Life and Health News
July 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 CONTINUING EDUCATION
Louisiana updated its licensure and continuing education requirements for insurance producers, consultants, adjusters, and public adjusters by mandating additional training on legislative updates in insurance law. The law also raises the claims threshold for unlicensed insurer employees adjusting property and casualty losses from $500 to $2,000. SB 40
New Mexico’s Office of Superintendent of Insurance announced the repeal of rule 13.10.34.24 NMAC on continuing education for producers selling excepted benefits plans, originally set to take effect April 1, 2026. The rule required specialized training and licensure compliance but will no longer apply once repealed. The OSI plans to introduce a replacement rule by the end of 2025. Notice Regarding 13.10.34.24 NMAC
AGENT / PRODUCER LICENSING AND APPOINTMENT
Maine will now be issuing 180-day apprentice insurance producer licenses without an exam. Sponsors must have a clean Maine license for at least a year and take full responsibility for their apprentices. Apprentices can only work on in-state risks under the sponsor’s license and cannot handle complex products or act as insurer agents unless appointed. Sponsors are limited to two apprentices per year. HP 567
BENEFICIARY
Texas amended its Insurance Code to clarify that caregivers at state supported living centers, assisted living facilities, intermediate care facilities, or group homes do not have an insurable interest in the lives of individuals with disabilities unless they are relatives—defined as a spouse, parent, stepparent, child, stepchild, sibling, stepsibling, or legal guardian. This applies to life insurance policies issued or renewed on or after January 1, 2026. HB 1041
CLAIMS / CLAIMS ISSUES
Oklahoma amended the Unfair Claims Settlement Practices Act to shorten the time limits for refund requests on paid claims. Insurers now have 6 months (down from 12), and health care providers have 12 months (down from 18) to request refunds after payment. SB 1050
Texas enacted new Insurance Code provisions requiring a uniform coordination of benefits questionnaire for health benefit plans. Beginning February 1, 2026, all health insurers using coordination of benefits provisions must adopt a single standardized form created by the Department of Insurance to streamline dual coverage determinations. HB 388
CREDIT INSURANCE
Illinois amended Part 1051 of its insurance regulations to update prima facie rates for credit life and credit accident and health insurance. The suicide exclusion period is reduced from one year to six months, and "war or any act of war" is added as an exclusion. The amendments also eliminate the triennial review and hearing requirements for rate adjustments. 50 Ill. Adm. Code 1051.50
DENTAL INSURANCE
Maine now prohibits insurers from requiring dental providers to charge fees for non-covered services and mandates that fees for covered dental services be set in good faith and not be nominal. These rules apply to individual and group dental insurance, as well as health maintenance organizations offering dental coverage. HP 1205
DISASTER / CATASTROPHIC EVENT
New Mexico’s Office of Superintendent of Insurance issued an Emergency Order in response to the Trout Fire, providing 90 days of enhanced insurance protections for affected residents. The order requires health insurers to offer premium grace periods, early prescription refills, out-of-network coverage, and waived cost-sharing, while property and auto insurers must allow premium and claims grace periods, waive deductibles, and cover additional living expenses for displaced homeowners. Emergency Order Dated 6/18/25
DISASTER PREPAREDNESS
New York issued updated disaster planning and response requirements for life and health insurers and related entities. The circular mandates annual business impact analyses and board-approved continuity and disaster response plans tailored to each entity’s operations. By August 15, 2025, entities must submit their plans and related documentation through the DFS portal. Insurance Circular Letter No. 4
DISCRIMINATION
Louisiana expanded anti-discrimination protections to prohibit employment discrimination based on military status, including in hiring, compensation, and training programs. The law defines military status and specifically bars insurers from discriminating when appointing or compensating insurance agents based on military status. SB 66
DRUG / PRESCRIPTION COVERAGE
Nevada caps cost-sharing for prescription insulin at $35 for a 30-day supply to improve affordability for people with diabetes, including type I, type II, and gestational diabetes. This limit applies to individual, group, and various health insurance policies and plans issued or renewed after October 1, 2025, with exemptions for certain Medicaid, CHIP, and government-related managed care plans. AB 555
FRAUD / ANTI-FRAUD
California updated its 2024 Special Investigative Unit (SIU) annual report requirements, setting a new submission deadline of September 15, 2025, for all licensed insurers. While report content remains unchanged, the Department will mail official notices in late June and offer training sessions on July 30 and August 20. The online portal will remain open until the deadline. SIU E-Blast 2025-12
GROUP HEALTH
Texas extends the automatic coverage period for newborns under certain health benefit plans from 32 to 61 days after birth. The state now requires notice of birth and any additional premium to be submitted by the 60th day, instead of the 31st, to continue coverage. These changes apply to plans delivered, issued, or renewed on or after January 1, 2026. SB 896
HEALTH INSURANCE - COMPREHENSIVE
Colorado amended its health insurance law to require health benefit plans with maternity coverage, issued or renewed on or after January 1, 2027, to cover up to three prenatal care visits without cost-sharing. This mandate does not apply to standardized health benefit plans under Section 10-16-1305. SB 118
Louisiana now requires health insurers to cover proton therapy for cancer patients, effective for new policies issued on or after January 1, 2026. Existing plans must comply upon renewal by January 1, 2027. Coverage may include standard cost-sharing but excludes limited benefit, excepted, and short-term plans of less than 12 months. SB 129
Nevada issued regulation prohibiting providers of vision insurance from controlling the professional judgment of vision care providers, employing them, or withholding payments based on their choice of labs or suppliers. It also bans conditioning a provider’s participation in one plan on their participation in other plans and requires disclosure of ownership or financial interests in suppliers. AB 448
MEDICARE SUPPLEMENT INSURANCE
Nevada now requires insurers to offer Medicare supplemental policies to individuals under 65 with disabilities or end-stage renal disease on the same terms as those aged 65 and older, including prohibiting denials or exclusions based on health status during specified open enrollment periods. The bill sets premium rate limits, mandates insurer notifications, and extends protections to nonprofit insurers, government employee plans, and self-insurance programs. SB 292
Wyoming introduced a “Birthday Rule” for Medicare Supplement Guaranteed Issue Periods. The Guaranteed Issue Period now begins on the insured’s birthday and lasts 63 days, allowing policyholders to switch to a Medicare Supplement plan with similar or lesser coverage without underwriting. Bulletin 06-2025
MISCELLANEOUS
Federal Department of Health and Human Services issued a Technical Assistance document clarifying procedures for reopening Federal IDR disputes under the No Surprises Act to correct certified IDR entity errors. The guidance allows correction of clerical, jurisdictional, and procedural mistakes through a streamlined process initiated via the Federal IDR portal CMS Notice Dated 6/6/25
Federal Financial Crimes Enforcement Network (FinCEN) issued updated guidance to help financial institutions detect and report Iranian sanctions evasion and related illicit activities. The advisory highlights red flags tied to oil smuggling, shadow banking, and weapons procurement, and coincides with OFAC sanctions on over 40 individuals and entities linked to Iran’s shadow banking networks. Financial institutions are urged to file Suspicious Activity Reports (SARs) using key term “IRAN-2025-A002” and remain vigilant under BSA obligations. FinCEN Notice Dated 6/6/25
PHARMACY BENEFIT MANAGERS
Alaska adopted new regulations outlining registration, operational requirements, and penalties for pharmacy benefits managers (PBMs), requiring detailed disclosures, financial documentation, and compliance with recordkeeping standards. PBMs must pay a $300 fee for registration or renewal and face civil penalties of up to $25,000 per violation for noncompliance. 3 AAC 31.020
Colorado enacted new regulations regarding pharmacy benefit manager (PBM) practices to reduce prescription drug costs by allowing flat-dollar service fees, banning income tied to drug prices, and mandating reimbursement for cost-saving efforts. PBMs must disclose drug cost information to health benefit plans, favor generics or lower-cost brands, and allow annual audits. HB 1094
Iowa enacted legislation strengthening oversight of pharmacy benefit managers (PBMs). The law requires PBMs to pass through 100% of rebates, reimburse pharmacies at NADAC plus a $10.68 dispensing fee, and submit quarterly reimbursement reports. It also establishes new appeal rights for pharmacies and mandates a state review of pharmacy services administrative organizations and the prescription drug supply chain. SF 383
Maine now prohibits carriers and pharmacy benefits managers from using spread pricing in contracts entered or renewed on or after January 1, 2026. They must certify compliance annually to the Department of Insurance starting December 31, 2026, with violations subject to enforcement. HP 1038
Maine now prohibits health insurance carriers and their contracted pharmacy benefits managers from reimbursing pharmacies at rates lower than those paid to affiliated pharmacies for the same prescription drugs or services. HP 113
Oregon now includes organizations acting as pharmacy services administrative organizations, or similar entities advising or representing member pharmacies, within the scope of third-party administrator activities. Third-party administrators must comply with other applicable licensing requirements when performing functions of insurance producers, adjusters, or insurance consultants. HB 3226
Texas now prohibits pharmacy benefit managers from limiting pharmacists or pharmacies from informing enrollees about out-of-pocket cost differences for prescription drugs with or without insurance claims. The state also voids any contract terms that restrict such disclosures and protects related communications with plan sponsors or administrators. SB 493
PRE-NEED CONTRACTS
Colorado updated the Revised Uniform Unclaimed Property Act to clarify reporting rules for legacy preneed contracts, define key terms like "cryptocurrency," and establish new timelines for presuming property abandoned. The law reduces compensation and record retention periods, mandates liquidation of virtual currency, and strengthens confidentiality protections for claimant information. HB 1224
Maine updated its regulations on pre-need funeral insurance and services by prohibiting contracts that mandate specific funeral providers and clarifying the use of life insurance for funeral payments. The law expands prearranged funeral plan definitions, removes commission prohibitions for procuring insurance, and restricts solicitation of prearranged plans by funeral establishments except when consumers initiate contact. HP 553
REPORTS - DATA CALLS & OTHER REPORTS
Arkansas issued a bulletin extending the Rule 128 data-reporting deadline for plan year 2026 from July 1 to July 31, 2025, allowing more time for health insurers, PBMs, and other entities to compile complete reports. The Insurance Department will review submissions for compliance and grant ten business days to correct any deficiencies. Bulletin 8-2025
Indiana released a bulletin notifying insurers, TPAs, and PBMs of new annual ownership reporting requirements under Public Law 239-2025. Entities must report detailed ownership information, excluding Social Security numbers, with fines of $1,000 per day for late submissions beginning in 2026. The Department plans to issue a follow-up bulletin with submission details. Bulletin 278
RESERVE VALUATION
New York issued a Special Considerations Letter outlining reserve and solvency requirements for life insurers, fraternal societies, and accredited reinsurers for the valuation date of December 31, 2025. It provides detailed actuarial guidance on asset adequacy analysis, assumptions, and filing deadlines under Regulations 126 and 147. Insurers must use conservative, historically validated assumptions and submit required filings between March and June 2026. Special Consideration Letter of 6/16/25
TRADE PRACTICES
New Hampshire’s Insurance Department issued a bulletin warning against misuse of the National Producer Number (NPN) override and improper “producer of record” designations in insurance sales. The bulletin highlights that listing a producer who did not interact with the consumer or using the NPN override to submit applications violates state law and may lead to fines, license suspension, or revocation. Bulletin INS 25-038-AB
UTILIZATION REVIEW - HEALTH CARE
Texas strengthened its health benefit plan preauthorization rules, now requiring utilization reviews to be directed by Texas-licensed physicians (excluding those with administrative-only licenses) and extending the preauthorization exemption evaluation period from six months to one year. The law enhances provider rights to independent reviews, limits rescission timing to January each year, and mandates public annual reporting by insurers. HB 3812