Life and Health News
November 2024
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!
AFFORDABLE CARE ACT
Federal Department of Health and Human Services, Centers for Medicare and Medicaid Services and the Center for Consumer Information and Insurance Oversight released the 2026 Draft Letter to issuers of Qualified Health Plans (QHPs) and Stand-Alone dental plans (SADPs) in the Federally-Facilitated Exchanges, or the Federally-Facilitated Small Business Health Options Programs (FF-SHOPs) and state-based exchanges on the federal platform. The letter focuses on updates for the 2026 plan year. 2026 Draft Letter dated October 4, 2024
AGENT / PRODUCER CONTINUING EDUCATION
California’s Department of Insurance approved a new 2025 Annuity Eight-Hour Training Course for all life agents, both resident and non-resident. This course is part of the continuing education requirements for California life agents. Effective January 1, 2025, life agents licensed on or after this date must complete the training before soliciting annuity business. Those already holding a lifeline of authority before January 1, 2025, must complete the course by their license's next expiration date, but no later than July 1, 2025. Licensing Notice Dated October 11, 2024
AGENT / PRODUCER TERMINATION
New Mexico’s Insurance Superintendent issued guidelines for the Annual Appointment Renewal Invoices for 2025 for those carriers with New Mexico agent appointments. Letter dated October 2, 2024
Oklahoma’s Insurance Department reminds all carriers to submit any changes to Producer Licensing Appointment contact emails within 20 days of the change. The process and deadline dates for the Producer Appointment Renewal are outlined, with the first deadline being November 15, 2024, when all producer terminations must be entered into NIPR. 2024 Appointment Renewal Notification
ANNUITIES / ANNUITY CONTRACTS
Louisiana's Department of Insurance amended regulations related to annuity sales, requiring producers to act in the best interest of consumers and establish supervisory systems. LAC 37 XIII.11701
Missouri's Department of Commerce and Insurance amended the Suitability in Annuity Transactions rule (20 CSR 400-5.900). The amendments adopt a “Best Interests” standard, requiring producers to prioritize consumers' interests over their own when recommending annuity products. BULLETIN 24-07
ARTIFICIAL INTELLIGENCE
California law mandates that health plans and insurers using Artificial Intelligence (AI) for utilization review and management must adhere to specific guidelines, effective January 1, 2025. These tools must be informed by individual patient medical histories and clinical circumstances, rather than relying solely on group data. It cannot replace healthcare provider decision making. SB 1120
California passed the "Artificial Intelligence Training Data Transparency" law. It requires developers of generative artificial intelligence systems to disclose specific information about the datasets used for training, including sources, data characteristics, and modifications made to the data. Developers must post this documentation on their websites by January 1, 2026. AB 2013
California passed a law requiring autodialing devices to inform consumers when a prerecorded message utilizes an artificial voice. This is effective January 1, 2025. AB 2905
CLAIMS / CLAIMS ISSUES
California passed a law that modified the reimbursement process for healthcare claims effective January 1, 2026. Key changes include transitioning from working days to calendar days for claim reimbursements, with a 15% annual interest rate on late payments for uncontested claims. Health care service plans must also reimburse claims within 30 calendar days and provide written notifications for contested claims, detailing the reasons for denial or contest. AB 3275
CONFIDENTIALITY / PRIVACY
California amended its Consumer Privacy Act of 2018 to require businesses that receive consumer personal information as part of a merger, or other transaction, to comply with a consumer's opt-out request made to the original business. AB 1824
New Mexico's Superintendent of Insurance released a new process for requesting confidentiality of forms filed with the Life and Health Division. Bulletin 2024-18
Oklahoma passed the Insurance Data Security Act in SB 543. It applies to licensees of the Insurance Department that have $5M or more in gross annual revenue that do not have a security program in place pursuant to HIPAA or the Gramm-Leach-Bliley Act. Bulletin 2024-10
CREDIT INSURANCE
South Carolina's Insurance Department approved 2025 credit accident and health insurance rates. Each insurer must notify the Insurance Department by December 1 each year of its intention to use rates no higher than those promulgated. Orders 2024-04 and 2024-06
CYBERSECURITY
Alaska now requires insurers and large broker firms to implement risk assessment and notification protocols for cybersecurity, while exempting smaller brokerage firms. The bill establishes strong data security measures for licensees and producers and requires them to maintain a comprehensive written information security program. The Department requires them to be notified of any significant cybersecurity incident within three business days after it occurs. SB 134
New York's Department of Financial Services alerted all regulated entities to take immediate action to thwart a cybersecurity threat currently being used to gain unauthorized access to information systems and targeting help desks and call centers. Industry Letter dated September 27, 2024
New York's Department of Financial Services issued guidance for regulated entities regarding cybersecurity risks associated with Artificial Intelligence (AI). The Department recommends a series of controls and measures to reduce risk, such as conducting AI-related threat risk assessments and Multi-Factor Authentication which will become mandatory for all authorized users by November 2025. Industry Letter dated September 27, 2024
DISCLOSURE REQUIREMENTS
California amended the Consumers Legal Remedies Act and mandates clearer disclosures in financial product solicitations. AB 3281
DISCRIMINATION
Delaware amended its Insurance Code to prohibit genetics-based discrimination in health insurance, clarifying that "insurance" refers specifically to health insurance and does not cover disability or long-term care insurance. Additionally, a new section addresses genetics-based discrimination in life insurance and annuities. HB 286
EXCEPTED BENEFITS
Michigan's Department of Insurance and Financial Services outlined new federal requirements for Short-Term Limited Duration Insurance (STLDI) and fixed indemnity excepted benefits coverage, replacing Bulletin 2018-20-INS. Bulletin 2024-23-INS
FILING REQUIREMENTS / PROCEDURES
Alabama's Insurance Department issued a new bulletin that revised older Bulletin 2021-06. The older bulletin included a "per filing" fee for various submissions. Specifically, a $50 fee will now apply for each Long-Term Care policyholder letter filing. Bulletin 2024-04
Colorado amended Regulation 4-2-11, specifically focusing on section 5 regarding general rate and dental loss ratio filing requirements. The amendments clarify procedures for rate filing submissions across various insurance types, including dental, long-term care, and Medicare supplement insurance. 3 CCR 702-4
Oregon's Division of Financial Regulation provided updated guidance and expectations to insurers who write Short Term Disability policies in light of the recent implementation of the Paid Leave Oregon program. Insurers must submit updated plan documents as described in the bulletin. Bulletin 2024-8
FRAUD / ANTI-FRAUD
Missouri's Secretary of State issued an emergency rule addressing fraudulent practices by investment advisers and their representatives. The primary aim is to clarify definitions of fraud in connection with securities transactions, specifying that certain behaviors by investment advisers will be deemed fraudulent under the Missouri Securities Act. Emergency Rule 15 CSR 30-51.174
HEALTH INSURANCE / HEALTH RATES
Arkansas's Department of Insurance provided guidelines for healthcare providers regarding the appeals process under the "Gold Card" laws. Providers have 12 months to appeal rescissions of exemptions, with specified documentation needed for eligibility. The bulletin also covers the assignment of an independent review organization, deadlines for reviews, and procedures for appealing disallowances of prescription drug prior authorizations. Bulletin 16-2024
California passed a law requiring health insurance policies starting July 1, 2025, to cover emergency and follow-up care for rape or sexual assault victims without cost-sharing for the first nine months after treatment begins. Additionally, for high deductible health plans, the no cost-sharing benefit applies only after the deductible is met. AB 2843
California passed a law requiring health insurance policies to cover Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Coverage cannot impose higher cost-sharing requirements than other benefits and cannot be denied or delayed based on prior treatment or different diagnostic names. AB 2105
Colorado's Division of Insurance issued updated guidance on Short-Term Limited Duration Insurance (STLDI) following new federal regulations. STLDI plans can now have an initial term of up to 3 months, with a maximum total coverage period of 4 months if renewed. Specific filing requirements are covered, and new or revised plans must include clear disclaimers, as well as questions about prior nonrenewable short-term coverage. Bulletin B-4.142
MENTAL HEALTH PARITY
California passed a law requiring insurers to include maternal mental health programs that provide at least one screening during pregnancy and one additional screening within the first six weeks postpartum. Further screenings may also be required. AB 1936
MISCELLANEOUS
Arkansas’s Department of Insurance issued a bulletin outlining its service of process requirements. Bulletin 15-2024
Federal Department of Health and Human Services issued a final rule to modify HIPAA privacy standards for reproductive health care. Starting December 23, 2024, all covered entities and business associates must secure a valid attestation for disclosure of certain PHI related to reproductive health care. HIPAA privacy notices should be updated by February 16, 2026. 45 CFR Parts 160 and 164
Federal Final Rule on Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans to provide mental health and substance use disorder benefits that are comparable to those for medical and surgical services. The rule was released by the Departments of Labor, Health and Human Services and Treasury and published in the Federal Register on September 23, 2024. 89 FR 77586
Federal Internal Revenue Service released its adjustments of certain benefit plan limits for 2025. Contribution limit for health FSAs increases to $3,300, an increase of $100 with a carryover limit of $660. Contribution limit for Health Savings Account for Self Only increased $150 to $4,300 and for Family increased $250 to $8,550. Rev. Proc. 2024-25, Rev. Proc 2024-40
Federal Internal Revenue Service issued guidance that allows amounts paid for condoms to be paid or reimbursed under a health Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA) and a Health Savings Account. Preventative care benefits provided before a HDHP deductible is met are expanded to include over-the-counter oral contraceptives, including emergency contraceptives, and male condoms. IRS Notice 2024-71, IRS Notice 2024-75
Indiana's Department of Insurance announced the withdrawal of Bulletin 245 concerning Association Health Plans (AHP) on October 15, 2024. This decision followed the U.S. Department of Labor's rescission of the 2018 AHP Rule, which had expanded the definition of "employer" under ERISA to include sole proprietors and small group employers, simplifying the establishment of AHPs. Bulletin 276
Wisconsin's Insurance Commissioner advised carriers, agents and other licensees that the Insurance Department is moving to a new location on November 4, 2024. The Department expects licensees to update the street address anywhere the previous street address appeared on their websites or on policy forms, policyholder notices, and other documents as required by some state statutes or administrative codes.
The new address: Office of the Commissioner of Insurance, 101 E. Wilson St., Madison, WI 53703
PHARMACY BENEFIT MANAGERS
Alaska amended its pharmacy benefit law. This bill implements new requirements for pharmacy benefit managers, such as registering with Alaska's insurance division, disclosing conflicts of interest, and passing on any negotiated discounts with drug manufacturers. HB 226
Arkansas's Insurance Commissioner issued an emergency rule to ensure fair pharmacy reimbursements under the Pharmacy Benefits Manager Licensure Act. Health benefit plans must include a reasonable dispensing cost to maintain network adequacy, and these costs must be uniformly applied across all pharmacies. Health insurers must submit reports detailing their dispensing cost calculations by November 30, 2024, for the 2025 plan year, with future reports due by March 1 for subsequent years. Emergency Rule 128
Delaware passed a law that prohibits discrimination against 340B drugs and covered entities by manufacturers and pharmacy benefits managers. Violations of these provisions are classified as unfair practices in the insurance business. HB 383
REGULATORY REPORTING REQUIREMENTS
Colorado's Division of Insurance announced the quantitative testing reporting requirement referenced in Regulation 10-1-1 is not applicable for the current reporting period due to the absence of an established regulation for such testing. Consequently, the annual report due on December 1, 2024, does not need to include a description of this quantitative testing. However, future reports will be required to include details of the quantitative testing conducted. Bulletin No. B-10.004
REINSURANCE
West Virginia's Insurance Department issued a list of companies that are accredited reinsurers and trusteed reinsurers. Notice dated September 30, 2024
REPORTS - ANNUAL / QUARTERLY STATEMENT
Florida updated insurance regulations regarding reporting requirements. Under section 624.424, certified public accountants preparing annual and quarterly reports for insurance companies are required to complete four hours of insurance-related continuing education every two years. This new regulation adds the continuing ed requirement of four hours of insurance related continuing education every two years to the qualifications for a CPA preparing the annual report and annual audited financial reports. FAC Rule 69O-137.002
REPORTS - DATA CALLS & OTHER REPORTS
New Mexico significantly changed its Surprise Billing Data Call Template. Plan Year 2023 information and data should be filed by December 1, 2024. Plan Years 2019 and 2022 data must be filed by January 6, 2025. Data collection for Plan Years 2021 and 2022 will be announced in the future. Bulletin 2024-20