Life and Health News
October 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!
AGENT / PRODUCER COMPENSATION
North Carolina issued a notice to insurers in the state that offer Medicare Supplement Insurance policies and certificates to resolve misunderstandings about mandated restrictions on agent compensation. Notice 08/26/24
AGENT / PRODUCER CONTINUING EDUCATION
California published a notice announcing a new 2025 annuity four-hour training course. The new course is required for producers to continue recommending annuities, prior to each license renewal. Notice Dated 09/19/24
New Jersey provided new rules and amendments effective September 16, 2024, to strengthen oversight and continuing education prerequisites for broker-dealers and investment adviser representatives. NJAC 13:47A-1.9
Utah has amended provisions in R590-142, the Continuing Education Rule. The changes notify insurance licensees about how the Insurance Department sets fees. R590-142-4
CONFIDENTIALITY / PRIVACY
Alabama made updates to the procedures to be followed when a third party requests the release of medical information. The changes were made to coincide with current Medicaid policy. 560-X-20-.05
DENTAL INSURANCE
Colorado amended its filing requirements for dental products. Changes include the requirement to file an annual dental loss ratio filing. The provision also provides dental coverage filing requirements for new and existing products. Regulation 4-2-11 s 5
DEPARTMENT OF INSURANCE
Florida updated its disciplinary guidelines for violations of Florida laws or rules. A copy of the guidelines may be obtained from the department or through its website. The updated guidelines provide a list of mitigating factors and considerations. 69W-1000.001
FILING REQUIREMENTS / PROCEDURES
Alabama updated its minimum filing fees including a minimum fee of $50 per filing for each long-term care policyholder letter. Bulletin 2024-04
FRAUD / ANTI-FRAUD
New Mexico has announced the launch of a new electronic submission process for the Insurance Fraud Act Assessment Filing to ease compliance for regulated entities. Electronic Filing Fraud Assessment Notice
HEALTH CARE EXCHANGE / MARKETPLACE
Rhode Island issued a bulletin for the purpose of issuing state-specific requirements for carrier notices of renewal and discontinuance in the Rhode Island Individual and Small Group Markets. Bulletin 2024-2
HEALTH INSURANCE - COMPREHENSIVE
Oregon has updated the services that health plans are required to cover during a comprehensive well-woman visit to include the thirteen well-woman preventive services identified by the United States Health Resources and Services Administration (HRSA) as of December 2022. It aligns with the guidelines set forth by the Women's Preventive Services Initiative (WPSI) and requires carriers to adhere to current practice and form filing requirements. OAR 836-053-0435
HOLDING COMPANIES
Louisiana amended its regulations to add additional language permitting electronic filing and to provide clarification as to the exemption with respect to the group capital calculation. LAC 37:XIII.128-131
LIMITED BENEFIT CONTRACTS
Colorado published a bulletin providing guidance on Short-Term Limited Duration Insurance including filing requirements for new or revised plans, effective 09/01/24. Carriers must submit rate and form filings in accordance with Colorado regulations. The bulletin also provides a policyholder notice. Bulletin B-4.142
Michigan published a bulletin notifying carriers about new federal requirements for short term limited duration insurance. Changes include new limitations on duration and contract disclosure. All rates and forms are to be submitted via SERFF. Bulletin 2024-23-INS
MENTAL HEALTH PARITY
Colorado adopted a regulation to establish the requirements, process, and form to be utilized by health benefit plans for step therapy utilization and exceptions for enrollees with serious mental illnesses. 3 CCR 702 Reg R-2-100 s 1
MISCELLANEOUS
Arkansas published a bulletin to establish a procedure for the handling of independent reviews of provider healthcare services prior authorization exemption rescissions and prescription drug prior authorization continuation disallowances. Bulletin 16-2024
Missouri's Department of Commerce and Insurance issued Bulletin 24-06 to inform regulated entities about new provisions from Senate Bill 1359. The new law allows entities at least 30 days to respond to requests for records or materials from the Department. Bulletin 24-06
New Mexico enacted new regulations, effective September 10, 2024, that will permanently establish standards for compliance with the Health Care Consolidation Oversight Act. 13.2.12 NMAC
Oklahoma Health Care Authority (OHCA) has made emergency changes necessary to maintain compliance with federal and state regulations which forbid third party insurers from denying a Medicaid member’s claim solely on the basis that prior authorization was not received for services covered under the state plan or a waiver. 317:30-3-24
OMNIBUS LEGISLATION
Alaska enacted SB 134 to address insurance data security. It sets certain standards for handling a cybersecurity breach and providing notification. SB134 also requires state-regulated private insurance plans which include breast diagnostic imaging to provide this coverage without cost sharing. SB 134
PHARMACY BENEFIT MANAGERS
Utah has revised the licensing requirements for pharmacy benefit managers by altering the fee payment process. R590-282-3
PUBLIC RECORDS
Colorado published a bulletin updating public records procedures. The bulletin outlines when and how records may be requested as well as the fees for doing so. Bulletin B-1.6
RATEMAKING
New Jersey amended provisions concerning minimum loss ratios for certain health benefit plans. SB 2875
REPORTS - DATA CALLS & OTHER REPORTS
Maryland published a bulletin, notifying companies of changes to the process and format for carrier reporting of adverse decisions and grievances. Bulletin 24-21
TAX CREDITS
The Nevada Tax Commission has approved a regulation that repeals certain tax credits for insurers that were eliminated in 2021. This includes provisions related to credits for insurers with home offices in the state and requirements for quarterly tax reporting. Essentially, insurers can no longer claim these credits, simplifying the tax framework but potentially increasing their tax liabilities. NAC 680B.150