Life and Health News
May 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!
CAPTIVES
Kansas enacted the Protected Cell Captive Insurance Company Act, establishing a framework for the creation and operation of protected cell captive insurance companies. The act requires separate accounting for each cell’s assets and liabilities, allows for both incorporated and unincorporated cells, and mandates commissioner approval for the formation process. HB 2334
CONFIDENTIALITY / PRIVACY
Rhode Island issued a bulletin to guide insurers on complying with the state’s new insurance data security law which adopts provisions of NAIC Model #668. The bulletin clarifies expectations for domestic and foreign insurers, including annual compliance statements, cybersecurity incident reporting, and proportional implementation of information security programs based on insurer size and complexity. It also emphasizes insurers' responsibilities regarding third-party service providers and outlines public disclosure requirements following a data breach. Bulletin 2025-1
CORPORATE GOVERNANCE
Nebraska updated qualifications for insurance corporation boards under section 44-211, requiring at least five directors and mandating one be a Nebraska resident unless a five-year waiver is granted. LB 325
DENTAL INSURANCE
Kentucky enacted a new law requiring insurers of dental benefit plans to honor written assignments of benefits from insured individuals to dental service providers. The law mandates that assignments be made using a standardized form, signed by both the insured and the provider, and ensures payments are made directly to providers according to the same criteria as original providers. HB 210
New Mexico now requires health insurance carriers to load approved dentists and dental hygienists into their payment systems within 30 days of receiving a complete credentialing application. Carriers must reimburse dental providers for covered services during credentialing delays, with reimbursement terms based on employment status, and with protections in place for licensed, insured providers. HB 402
North Dakota amended its insurance code to prohibit preferred provider arrangements from restricting covered individuals from receiving, or paying for, additional dental care services denied by their dental plan. The law also ensures that, unless disclosed beforehand, covered individuals cannot be charged more than the contracted rate for those services under the preferred provider agreement. SB 2377
FILING REQUIREMENTS / PROCEDURES
Texas updated its insurance regulations regarding the filing process for life, health, and annuity products, including HMO filings. The changes modernize requirements for filings, enhance consumer protections, and introduce clearer rules on premium payments and third-party involvement. 28 TAC s 3.1+
FRAUD / ANTI-FRAUD
Illinois issued a bulletin clarifying that insurers are not required to establish regular fraud reporting programs, either to the Department or third-party organizations, and participation is voluntary. The bulletin encourages reporting workers’ compensation fraud and consumer fraud through designated units but emphasizes that Illinois lacks a general insurance fraud bureau. For criminal cases, insurers are advised to report to the relevant law enforcement agency. Bulletin 2025-06
HEALTH CARE EXCHANGE / MARKETPLACE
Massachusetts issued guidance for insurers regarding policy form material submissions for merged market health and dental plans. The guidance requires inclusion of essential health benefits, adherence to federal actuarial value standards, and alignment with updated network adequacy requirements. Carriers must submit provider data to Quest Analytics by May 15, 2025. Filing Guidance Notice 2025-M
HOLDING COMPANIES
Illinois amended its insurance regulations to clarify prior notification requirements for transactions within insurance holding company systems. The rule updates standards for director disapproval within 30 days of complete notice, revises references to the AIC Accounting Practices and Procedures Manual, and strengthens requirements for cost-sharing and management services agreements to align with the NAIC model regulation. 50 Ill. Adm. Code 654.30
New Mexico updated its insurance code to authorize group capital calculation reports and liquidity stress tests for insurance holding companies. The Health Maintenance Organization (HMO) law is also amended to extend the examination timeline from every three years to at least five years. HB 398
LIFE SETTLEMENTS / STOLI
Idaho updated its rules on life settlements to revise definitions, remove specific registration and disclosure requirements, eliminate mandatory form filings, and repeal annual reporting obligations. The rule also updates provisions related to settlements occurring within two years of policy origination. IDAPA 18.03.02
North Dakota updated its licensing rules for life settlement producers by standardizing renewal terms for all licenses issued after January 1, which now must be renewed by April 30 of the following year. The amendment aligns provider license terms with domestic stock life insurance companies and broker license terms with insurance producer licenses. Licenses will expire if not renewed by the deadline. SB 2092
LONG-TERM CARE INSURANCE
North Dakota enacted new standards for long-term care insurance policies, requiring clear definitions for certain terms when used in policies. The law prohibits insurers from delaying or denying benefits to basic care facilities if the insured is eligible. It also mandates that insurers provide a copy of the policy to the insured or their representative within 30 days upon request. SB 2172
MEDICARE SUPPLEMENT INSURANCE
Indiana enacted new legislation to establish eligibility criteria for Medicare supplement policies. The law ensures that individuals applying within a six-month window after turning 65 and enrolling in Medicare Part B are not penalized, and allows current policyholders to switch issuers within 60 days of their birthday while maintaining their plan type. It also prohibits discrimination in policy pricing based on health status or medical condition for eligible applicants. HB 1226
Louisiana introduced a "Refund Filing Template" to streamline compliance with Regulation 33 for Medicare Supplement policies. Louisiana issued this directive mandating all health insurance issuers, including health maintenance organizations, use the template for annual refund filings starting April 30, 2025. Directive 227
Utah amended its accident and health insurance laws to allow enrollees to choose a comparable or lower-tier plan annually without facing medical underwriting. Insurers are also now prohibited from denying coverage based on medical history. HB 258
MISCELLANEOUS
Colorado repealed its unconstitutional statutory ban on same-sex marriage, aligning state law with the U.S. Supreme Court’s 2015 Obergefell v. Hodges decision. Specifically, Colorado removed language defining marriage as between only one man and one woman. SB 14
Illinois updated its securities regulations to align with federal standards. The rule refines definitions, updates registration and education requirements for Investment Adviser Representatives (IARs), and introduces new continuing education mandates, with penalties for non-compliance. 14 Ill. Adm. Code 130.200
Kansas renamed the Kansas Insurance Department to the Kansas Department of Insurance. HB 2050
MISCELLANEOUS HEALTH / ACCIDENT
Arkansas enacted the Medical Audit Bill of Rights Act to standardize and protect healthcare providers during audits by health insurers. The law creates new processes and requirements for insurance companies, third-party payors, and entities who administer claim services. HB 1314
Arkansas expanded the Prior Authorization Transparency Act to implement a "Gold card program," allowing healthcare providers with high approval rates to bypass prior authorization requirements. The amendments define eligibility, duration, rescission procedures, and protections against payment denials for exempted providers. HB 1301
Arkansas now prohibits healthcare insurers from requiring step therapy or fail-first protocols for noninvasive ventilators when certain medical conditions are met. The new law ensures Medicaid managed care organizations reimburse for these ventilators at no less than 100% of the Arkansas Medicaid fee schedule. HB 1321
MISCELLANEOUS LIFE / ANNUITY
Tennessee amended its life insurance law to clarify that proceeds from life insurance policies or annuity contracts designated for a spouse, children, or dependent relatives are fully exempt from creditor claims. This protection shields the funds from execution, garnishment, or seizure—even after the proceeds are used. HB 1045
NOTICE TO INSUREDS
Illinois adopted amendments to the consumer complaint notification procedure, reflecting the shift to online consumer complaints. Insurers must now send notifications to policyholders upon policy renewal, and provide Department of Insurance (DOI) office locations for filing complaints. The amendments also update notification forms, clarify DOI contact details, and remove certain insurance exemptions. 50 Ill. Adm.
PHARMACY BENEFIT MANAGERS
Alabama amended the Pharmacy Benefits Manager Licensure and Regulation Act, establishing civil penalties and legal remedies for harmed parties, setting minimum reimbursements for independent pharmacies, and mandating full rebate pass-through to health plan clients. SB 252
Arkansas enacted the Pharmacy Nondiscrimination Act which ensures any willing pharmacy or pharmacist can join Pharmacy Benefit Manager (PBM) networks under fair terms, and prohibits discriminatory exclusions. Violations may result in fines up to $100,000, license suspension, or bans on selling PBM services. SB 103
REGULATORY REPORTING REQUIREMENTS
Mississippi issued a bulletin requiring all health insurance issuers, excluding ERISA and Workers’ Compensation plans, to submit an annual Prior Authorization Report starting June 1, 2025. The report must include aggregated, de-identified data on prior authorization requests, denials, appeals, and appeal outcomes. Bulletin 2025-2
North Dakota amended its insurance law to update how insurance companies publish abstracts of their annual statements, no longer requiring the commissioner to designate a single newspaper. Instead, companies must now use a standardized form and distribute the abstract across all newspapers within the judicial district where they operate. HB 1398
TRADE PRACTICES
Nebraska amended the Unfair Trade Practices Act to include health insurance lead generators. A health insurance lead generator is defined as a person who utilizes a lead generating device to: (a) publicize the availability of or what purports to be a health insurance product or service that the person is not licensed to sell directly to the customer; (b) identify a customer who may want to learn about health insurance, or (c) sell or transmit customer information to an insurer or producer for follow-up contact and sales activity. LB 326
UNCLAIMED PROPERTY
Montana amended the Uniform Unclaimed Property Act to modernize definitions and clarify abandonment rules. The changes add "payroll card" as a defined property type, update when such property is presumed abandoned, and allow notice to apparent owners via email if they've consented. HB 164
North Dakota updated its Revised Uniform Unclaimed Property Act to include virtual currency as property presumed abandoned after three years. The bill revises notice procedures for examinations, clarifies limitations periods, and allows claims on held property to offset state civil judgments. HB 1149
UTILIZATION REVIEW - HEALTH CARE
Arkansas updated the Prior Authorization Transparency Act to expand definitions, strengthen disclosure requirements, exempt certain services from prior authorization, and mandate timely insurer responses. The update also enforces claim payment obligations, defines prior authorization durations, and introduces penalties for non-compliance. HB 1300