Life and Health News
September 2023
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
Idaho announced that, beginning September 1, 2023, Pearson VUE will provide examination delivery service for all regulatory licensing for the Idaho Department of Insurance. This includes producer and adjuster licensing. Producer candidates interested in scheduling an examination should follow the links on the department's website. News Release Dated August 24, 2023
ANNUITIES / ANNUITY CONTRACTS
Oklahoma adopted the NAIC Annuity Suitability and Best Interest Standard Model Act and issued a bulletin setting forth producer training requirements. OAC 365:25-17, Bulletin 6-2023
CAPITAL AND SURPLUS REQUIREMENTS
Delaware's Department of Insurance informed insurers of an increase to the minimum amount of capital stock or unimpaired basic surplus and free surplus an insurer must possess and maintain throughout the year. Domestic and Foreign Insurers Bulletin 140
CAPTIVES
Arizona enacted legislation amending its definitions of branch captive insurer and foreign captive insurer and regarding the examination of a foreign captive insurer. HB 2005
DENTAL INSURANCE
California enacted legislation requiring, beginning January 1, 2025, that dental coverage providers disclose whether coverage is state regulated. The disclosure may appear on the electronic or physical identification card, or both, and on the provider portal. AB 952
Maine adopted a new rule establishing standards for calculating loss ratios for dental plans, reporting those ratios to the Superintendent, and reviewing plan credibility. The rule provides for recognizing activities that improve overall dental care. Chapter 835
DISASTER / CATASTROPHIC EVENT
Florida issued a reminder to industry of the requirements of Section 252.358, Florida Statutes. Any health insurer, managed care provider or similar provider must allow early prescription refills when the Governor declares a state of emergency. OIR Notice Dated August 26, 2023
FILINGS: HEALTH
Delaware adopted regulatory amendments and removed the requirement that carriers quarterly file a list of exempt plan numbers with the department. 18 DE Admin Code 1316
FRAUD / ANTI-FRAUD
New Mexico's Superintendent of Insurance informed insurers that it is extending the deadline to pay the New Mexico Fraud Assessment until October 2, 2023. After that time, unpaid insurers will be assessed a penalty of $1,000 per month. Notice dated August 29, 2023
HEALTH INSURANCE / HEALTH RATES
Colorado adopted an emergency regulation to implement SB 23-284 to ensure that health plans and pharmacy benefit managers acting on behalf of carriers provide the required coverage for contraception in compliance with the Public Health Service Act, as amended by the Affordable Care Act. 3 CCR 702-4
Illinois enacted amendments to its statutes requiring accident and health insurance or managed care plans, which provide coverage for prescription drugs and are amended, delivered, issued, or renewed after 1-1-2025 provide coverage for prescription estrogen. HB 1565
Illinois enacted an amendment lowering, effective 7-1-2025, the maximum amount payable for a 30-day supply of prescription insulin from $100 to $35. HB 2189
Louisiana amended current regulations to increase the Medicaid reimbursement rate for services provided by licensed midwives and certified nurse midwives. It also amended rates for services rendered by freestanding birthing centers. LAC 50:IX.15161, LAC 50:IX.15163, LAC 50:XV.27101
Oregon amended its insurance code to prohibit a health benefit plan from requiring a deductible, co-payment, coinsurance, or other cost-sharing for the coverage of HIV post-exposure prophylactic drugs or therapies prescribed following a possible exposure to HIV. HB 2574
HOLDING COMPANIES
New York revised its law dealing with holding companies, annual group capital calculation, and liquidity stress testing. SB 7095
LIMITED BENEFIT CONTRACTS
The Federal Department of Labor (DOL), Health & Human Services (HHS), and the IRS jointly proposed regulations that would limit the permissible duration of short-term, limited duration health insurance (STLDI). The proposed regulation also would modify the conditions for certain fixed indemnity insurance, such as hospital indemnity, to be considered an excepted benefit. It further clarifies the tax treatment of certain benefit payments in fixed amounts received under employer-provided accident and health plans. Comments are requested. 29 CFR Part 2590
MEDICARE SUPPLEMENT INSURANCE
Maryland adopted amendments to its Medicare Supplement Policy standards. The amendments include an annual open enrollment period for the 30 days following a policyholder's birthday. COMAR 31.10.06
MISCELLANEOUS
Georgia published a directive to producers and insurers providing notification that pet insurance may now be sold under the lines of life, accident and sickness, property and casualty or personal lines. Directive 23-EX-4
Illinois adopted amendments to its Illinois Adult Protective Services Act by changing certain definitions and clarifications. Additional changes pertain to the handling of suspicious deaths. HB 2858
Oregon amended its Death with Dignity Act to remove the requirement that the person be an Oregon resident. HB 2279
Oregon's Securities Law was amended to allow the Director to make a proper inquiry of a licensed broker-dealer, salesperson, investment adviser, etc. and to require the person to respond promptly and truthfully to the inquiry. HB 2274
PHARMACY BENEFIT MANAGERS
Kansas adopted a new regulation which details the information required to be included in the Pharmacy Benefits Manager network adequacy report. 40-1-54
Oregon amended its Pharmacy Benefit Manager (PBM) law to prevent a PBM from imposing a fee on a pharmacy after the point of sale. The law also does not allow a PBM to make a retroactive payment denial or reduction of payment on a claim for reimbursement, among other changes. HB 2725
REGULATORY REPORTING REQUIREMENTS
Missouri adopted a rule requiring the quarterly reporting of rates and charges by supplemental health care service agencies. The rule applies to agencies that participate in Medicare or Medicaid. 19 CSR 30-105.070
New Mexico's Superintendent of Insurance reminds major medical insurance carriers that the Prior Authorization Rule requires the reporting of their authorization policies and provider performance. The report is due by September 30 each year. Bulletin 2023-020
REPORTS - DATA CALLS & OTHER REPORTS
New Mexico's Superintendent of Insurance issued a data call to fully insured health insurance companies to report on the number of individuals in the state receiving health insurance coverage of substance use disorder treatment benefits. Bulletin 2023-019
Oregon requires a health insurer to file an annual report with the Department of Consumer and Business Services regarding drugs reimbursed by its health benefit plan. The law also requires a pharmacy benefit manager to file a report that includes the aggregated dollar amount of rebates, fees, price protections, and other payments received from drug manufacturers. SB 192
THIRD PARTY ADMINISTRATORS
New Hampshire revised the law that requires an insurer to conduct an audit of a benefit administrator who has more than 100 certificate holders of the insurer. The change states that an insurer must conduct, at least semi-annually, an on-site or virtual audit of the operations of the benefit administrator. Previously, one of the audits had to be on-site. SB 99
TRADE PRACTICES
Oregon revised its telemarketing law to make a person who knows or consciously avoids knowing that another person is violating a telephone solicitation practice subject to a penalty for violation to the same extent as the person engaged in the violation. HB 2759