Life and Health News
March 2022
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
Maryland amended it regulation dealing with producer registers and documentation of appointments. The regulation removes the requirement that an insurer must provide an insurance producer with written documentation that includes the producer's residence or business address within 30 days of appointment. This requirement is being removed as being unduly burdensome on the insurer because many producers work out of multiple locations. 31.03.13
CANCELLATION / NON-RENEWAL / PREMIUM OR COVERAGE CHANGES
Louisiana updated and reissued Directive 147 dealing with health insurance in the individual, large and small group markets. The Directive updates requirements for discontinuance of health insurance products as of February 1, 2022. Directive 147 (Revised and Reissued)
Missouri's Insurance Department issued a bulletin to provide information regarding the practice of replacing insurance coverage terminated by one carrier with insurance coverage provided by a different carrier. Bulletin 22-01
DISASTER / CATASTROPHIC EVENT
California passed a law that ensures employees have access to COVID-19 supplemental paid sick leave through September 30, 2022. The 2022 version of this law is similar but not identical to the 2020 leave law. Small businesses employing 25 or fewer workers are exempt from the legislation. Local ordinances may also impact the leave. SB 114
DRUG / PRESCRIPTION COVERAGE
Rhode Island amended its code to require health insurance carriers to limit the copayment for a 30-day supply of insulin used to treat diabetes. Prescription insulin is not subject to any deductible. 27-20.8-3
FINANCIAL REGULATION
Arkansas' Insurance Department notified domestic companies that the Department intends to adopt amendments, revisions and modifications to the Accounting Practices and Procedures Manual as of March 2022. The effective date for domestic reporting entities is on or before March 1, 2023. Bulletin 1-2022
GUARANTY ASSOCIATION
Nevada's Life and Health Insurance Guaranty Association revised its Notice of Protection form. The revised notice must be used on or before July 1, 2022. Notice of Protection dated January 7, 2022
MISCELLANEOUS HEALTH / ACCIDENT
Arkansas' Insurance Department issued a bulletin providing information on requirements in the federal No Surprises Act that apply to health care providers, facilities, and providers of air ambulance services for plans starting in 2022. Bulletin 3-2022
Delaware's Insurance Department updated Bulletin 115 to encourage health insurers to proactively plan for COVID-19 at-home tests covered by carriers, and the Federal No Surprises Act. Bulletin 115 Updated
Illinois issued a bulletin to all companies writing accident & health insurance and managed care plans relating to the initial implementation of the federal No Surprises Act. Bulletin 2022-03
Louisiana's Insurance Commissioner advised consumers who are enrolled in High Deductible Health Plans with Health Savings Accounts to avoid the use of third-party payments, such as pharmacy discount cards. If third-party payments are applied before the individual's HDHP annual deductible is met, with the exception of third-party payments made toward preventative care, the tax benefits provided by the Health Savings account could be lost and potentially create a serious tax event for the individual. Bulletin 2022-01
Rhode Island amended provisions requiring insurance coverage for certain prostate and colorectal preventive screening examinations. Cost-sharing for colorectal screening examinations, lab tests, initial and follow-up colonoscopies is prohibited. HB 5432
Rhode Island will prohibit insurance companies from varying the premium rates for a health coverage plan based on the gender of the individual insured beginning January 1, 2023. HB 5763
The Centers for Medicare and Medicaid Services (CMS) has begun publishing state-specific enforcement letters detailing anticipated federal and state responsibilities with respect to enforcement of the No Surprises Act. The letters can be found on the CCIIO website under cms.gov. Consolidated Appropriations Act Enforcement Letters
U.S. Department of Labor, Health and Human Services and Treasury issued five additional frequently asked questions (FAQs) on February 4, 2022, clarifying certain aspects of the expanded COVID-19 test requirement. FAQs About Families First Coronavirus Response Act Part 52
NOTICE TO INSUREDS
Illinois passed the Consumer Coverage Disclosure Act that requires employers offering group health insurance coverage to provide a new notice to eligible employees. Under this law, a covered employer must prepare and provide its Illinois employees with a new notice that compares the benefits offered under the employer's group health insurance coverage with "essential health benefits" required through the Illinois insurance marketplace. The law puts the onus on employers, not insurers, to provide the benefit comparison notice. This applies to fully insured plans and self-insured coverage. 820 ILCS 46/1; SB 1905
PHARMACY BENEFIT MANAGERS
Arkansas' Insurance Department issued seasoning information regarding newly licensed pharmacists. The Commissioner expects each PBM to have three characteristics in their seasoning requirements for credentialing: (1) pharmacy must directly be provided with notice of a lack of seasoning requirements with a dedicated email, phone number, and address of the PBM to make an exceptions or appeal request; (2) exceptions process for rural locations of the pharmacy and common ownership of the pharmacy; and (3) the PBM must address in writing the reasons for the denial of seasoning and shall have no longer than 30 days to review an exception request. Bulletin 4-2022
New York amended public health law to provide that Pharmacy Benefit Managers must register with the state insurance department effective March 31, 2022. Beginning in 2023 PBMs must obtain licenses and adhere to state regulations. SB 3762
Rhode Island passed a law stating that a plan sponsor, health insurance carrier or pharmacy benefits manager cannot prohibit a pharmacist from providing an insured information regarding the amount of the insured's cost share for a prescription drug. HB 6477
REPORTS - DATA CALLS & OTHER REPORTS
Kentucky amended a regulation regarding data reporting requirements under health insurance contracts. The change establishes the data elements and the format for submitting annual reports to the department of insurance. 806 KAR 17:240
STANDARD VALUATION LAW
Nebraska's Director of Insurance adopted the updates made to the valuation manual which were fully adopted by the NAIC as of August 17, 2021, for the reporting year 2022. Bulletin CB-138 Amended
STOP LOSS
Vermont amended its Health Care Stop Loss Insurance Regulation. The regulation applies to policies issued or renewed on or after March 1, 2022. Reg. H-2009-02 (Revised)
THIRD PARTY ADMINISTRATORS
Vermont's Insurance Department posted FAQs regarding the Third Party Administrator Rule that is effective July 1, 2022. These FAQs state that only Third Party Administrators of life, annuity, health, or stop-loss coverage, including tax-advantaged accounts for health-related expenses must obtain a TPA license. Regulation I-2021-01
UTILIZATION REVIEW - HEALTH CARE
Kentucky revised regulations concerning the registration of insurers or private review agents, and the utilization review process, including internal appeal of decisions. 806 KAR 17:280