Newsletter
Welcome to our latest newsletter! As a thought leader in the Insurance Industry for over 52 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!
Texas law provides for examination expenses to be collected from each domestic and foreign insurance company that is examined during calendar year 2021. The Department has determined its overhead assessment rates to be charged and its average annual salary of examiners and other department employees. All invoices must be paid within 30 days from the date of the invoice. Commissioner Order No. 2020-6631
Nebraska notified insurers that the date for waiver of proctor requirements for continuing education self-study online courses is extended from December 31, 2020 until further notice. Notice of December 17, 2020
New York's Cybersecurity Division issued a Cyber Chain Compromise Alert regarding SolarWinds and the corruption of Orion IT monitoring and management product. Carriers are required to notify the Department if their companies are directly impacted and file a notice of a Cybersecurity Event. Industry Letter of December 18, 2020
Alaska issued an order extending protections to consumers during the COVID-19 emergency. Order R20-15
Alaska issued an order outlining COVID-19 requirements for health insurers. Order R20-14
Alaska issued an order outlining how the COVID-19 vaccine will be administered. Insurers are to pay, with no cost-sharing to consumers for the administration of the vaccine whether it be a two-shot series or a single shot. The Order also specifies that infusion therapies intended to treat COVID-19 will be covered by all health plans covering infusion services. Order R20-16
Colorado adopted an emergency regulation requiring carriers offering health benefit plans to reimburse providers for provision of telehealth services using non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This emergency regulation is effective December 15, 2020 and replaces Emergency Regulation 20-E-11. Emergency Regulation 20-E-16
Colorado adopted an emergency regulation which requires carriers to provide covered persons with treatment related to COVID-19 and access to COVID-19 vaccines without cost-sharing. This regulation replaces emergency regulation 20-E-12 which became effective August 17, 2020. Emergency Regulation 20-E-17
Delaware issued a bulletin informing health insurance carriers and producers of the availability and coverage requirements concerning vaccines for COVID-19. Bulletin No. 123 and Bulletin No. 35
New Mexico issued an Order requiring entities who provide health benefits to cover every currently FDA approved COVID-19 vaccine as a preventative service without any cost sharing or prior authorization requirements. This applies whether the vaccine is administered by an in-network or out-of- network provider. COVID-19 Coverage Mandates and Cost Sharing - December 18, 2020
New Mexico reminds insurance carriers they cannot impose cost sharing for COVID-19 testing, diagnosis and treatment. As stated in Bulletins 2020-008 and 2020-009, this applies to in-network and out-of-network providers. Carriers are particularly encouraged to provide prompt payment to health care physicians and clinicians even though they may not be practicing in their area of specialty during the emergency. Notice to Carriers COVID-19
New York has directed health carriers, utilization review agents and licensed independent adjusters (TPAs) to suspend certain preauthorization and notification requirements for 60 days following 12/23/20. This is necessary due to hospitals implementing surge and flex protocols to balance patient loads due to COVID-19. The TPAs are strongly encouraged to apply this request to their self-funded plans. Circular Letter 2020-17
New York has informed health carriers they are required to cover COVID-19 immunizations with no cost sharing whether administered by in-network or out-of-network providers. Carriers were asked to provide a vaccine contact person's name and contact information to the Department of Financial Services by December 20, 2020. Circular Letter 2020-16
North Dakota Insurance Commissioner issued a bulletin regarding COVID-19 administration costs. A consumer cannot be charged a co-pay, coinsurance or a deductible for receiving a vaccination whether the provider is in-network or out-of-network. This applies to health carriers offering group or individual insurance, small group, large group, short-term limited duration plans, fully insured and self-insured plans. Bulletin 2020-12
Puerto Rico's Commissioner directed insurers and health service organizations to provide the COVID-19 invoice codes, sampling codes and rates for the three kinds of tests for the diagnosis and detection of COVID-19 to providers and/or laboratories by December 16, 2020. COVID tests are to be provided free of cost to the insured. Ruling CN-2020-289-D
Wisconsin's Commissioner of Insurance issued a bulletin regarding COVID-19 immunization coverage. The commissioner expects that all self-funded and fully insured group health plans, individual health plans and short-term limited duration plans cover, without cost sharing to the insured, all costs associated with the vaccination, including those that require two doses. The requirements apply even if an out-of-network provider administers it. Bulletin dated December 22, 2020
Maryland issued a bulletin regarding student health plans form and rate filing instructions to the 2021-2022 school year. Bulletin 20-44
New Mexico has lifted the rate moratorium on previously approved dental, vision and disability excepted benefit plans. Bulletin 2020-022
Nebraska announced the implementation of a portal for the processing of external reviews of a claim denial involving medical decision making. This applies to major medical and short-term limited duration health insurance. The notice gives examples of appeal language that may need to be revised. Notice of December 7, 2020
Puerto Rico issued a circular letter informing health organizations and insurers who write commercial medical plans that it will use Maximus for external review of final adverse claim decisions. A covered person will pay only a nominal cost not to exceed $25 for each review request up to a limit of $75 per policy year, which will be reimbursed if the opinion is in the insured's favor. Circular Letter CC-2020-1977-D
Colorado issued guidance on requirements for long-term care insurance rate filings to comply with Section 5.B.3.a.7 of Colorado Insurance Regulation 4-2-11. The guidance provides the elements required for a complete rate filing submission. Bulletin B-4.113
Florida issued revised Rule 69O-191.055, changing the manner in which health maintenance organizations' target loss ratio may be increased or reduced. FAC 69O-191.055
California issued a reminder notice to health insurance companies regarding significant changes made to the state's Mental Health Parity Act. Insurers must submit amended forms to the Insurance Department. They are also asked to review their medical necessity criteria and utilization review policies and procedures, and implement any changes necessary to make them consistent and compliant with SB 855. Requirements under this new law took effect on January 1, 2021. Notice dated December 10, 2020 - SB 855
Nevada's Insurance Department gave notice that insurers wishing to stop writing a particular line of insurance, consolidate or merge business, or move business to a new or different company must comply with Nevada Revised Statute NRS 687B.410. An insurer that intends to stop writing a class of business must submit a request to the DOI at least 60 days prior to sending notice to insureds. Notice dated December 8, 2020
Connecticut issued a notice informing ACA-compliant health plans and self-funded health plans that they cannot apply any cost sharing for approved COVID-19 immunizations from in-network or out-of-network health care providers. Reimbursement to an out-of-network provider is to be paid at Medicare rates; in-network providers are to be reimbursed at in-network negotiated rates. December 8, 2020 Notice
Maryland issued a bulletin to explain the MIA’s enforcement position with respect to attempts by participating providers to hold individuals insured by licensed carriers responsible for additional fees for enhanced infection control and personal protective equipment and the steps that the MIA expects licensed carriers to take to assure that their participating providers are not billing their insureds for such additional fees. Bulletin 20-43
Mississippi adopted a revised rule modifying the required Guaranty Association Summary Document that must be delivered at the same time as the delivery of the policy or contract. Title 19, Part 1, Chapter 24
South Carolina has a new requirement to issue a Guaranty Association Notice for a new policy or renewal policy effective 60 days from December 14, 2020. The notice must be submitted to the Director of Insurance for approval. Bulletin 2020-11
New Mexico has extended the date for the Credentialing System Loading Data Call from December 31, 2020 to March 1, 2021. This extension allows for full year information to be reported for the year 2020. Notice dated December 8, 2020
Alabama adopted the NAIC's 2021 Valuation Manual, effective January 1, 2021. Amended Regulation 161; Chapter 482-1-161
Oklahoma notified life and accident and health insurers that the state has adopted the NAIC changes for the 2021 Valuation Manual. The manual is effective January 1, 2021. Order Adopting 2021 Valuation Manual