Life and Health News
April 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!
ACTUARIAL
Idaho issued guidance requiring all authorized insurers to adopt the revised NAIC Accounting Practices and Procedures Manual and Valuation Manual for preparing their 2025 quarterly and annual financial statements. Insurers offering life insurance, accident and health insurance, annuity contracts, and deposit-type contracts must use the January 1, 2025, edition of the Valuation Manual for reserve calculations. Bulletin 25-01
AGENT / PRODUCER LICENSING AND APPOINTMENT
Arkansas updated the company appointment renewal process for producers, requiring licensed entities to file annually under the Producer License Model Act. Appointment renewals must be completed by May 24, 2025, and terminations submitted by the same date via NIPR. Renewals will be accepted from June 1 to June 30, 2025. Bulletin 3-2025
New Mexico's Office of the Superintendent of Insurance (OSI) announces the transition to an online procedure for reporting name changes for individuals and business entities. Name changes must be submitted through www.NIPR.com, with a $50 penalty for late submissions. Notice - Licensees Name Change
West Virginia's Offices of the Insurance Commissioner announced that company appointment renewals for producers will be processed through the National Insurance Producer Registry (NIPR) starting June 6, 2025. A $25 renewal fee per individual per company is due August 31, 2025, after which appointments will be canceled. Non-payment will result in terminations effective May 31, 2025. Notice Dated 3/18/25
ARTIFICIAL INTELLIGENCE
Wisconsin's Office of the Commissioner of Insurance (OCI) issued a bulletin requiring insurance entities to ensure their use of Artificial Intelligence (AI) complies with existing legal frameworks, particularly around unfair trade practices and discrimination. The bulletin outlines OCI's expectations for AI development and deployment, emphasizing the creation of a written AI System Program with governance, risk management, and internal audit controls to mitigate consumer risks. It also sets guidelines for engaging with third-party AI systems and details the documentation OCI may request during audits. Bulletin Dated 3/18/25
CLAIMS / CLAIMS ISSUES
New Hampshire issued a bulletin clarifying the limitations on health carriers' ability to retroactively collect reimbursements from healthcare providers, emphasizing that claims settled for more than 12 months cannot be denied retroactively, except under specific conditions. The bulletin reminds carriers of the statutory requirements for retroactive denials, including providing a written explanation and advance notice, and highlights the importance of proper coordination of benefits and the use of federal denial reason codes in communications with providers. Bulletin INS 25-021-AB
CONFIDENTIALITY / PRIVACY
Kentucky amended its Consumer Data Protection Act to clarify the scope and exemptions of consumer data privacy regulations, including health-related information and research data. The amendments also expand the requirements for data protection impact assessments, now covering profiling activities that are deemed "unlawful" in addition to those that pose a risk of unfair treatment or disparate impact on consumers. HB 473
DISCRIMINATION
Iowa amended its laws to align legal definitions and protections with biological sex at birth, removing "gender identity" from protections against discriminatory practices in credit transactions. This means protections against discrimination in consumer credit, loans, and insurance offerings will no longer explicitly cover gender identity. SF 418
ELECTRONIC TRANSACTIONS
Colorado now allows for the electronic delivery of health coverage plan information and documents. The law mandates standardized health benefit plan identification cards in both printed and electronic formats, and requires carriers to obtain consent before delivering notices electronically. It also permits health plans to be posted on carriers' websites, with specific consent and conditions for access. SB 10
FILINGS: HEALTH
Illinois issued a bulletin providing guidance to health insurance issuers on the submission deadlines for small group ACA quarterly rate filings for the third and fourth quarters of the 2025 plan year. Issuers must submit rate changes by March 18, 2025, for rates effective July 1, 2025, and by June 18, 2025, for rates effective October 1, 2025. The DOI will publish non-proprietary portions of these filings and initiate 30-day public comment periods on March 25, 2025, and June 25, 2025. Bulletin 2025-03
Missouri's Department of Insurance issued a bulletin detailing the health insurance rate filing requirements for the 2026 plan year. Health carriers must submit rates based on the assumption that the expanded eligibility for Advanced Premium Tax Credits (APTCs) will expire, with the filing deadline set for June 4, 2025. The bulletin also provides specific guidance on pricing factors, Cost Sharing Reduction (CSR) adjustments, and induced demand factors. A Notice was also issued providing ACA health rate filing guidelines for plan year 2026. Bulletin 25-01 and Notice dated March 14, 2025
Virginia issued guidance regarding the submission of insurance products and premium rates for approval, outlining updated filing requirements and deadlines for carriers licensed to sell accident and sickness insurance, health maintenance organizations, and dental plans in Virginia. The initial filing deadline is April 18, 2025, with the first transfer deadline on July 1. SCC Notice Dated 3/7/25
HEALTH CARE EXCHANGE / MARKETPLACE
Arkansas issued a bulletin to guide health insurers in preparing Plan Year 2026 individual, on-Marketplace rate filings, requiring two sets of rates based on the potential expiration or continuation of ARPA expanded tax credits. The bulletin introduces a standardized method for applying a Cost Sharing Reduction (CSR) load to On-Marketplace Silver plans and mandates detailed documentation of the impact on rates, enrollment, and revenue. Bulletin 4-2025
Delaware published guidance for qualified health plan (QHP) rate filings for the 2026 Plan Year, requiring insurers to submit two sets of rates - one assuming the expiration of ARPA premium tax credits by December 31, 2025, and another assuming their extension through December 31, 2026. Insurers must provide actuarial memoranda to explain the rate adjustments for each scenario, with all filings due through the SERFF system by July 2, 2025. Domestic-Foreign Bulletin 149
HEALTH INSURANCE / HEALTH RATES
Delaware issued a bulletin providing updated guidance on completing the 2026 Affordability Standards Data Submission (ASDS) template for health benefit plan rate filings. Insurers must ensure compliance with Regulation 1322 by submitting the updated ASDS template, including new codes for primary care and care management services, by June 20, 2025, for individual and small group plans and September 19, 2025, for large group plans. Additionally, carriers must reimburse providers at Medicare rates for specific services and adhere to the 5.50% price trend cap for medical services. Domestic-Foreign Insurers Bulletin 138 (Revised)
Illinois' Insurance Department (DOI) issued an update for health insurance issuers regarding applied behavior analysis licensure. The DOI informs issuers that Behavior Analysts and Assistant Behavior Analysts are now included in the CORE licensing system, with a grace period for licensure delays extending until April 21, 2025. Bulletin 2025-04
Mississippi extended its provision requiring health insurance and employee benefit plans to cover telemedicine services to the same extent as in-person consultations. This extension applies until the statute is repealed on July 1, 2028. SB 2415
Texas amended regulations governing Health Maintenance Organizations (HMOs), addressing issues such as balance billing protections, mandatory disclosures, and physician contracts. The amendments clarify HMO responsibilities for out-of-network claims, improve physician directory requirements, and update contractual provisions for group and individual agreements. 28 TAC s 11.506
HOLDING COMPANIES
Idaho amended its Holding Company Law to include Group Capital Calculation instructions and NAIC liquidity stress test frameworks, among other changes. HB 71
Mississippi amended its Holding Company Act to include NAIC group capital calculation and liquidity stress test requirements. The amendments revise the registration and reporting requirements for insurers, establish confidentiality provisions, and clarify regulatory requirements for transactions within holding company systems. SB 2412
North Dakota amended regulations governing insurers within insurance holding company systems. The changes include new definitions, annual group capital calculation filings, and requirements for liquidity stress tests. The amendments also set standards for transactions within insurance holding companies, ensure adequate insurer surplus, and establish strict confidentiality protocols for investigative materials and financial assessments. HB 1124
INTERNAL AND EXTERNAL REVIEW
Kentucky's Department of Insurance (DOI) issued a Notice outlining the requirements for insurers to establish an external review process to resolve disagreements between covered persons and insurers regarding adverse determinations. The notice mandates insurers request external reviews through the DOI's eServices, ensuring no conflict of interest with the assigned Independent Review Entity (IRE), and provides procedures for assignment, notification, and reassignments when necessary. Notice Dated 3/13/25
MISCELLANEOUS HEALTH / ACCIDENT
Illinois' Insurance Department issued guidance for health and dental carriers and HMOs requiring self-audits of each provider directory at least every 90 days and submit a report to the Department. In addition, each online provider directory must be updated monthly within 2 business days after being notified of a change by a participating provider. Failure to update a directory as prescribed may result in fines. Bulletin 2025-05
South Dakota released a bulletin outlining new compliance requirements for Enhanced Direct Enrollment Entities (EDEs), health insurance issuers, and producers. The bulletin mandates that EDEs secure both a third-party administrator and insurance producer license, prohibits working with unlicensed entities (except federally certified Navigators), and requires health insurance issuers to appoint any EDE they compensate. Insurance producers must also be licensed and appointed by the issuer to use an EDE for consumer enrollment. Bulletin 25-01
MISCELLANEOUS LIFE / ANNUITY
Michigan's Department of Insurance (DOI) issued a bulletin updating the maximum amount for cemetery or funeral predeath assignments under section 500.2080 of the Insurance Code. Bulletin 2025-01-INS
PHARMACY BENEFIT MANAGERS
Arkansas enacted the Pharmacy and Pharmacist Timely Reconciliation and Payment of Pharmacist Services Act to regulate pharmacy benefits managers (PBMs) and the processing of pharmacy claims. The law introduces new definitions, mandates timely payment for clean claims, and requires PBMs to notify pharmacies of claim issues within specified time frames, with penalties for late payments. HB 1620
PREMIUM TAX
Wisconsin's Office of the Commissioner of Insurance announced the adoption of the OPT/ns system for submitting and paying Wisconsin premium taxes, fire department dues, and fees. Insurers must use this system for all premium tax payments, with a $17.50 non-refundable transaction fee applied. Bulletin Dated 2/27/25
REGULATORY REPORTING REQUIREMENTS
New Hampshire's Department of Insurance (DOI) informs health carriers and related entities about a delay in the enforcement of certain filing requirements, including utilization review filings, market conduct annual reports, and certificates of compliance regarding advertisements. The DOI will not enforce compliance for filings due on April 1, 2025, and April 1, 2026, but will provide guidance and templates for subsequent submissions due in 2027 and beyond. Bulletin INS 25-024-AB
REPORTS - DATA CALLS & OTHER REPORTS
Arkansas updated the reporting process for Rule 128 submissions, extending the review period from 20 to 60 business days due to a high volume of reports. If a report is incomplete or deficient, submitters will be notified and given 10 business days to correct and resubmit it. Bulletin 2-2025
Pennsylvania issued guidance on the Medicare Supplement Data Call, requiring insurers to submit annual refund calculation data for Medicare Supplement benefit plans by May 31, 2025. Insurers must use designated Excel worksheets for reporting, ensuring accurate Type of Insurance (TOI) and Sub-Type of Insurance (Sub-TOI) codes, with filings submitted through SERFF. 2025 Medicare Supplement Data Call
THIRD PARTY ADMINISTRATORS
Puerto Rico adopted Rule 111 amending the licensing process for third-party administrators. The rule mandates that entities operating as third-party administrators in Puerto Rico must obtain a license, complete the Uniform Application, and pay a $2,500 annual fee, with a 30-day submission deadline for existing administrators. Insurers must ensure all administrators are properly licensed. Ruling CN-2025-369-SR
TRADE PRACTICES
Massachusetts adopted new rules to prevent unfair and deceptive practices in marketing, solicitation, and sale of products, including trial offers and contracts with negative option features. The regulation mandates clear and conspicuous disclosure of total prices, prohibits misleading fees, and requires straightforward cancellation mechanisms for trial offers. 940 CMR 38.01
UNCLAIMED PROPERTY
Idaho updated its Unclaimed Property Law to clarify when certain properties, including amounts owed by insurance companies, are presumed abandoned. HB 165
South Dakota updated the Uniform Unclaimed Property Act to include provisions for virtual currency and related notice requirements. The act defines virtual currency, mandates liquidation or notification of unclaimed digital assets, and clarifies the process for reporting and managing abandoned property. It also revises the definition of "last known address" and introduces new notice and reporting rules for holders of unclaimed property. HB 1196