Life and Health News
March 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
California announced a partnership with Secure Screening Solutions Inc., operating as Capital Live Scan (CLS), to serve as the new Live Scan fingerprint vendor for resident license applicants in the insurance industry. Starting February 14, 2025, applicants, including agents, brokers, adjusters, and bail agents, must schedule fingerprinting appointments through CLS for a background check by the DOJ and FBI. Notice Dated 2/13/25
ARBITRATION
Colorado amended its regulations, effective March 30, 2025, to establish a standardized arbitration request form for out-of-network providers disputing payments from carriers. The amendment outlines the arbitration process, including the appointment of arbitrators, timelines for final offers, and qualifications for arbitrators, with noncompliance resulting in penalties. It applies to health benefit plans for claims incurred on or after January 1, 2020, and includes forms for arbitration requests and decision reporting. 3 CCR 702 Reg. 4-2-65
ARTIFICIAL INTELLIGENCE
Delaware issued a bulletin reminding insurance carriers to ensure their use of Artificial Intelligence (AI) complies with existing laws, particularly those related to unfair trade practices and discrimination. Delaware emphasizes the need for fairness, ethical use, and accountability, requiring carriers to develop and maintain a written program for responsible AI use, including governance frameworks, risk management controls, and compliance with relevant insurance laws. Domestic-& Foreign Bulletin 148
New Jersey issued a bulletin to insurers emphasizing the need for compliance with insurance laws and regulations when using Artificial Intelligence (AI) in their operations. The bulletin outlines the Department's expectations for AI-driven decisions, ensuring they align with legal standards, particularly regarding fairness, discrimination, and transparency. Insurers must implement an AI Systems Program (AIS Program) with robust governance, risk management, and internal audits to mitigate risks. Bulletin 25-03
CLAIMS / CLAIMS ISSUES
Arizona issued a bulletin describing insurer obligations for timely claims processing and payment. Insurers must maintain records of provider grievances, submit semi-annual reports, and designate a primary contact for grievance matters. The bulletin also provides guidelines for resolving grievances and adjusting payments or denials within specific timeframes. Bulletin 2025-01
CONFIDENTIALITY / PRIVACY
New York issued a bill clarifying the requirements for notifying the Department of Financial Services (DFS) about data breaches. This amendment to General Business Law Section 899-aa specifies that only entities under the jurisdiction of the DFS are required to notify the Department in the event of a data breach. SB 804
DISCRIMINATION
Alabama enacted a new bill amending the Alabama Code to define key sex-based terms, mandating that entities who collect vital statistics identify individuals as either male or female based on biological sex observed at birth. SB 79
DRUG / PRESCRIPTION COVERAGE
Colorado amended its regulations, effective March 30, 2025, to standardize the drug benefit prior authorization process and require drug appeals for health carriers offering prescription drug benefits. The amendments introduce a uniform prior authorization form, impose timeframes for processing requests, and require that prior authorization approvals be valid for at least 180 days, with an extension to one year starting in 2026. The regulation also includes provisions for chronic maintenance drugs, substance use disorder treatments and requires secure electronic submissions for provider requests by 2027. 3 CCR 702 Reg. 4-2-49
Utah issued a bulletin requiring insurers to cap the price of insulin at $10 and $35 for a 30-day prescription supply in 2026. Insurers must comply with this mandate in policies issued or renewed in 2026. Bulletin 2025-3
West Virginia issued a bulletin addressing amendments to the Pharmacy Audit Integrity Act (PAIA), as updated by House Bill 2263 in 2021. The bulletin clarifies that health insurers must calculate the cost-sharing for prescription drugs at the point of sale to reflect 100% of any received rebates, using excess rebates to lower premiums. It also mandates that insurers report the total amount of prescription drug rebates and their effect on health insurance rates, highlighting the impact for the 2024 and 2025 plan years. Bulletin 2025-01
ESSENTIAL HEALTH BENEFITS
Nevada is seeking public input on potential revisions to its Essential Health Benefits (EHB) plan, which has been in place since 2017. The Division of Insurance is considering updating the EHB benchmark plan, including adding coverage for FDA-approved drugs for opioid use disorder, HIV, and hepatitis B and C. Stakeholders can participate in public meetings and submit feedback by March 19, 2025. Notice Dated 2/10/25
FILING REQUIREMENTS / PROCEDURES
California's Department of Managed Health Care (DMHC) released an All-Plan Letter (APL) outlining the filing requirements for Qualified Health Plans (QHPs), Qualified Dental Plans (QDPs), and Off-Exchange products for Plan Year 2026. The guidance outlines the regulatory submission process and ensures compliance with the Knox-Keene Act and DMHC regulations. DMHC APL 25-002
Colorado issued guidelines to insurance carriers regarding the form filing and annual certification requirements for short-term disability insurance products offered as part of the Paid Family and Medical Leave Insurance (FAMLI) program. Carriers must submit updated forms by March 31, 2025, including required documentation and certifications, and submit annual certifications by December 31 each year, starting with plan year 2025. Bulletin B-4.147
Massachusetts issued guidance to inform health insurance carriers of the requirements and deadlines for submitting rate filings for the Calendar Year 2026. Carriers must submit the 2026 Plan and Benefit Template, Plan ID Crosswalk Template, and rate filings via SERFF by May 15, 2025. Carriers are also encouraged to contact the DOI by April 15, 2025, regarding significant changes to cost-sharing or benefits before filing. Filing Guidance Notice 2025-B
Virginia issued SERFF filing instructions outlining requirements for insurers submitting form and premium rate filings. The guidelines detail compliance with Virginia's insurance laws and mandate specific submission formats, checklists, and the inclusion of a Certificate of Compliance. SCC Notice Dated 2/3/25
FINANCIAL REGULATION
Arkansas issued a bulletin announcing its intent to approve the NAIC’s Accounting Practices and Procedures Manual (APPM). The adoption of the new manual will apply to the Annual Statement for December 31, 2025, and must be submitted to the DOI by March 1, 2026. Bulletin 1-2025
HEALTH INSURANCE / HEALTH RATES
California's Department of Managed Health Care (DMHC) issued an All-Plan Letter (APL) providing guidance on renewal notice requirements for large group contract holders, including In Home Supportive Services. It mandates that contract holders must be notified of rate changes or coverage modifications at least 120 days before renewal and allow a 60-day period for review of any proposed changes. DMHC APL 25-003
Louisiana now mandates health insurance issuers, health maintenance organizations, and self-insurers cover standard fertility preservation services under Act No. 299. This law ensures coverage for fertility preservation related to treatments that could result in infertility, particularly for cancer patients, without requiring preauthorization but allowing for reasonable cost-sharing. Directive 225
Maryland issued a bulletin addressing unfair discrimination in insurance practices and clarifying Bulletin 17-10. The bulletin mandates insurers avoid charging premiums that differ from rates filed with the Commissioner or the policy terms, and requires uniform access to credit card payment options for all insureds of a particular product, if such an option is offered. It further specifies criteria for determining the uniqueness of insurance products, including distinctions based on policy forms, rate filings, and underwriting guidelines. Bulletin 25-5
Massachusetts increased rates for vision care services. These amendments impact 101 CMR 315.00, which includes sections on general provisions, definitions, rate provisions, allowable fees for vision care services, and severability. 101 CMR 315.01
Massachusetts issued a set of Frequently Asked Questions (FAQs) to clarify reproductive access rights under An Act Expanding Protections for Reproductive and Gender-Affirming Care (Chapter 127 of the Acts of 2022). This law mandates that all fully insured health plans in Massachusetts, except for self-funded plans, cover abortion and abortion-related services, including emergency contraception, without cost-sharing. Notice Dated 2/12/25
Michigan issued a bulletin outlining the adjustments to deductibles for Qualified Health Coverage (QHC) in relation to no-fault coverage under Public Acts 21 and 22 of 2019. The bulletin confirms that the maximum deductible for QHC will remain at $6,579 for the fiscal year from July 1, 2025, to June 30, 2026. Bulletin 2025-06-INS
New York issued a Supplement to their Circular Letter to enforce mandatory health insurance coverage for Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection. The update prohibits insurers from requiring prior authorization for PrEP medications and mandates coverage of all FDA-approved PrEP formulations without cost-sharing for policies issued or renewed on or after February 29, 2024. Circular Letter 2017-21 Supp. 3
Vermont has enacted changes to its health insurance market effective January 1, 2026, which include unmerging the individual and small group health insurance markets and updating provisions related to the Vermont Health Benefit Exchange. The amendments increase the maximum number of employees for qualifying employers from 50 to 100, redefine “health benefit plan” and “small employer,” and adjust the responsibilities of the Exchange. HB 35
MEDICARE SUPPLEMENT INSURANCE
Kentucky amended the minimum standards for Medicare supplement insurance policies and certificates. The amendment prohibits insurers from denying, conditioning coverage, or discriminating based on an applicant's health status, claims experience, or medical condition during the initial open enrollment period for individuals 65 and older. 806 KAR 17:570
MISCELLANEOUS
Delaware updated regulations for the Healthy Delaware Families Act and the Paid Family Medical Leave (PFML) Program. These updates clarify eligibility, benefit amounts, and duration, as well as procedures for filing claims, employer contributions, and appeals. The amendments also outline changes for small businesses, private plans, and reporting requirements. DIA 1401
Iowa has adopted Chapter 101, "Adjustment and Modification of Support," to streamline the process of reviewing and adjusting child support obligations. The new regulations introduce definitions and detailed procedures for financial information review. 441-101.1
PHARMACY BENEFIT MANAGERS
Texas' Attorney General issued an opinion regarding the enforcement of HB 1763 and HB 1919. These bills, part of Chapter 1369 of the Texas Insurance Code, regulate contracts with pharmacists, pharmacies, and certain referral and solicitation practices. The opinion clarifies that these regulations are not preempted by ERISA and apply to both Texas-domiciled plans and any plans covering Texas residents or engaging with Texas pharmacy providers. Additionally, the rule prohibits issuers and pharmacy benefit managers (PBMs) from reducing claim payments after adjudication. Opinion KP-0480
Virginia announced updates to the Rebate Reporting Workbook, including revised forms and instructions, in response to recent changes in the Pharmacy Benefits Management Law under subsection B of 38.2-34681 of the Code of Virginia. These updates affect carriers, Health Services Plans, HMOs, Life and Health Interested Parties, and Pharmacy Benefits Managers, who must submit their 2024 report by March 31, 2025. SCC Notice Dated 1/29/25
PREMIUM TAX
New Hampshire issued premium tax instructions for life, accident, and health insurance companies, with filings due March 1, 2025. The notice outlines the requirement for electronic funds transfers (EFT) for payments over $20,000, specifies filing requirements and tax computations, and outlines conditions for refunds and credits. Notice Dated 2/5/25
REPORTS - DATA CALLS & OTHER REPORTS
Illinois issued a data call for the creation of the Cost-Sharing Reduction (CSR) load for the 2026 benefit year, requesting data from insurance companies writing individual comprehensive major medical insurance. Companies must submit enrollment and experience data for 2022, 2023, and 2024 for all individual ACA Silver plans offered through the Exchange by March 14, 2025. Bulletin 2025-02
New York requires all licensed life insurers and accredited life reinsurers to respond to the 2025 Liquidity and Severe Mortality Inquiry by May 1, 2025. The inquiry, to be completed by the Chief Financial Officer, aims to assess insurers’ ability to handle stress liquidity exposure and financial flexibility in the face of both expected and unexpected cash demands. Liquidity and Severe Mortality Inquiry 2025
THIRD PARTY ADMINISTRATORS
Puerto Rico's Office of the Commissioner of Insurance adopted Rule No. 111, which introduces standardized registration and licensing requirements for third-party administrators (TPAs) in the areas of life, annuities, health insurance, and stop-loss coverage. This rule aims to regulate entities wishing to operate as TPAs within Puerto Rico, with specific exemptions for certain entities. Rule CXI s 1