating providers, covering out-of-network services as if they were in-network, when their networks do not include sufficient providers. Requests for such benefit provision are to be documented and supplied to the Commissioner upon request. Carriers and providers are to give each other at least 60 days' notice if the provider is leaving or being removed from the network and the carrier is to notify all covered persons being treated by the provider when the provider is leaving or being removed. Requires carriers to maintain a provider directory on the carrier's website and update it monthly. Senate Bill 433
Connecticut enacted legislation concerning the use of experimental drugs, allowing for terminally ill patients with a written informed consent to receive investigational drugs, biological products or devices which the patient seeks for treatment. Manufacturers may make such products available to such patients with or without compensation and health insurance carriers may provide coverage for such products. Senate Bill 371
Connecticut enacted legislation to require coverage of tomosynthesis for breast cancer screening, at the choice of the patient, as an option for mammography. House Bill 5233
Connecticut published a bulletin to all health carriers addressing its opioid abuse epidemic and providing guidance on its mandated coverage for pain management, specifically related to abuse-deterrent prescription drugs. Drug lists are required to be reported to the marketplace (exchange) or the Department (if off the exchange) effective Jan 1, 2017. Bulletin HC-112
Connecticut updated its statutes to prevent individual health carriers from requiring prior authorization for the interhospital transfer of (1) a newborn infant experiencing a life-threatening emergency or condition or (2) the hospitalized mother of such newborn infant to accompany her newborn infant. Senate Bill 160
South Carolina enacted its "Right to Try Act," which gives certain patients with a terminal illness the right to try an investigational drug, biological product or device to treat the illness. It protects from liability: 1) entities providing care using such investigational products and; 2) the manufacturers of such products. It also protects health care providers and entities from professional disciplinary action for recommending them. Insurers may provide coverage for such products, but are not required to do so. House Bill 4542
Vermont amended its Code to require health insurance plans to provide without any cost sharing requirements at least one drug, device or other product within each method of contraception for women identified by the U.S. Food and Drug Administration and prescribed by an insured's health care provider. Additional details are included. House Bill 620
Vermont enacted legislation related to prescription drugs and cost containment for them. All health insurers will be required to provide information to enrollees, potential enrollees and health care providers about the Exchange plans' prescription drug formularies, which are to be posted online in a standard format and to include specified cost information and other details. Senate Bill 216
Vermont enacted legislation to require that health insurers with a minimum of 2000 insured lives in the state at the end of a preceding year or who offer insurance through the state's Exchange shall submit, in plain language, with their annual statements detailed claims and utilization review data addressing the specific items listed. Senate Bill 255
Washington updated its regulation of utilization review, to streamline the prior authorization process and allow additional time for issuers to process a medical prior authorization request if insufficient information has been provided for them to make a decision. WAC 284-43-2000 Dated May 16, 2016
HEALTH INSURANCE / HEALTH RATES
Louisiana enacted new legislation requiring health insurance carriers to provide coverage for the diagnosis and treatment of temporomandibular joint and associated musculature and neurological conditions. Senate Bill 476
Maryland amended its health coverage requirements with respect to in vitro fertilization. Ins. s 15-810
Maryland amended its timeline for a healthcare service claim to be submitted to an insurance company for payment by health benefit plans. Ins. s 12-102
Maryland enacted legislation for insurers that provide contraceptive drug and device coverage pertaining to male sterilization and prescription contraceptive coverage requirements. Ins. s 15-826.1 & Ins. s 15-831
Maryland revised its law regarding the proof of loss requirements. Health benefit plans will now have separate requirements regarding proof of loss. Ins. s 15-213 & Ins. s 12-102
Minnesota enacted legislation to require health carriers to update their web sites once a month with any changes to the carrier's provider network, including provider changes from in-network status to out-of-network status. HF 3142
Missouri enacted legislation for health carriers regarding requirements for step therapy for prescription drugs. House Bill 2029, 376.2030, 376.2034
Ohio announced a special enrollment period due to the insolvency of InHealth. All insurance companies doing business in the individual market in Ohio must accept enrollees affected by the InHealth liquidation during the 60-day special enrollment period that runs through July 26, 2016, regardless of whether the enrollee is on or off the Exchange. BULLETIN 2016-02
Ohio issued a bulletin providing guidance and filing requirements for extended transitional individual policies and small group coverage for non-ACA compliant health plans through calendar year 2017. Bulletin 2016-01
Wisconsin published a bulletin with updated guidance regarding coverage of colorectal cancer screening. Bulletin dated June 8, 2016
IIPRC / INTERSTATE COMPACT
Connecticut enacted legislation adopting the National Association of Insurance Commissioners' Interstate Insurance Product Regulation Compact effective July 1, 2017. The state has opted out of the Long-Term Care and Disability Income standards. House Bill 5051
SERFF has added the Group Disability Income product line for all compacting states except Montana and Wyoming. The Notice provides filing procedures for submission of Group Disability Income product filings. IIPRC FILING INFORMATION NOTICE 2016-2
INSURER INVESTMENTS / SECURITIES
Louisiana amended its law regarding which securities may be chosen as investments by domestic insurers. R.S. 22:584
LONG-TERM CARE INSURANCE
Maryland established long-term care insurance policy requirements for partnership policies. COMAR 31.14.03.05
LICENSING ASSISTANCE FROM FIRST CONSULTING
Do you have a licensing issue, or work with TPA’s that need licensing expertise?
Click here to find out how First Consulting can help.
MANAGED CARE PLANS / HMOS
Louisiana amended legislation addressing certain prohibited clauses in provider contracts. A managed care organization may not require, as a condition of contract, that a healthcare provider render services under all health benefit plans offered by the managed care organization nor may it terminate a healthcare provider when the provider refuses to render certain services. An exception is made for out-of-state services. House Bill 1140
New Hampshire amended its managed care law to include definitions for the terms "contracted pharmacy," and "drug product reimbursement." The law advises what all contracts between a carrier or pharmacy benefit manager and a contracted pharmacy must include. 420-J:3, 420-J:8
New Hampshire clarified prior authorization requirements under the managed care law for substance use services. Senate Bill 532
New Jersey readopted its regulation pertaining to benefits or coverage of service for hemophilia treatment applicable to carriers offering health benefit plans that are managed care plans, and to all such health benefits plans offered by a carrier. NJAC 11:24C-3.1
MARKET CONDUCT EXAMINATIONS
Connecticut enacted legislation concerning market conduct authority and data call confidentiality. It also addresses changes regarding applicability of various provisions to domestic and foreign HMOs, health arts practitioners, annual statements and utilization review programs. Senate Bill 368
MARRIAGE EQUALITY / CIVIL UNIONS / DOMESTIC PARTNERS
Colorado enacted legislation to address the effect of a U.S. Supreme Court ruling on same-sex marriages. Parties to a civil union who marry each other will have the civil union terminated upon solemnization of the marriage. Persons who are party to a civil union and marry, enter a civil union with or cohabit with someone else are guilty of bigamy unless a specified affirmative defense can be presented. If a civil union and marriage are merged, any calculation of the duration of the marriage includes the duration of the civil union. Senate Bill 150
MISCELLANEOUS
Illinois amended its record retention requirements to allow all companies to dispose of or destroy certain records in their custody that do not have sufficient administrative, legal or fiscal value to warrant their further preservation. 50 Ill. Adm. Code 901.20
Louisiana enacted legislation requiring approval by the Commissioner of Insurance for the merger of a domestic insurer or health maintenance organization with any other person and notes information the request for such a merger should include. Senate Bill 199, R.S. 22:76, R.S. 22:264.1
Maryland revised its statute pertaining to civil actions, liability of disability insurers and failure to act in good faith. House Bill 990
Maryland adopted regulations to establish a limit on the value of incentives offered by insurance carriers in wellness programs. COMAR 31.10.38.01 et al
MISCELLANEOUS HEALTH / ACCIDENT
Connecticut enacted legislation, effective Oct 1, 2016, to define and authorize a new type of insurance: short-term care (STC). STC means an individual health policy designed to provide, within the terms and conditions of the policy, benefits on an expense-incurred, indemnity or prepaid basis for necessary care or treatment of an injury, illness or loss of functional capacity provided by a certified health care provider in a setting other than an acute care hospital, for a period not exceeding 300 days. House Bill 5521
Utah amended its Universal Health Insurance Application Rule. The rule applies to all insurers offering a health benefit plan in Utah outside the Federally Facilitated Marketplace to individuals and small employer health benefit plans. Rule R590-247-1 Dated 04-15-2016
NONFORFEITURE
Alabama reenacted with changes and recodified its Standard Nonforfeiture Law for Life Insurance to provide consistent minimum cash value requirements for assorted life products and more appropriate allowances for acquisition expenses, and to remove the exemption for group life products. Senate Bill 169
Minnesota amended its statute regarding nonforfeiture standards for life insurance, reserve valuation requirements, and actuarial opinion of reserves requirements after the operative date of the valuation manual. I - HF 3384, 61A.24, 61A.25
PATIENT PROTECTION AND AFFORDABLE CARE ACT
Puerto Rico issued a ruling to all disability insurers and health service organizations that write health insurance plans in Puerto Rico clarifying Ruling Letter No. CN-2016-197-AS, as related to the submission of forms and rates effective for calendar year 2017. Ruling CN-2016-202-AS
Utah issued a bulletin extending transitional PPACA plans, superseding bulletins 2016-2 and 2015-5 and further extending Utah's position regarding Market Transition provided in Bulletin 2013-4(a). Bulletin 2016-2(a)
PREMIUM TAX
Arizona enacted legislation to change its premium tax rates for all lines except fire, health care service plans and disability insurance. House Bill 2002
Colorado enacted legislation regarding the requirements for an insurance company to be deemed as maintaining a home or regional office in the state for premium tax purposes. Senate Bill 165
RISK-BASED CAPITAL
New Hampshire amended the risk-based capital trend test for life and health insurers. House Bill 1450, 404-F:3
South Carolina amended its Code relating to risk-based capital plans to increase the Risk Based Capital multiplier for a Company Action Level event for a life and health insurer from 2.5 to 3.0; to amend provisions relating to the chartering of risk retention groups; to require an out-of-state risk retention group to submit material revisions to its Plan of Operation to the Director; and to apply certain requirements to risk retention groups licensed as captive insurers. Senate Bill 978
STANDARD VALUATION LAW
Maine issued a bulletin advising that the operative date of the uniform valuation manual, for purposes of the Maine Standard Valuation Law, is January 1, 2017. The Standard Valuation Law establishes a principle-based valuation methodology that is applicable, subject to specified exceptions, to life, health and annuity business written after the "operative date" of the uniform valuation manual adopted by the National Association of Insurance Commissioners (NAIC). Bulletin 413
Nebraska issued a bulletin advising that the operative date of the valuation manual adopted by the NAIC shall be January 1, 2017. Bulletin CB-136
Rhode Island issued a bulletin stating that the operative date of the uniform valuation manual, for purposes of the state's Standard Valuation Law, is January 1, 2017. Bulletin 2016-3
Tennessee published a bulletin announcing the operative date of the uniform valuation manual for purposes of its Standard Valuation Law is January 1, 2017. Bulletin 16-01
UNCLAIMED BENEFITS
Missouri enacted legislation creating the Unclaimed Life Insurance Benefits Act that requires a comparison of in-force life insurance policies, contracts, and retained asset accounts against a death master file for potential matches to pay beneficiaries or remit unclaimed benefits. House Bill 2150
LICENSING ASSISTANCE FROM FIRST CONSULTING
First Consulting & Administration, Inc. assists with obtaining and renewing Third Party Administrator (TPA) licensing. We also assist with licensing other specialized market operations such as Warranty Service Providers and Limited Health Service Organizations. Plus, First Consulting assists with expanding insurers' Certificates of Authority.
We are experienced with each licensing process and with the various state-specific requirements. Our services include advising what materials are needed for each filing, assembling the filings, and following up to secure approval of the filings.
Contact me for a no obligation proposal and cost estimate.
John Palmer
816.391.2744
John.Palmer@FirstConsulting.com
GOT THE DOL FIDUCIARY RULE IMPLEMENTATION BLUES?
Let First Consulting Help!
Now that the final DOL “Fiduciary Rule” has been out for a few months, you may be finding that you have more questions than answers when it comes to implementation. Maybe you just don’t have the energy to read 1,023 pages of DOL rulemaking. And then there’s that looming April 10, 2017 effective date to think about. Sounds to me like you may have a case of the DOL Fiduciary Rule Implementation Blues.
Let First Consulting help turn your DOL Rule implementation into a happier tune! Here are just a few of the DOL Rule services First Consulting offers:
- DOL Rule Consulting (geared toward your unique challenges under the rule, including what competition is doing as well as implementation and communication strategy)
- Training (for agents, in-house marketers, management, and Board of Directors)
- Product Drafting/Filing (retooling of annuity products to compete under DOL Rule)
- Policies/Procedures (changes to internal/external policies/procedures)
- Operational Compliance (risk assessments, changes to in-house infrastructure)
- Document Drafting (point-of-sale documents/disclosures, compliance/suitability guides)
Call me today for a free, no-obligation discussion about how First Consulting can help.
Kevin W. Mechtley
816.886-3272
Kevin.Mechtley@FirstConsulting.com