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Life and Health News December 2023
Life and Health News
December 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
Kansas published notice of producer application fees for 2024. Notice of Application Fee Amounts 11-09-23
Wisconsin's Commissioner of Insurance announced the process and deadlines associated with agent appointment renewal invoices for 2023. Bulletin dated November 14, 2023
ANNUITIES / ANNUITY CONTRACTS
Washington adopted the NAIC Model Regulation concerning the best interest standard for annuities. WAC 284-17-265
CLAIMS / CLAIMS ISSUES
New Hampshire amended its Group Coordination of Benefits regulation. Regulation 1904.01
CYBERSECURITY
Missouri issued a bulletin providing companies with more detail concerning their obligations to report cybersecurity breaches to the department of insurance. Any security breach should be reported to the department within 10 days of becoming aware of the breach. The bulletin provides additional instructions for making the notification. Bulletin 23-04
New York amended its rule relating to cybersecurity requirements. 23 NYCRR 500.1
Vermont's Department of Financial Regulation provided guidance to regulated entities regarding its interpretation of the consumer notification requirements included in the Security Breach Notice Act. Bulletin 5
DISCRIMINATION
Michigan adopted a bill prohibiting an insurer from discriminating against an applicant for a long-term care policy, based solely upon the applicant's status as a living donor. SB 384
New York revised the statute of limitations for claims resulting from all unlawful discriminatory practices from one year to three years. SB 3255
ELECTRONIC TRANSACTIONS
California amended its Uniform Electronic Transactions Act to exempt certain transactions including authorization for release of information under the Confidentiality of Medical Information Act. The amendments also require the authorization to contain an expiration date or event, and limits the duration to one year or less. AB 1697
FILING REQUIREMENTS / PROCEDURES
Kentucky published a bulletin notifying companies of the electronic filing requirements for all financial documents, including annual statements, effective immediately. Bulletin 2023-05
New York provided guidance to carriers who write accident and health insurance, health maintenance organizations, prepaid health plans and others regarding filing and approval of forms and rates. Circular Letter 7 (2023)
HEALTH INSURANCE - COMPREHENSIVE
New Hampshire's Commissioner of Insurance issued a Bulletin to all health insurers relating to mental health services. Health insurers are directed to work with their contracted health care providers regarding correct billing codes to reduce denial rates for claims. Bulletin INS 23-038-AB
Texas enacted legislation relating to consumer protections against medical and health care billing by emergency medical services providers. SB 2476
LONG-TERM CARE INSURANCE
New York passed a law increasing the transparency in the approval process of long-term care premium rate increases. Additional notices from carriers and the insurance department to insureds are required. SB 2330
MISCELLANEOUS
California updated the Mental Health Services Act, renaming it the Behavioral Health Services Act and expanding services covered to include substance abuse disorders. The bill will go to statewide vote and, if passed, become effective 1-1-2025. SB 326
Colorado adopted a regulation to provide guidance needed to comply with its requirements for health benefit plan identification cards. It also provides guidance on the use of dental coverage plan identification cards. 4-2-29
District of Columbia adopted the Prior Authorization Reform Amendment Act of 2023. The act sets procedures for utilization review entities to follow, sets notice requirements and when a review may be required. B 124
Florida adopted amendments to statutes to amend the definition of "scrutinized company." The state Board of Administration will maintain a list of scrutinized companies with activities in Iran Terrorism Sectors. Domestic companies are required to annually file a list of companies in which they have investments which are on the Scrutinized Companies list. HB 5
Louisiana rescinded Bulletin 2022-01 regarding unintended tax consequences with Health Savings Accounts. The bulletin is no longer needed because Louisiana has amended its state statute to align with federal law. Bulletin 2022-01-R
Washington amended the rules relating to health care benefit manager registration and renewal fees. Rule 284-180-210
Washington's Insurance Commissioner clarified the address of record used for all notices, orders, and written communications and for communications with insurance producers. WAC 284-17-005
PHARMACY BENEFIT MANAGERS
Arkansas issued a bulletin reminding pharmacy benefits managers and insurers of prohibited practices, specifically the anti-claw back law. The department has received recent complaints regarding the practice. Bulletin 18-2023
New York adopted Pharmacy Benefit Manager Regulations relating to assessments, filings and other requirements for issuance and maintenance of a license, and reporting and record keeping requirements. Regulations 219, 223, 224 and 225
New York sent a letter to Pharmacy Benefit Managers licensed in New York informing them of two clarifications to the licensing application instructions sent on October 31, 2023. Letter dated November 10, 2023
REGULATORY REPORTING REQUIREMENTS
New York adopted the 2023 NAIC Accounting Practices and Procedures Manual. The manual is used in the preparation of quarterly and annual statements for 2023 filed in 2024. 11 NYCRR 83.2
RESERVE VALUATION
Colorado adopted amended regulations governing reserve financing arrangements for certain life insurance policies. The regulation applies to reinsurance policies ceding liabilities by any life insurance company domiciled in the state of Colorado. 4-1-16
TRADE PRACTICES
Illinois enacted amendments to the Consumer Fraud and Deceptive Business Practices Act, including required content and disclosures for postcards used to solicit contact from consumers. SB 1440
Michigan amended its law governing producer practices. An agent will be considered a fiduciary for all money received and held by the agent. Effective 5-5-2024, the act provides for additional duties when acting as a fiduciary in the handling of funds. HB 4376
Newsletter
Property & Casualty News December 2024
Property & Casualty News
December 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!
ADVERTISING / SALES & MARKETING
New York amended the General Business Law to require telemarketers to disclose requests for personal or financial information within the first 30 seconds of a call. Telemarketers must also provide their address and the company’s address on their website and in written communications. The law also mandates telemarketers to disclose the purpose of their call within 30 seconds. AB 7939
AGENT / PRODUCER LICENSING AND APPOINTMENT
Wisconsin will process all 2025 company appointments electronically through the National Insurance Producer Registry (NIPR). The appointment renewal invoice will include all resident/nonresident appointment renewals. All agents will appear on the renewal list unless the agent was terminated by 11:59 p.m. CST on December 31, 2024.The renewal process will begin on January 5, 2025, and end on March 15, 2025, with electronic payment methods. Failure to settle by the deadline will result in termination and reappointment of all agent appointments. Bulletin dated November 14, 2024
ARTIFICIAL INTELLIGENCE
California passed a law that requires developers of generative artificial intelligence systems to disclose detailed information about the datasets used to train, test, or modify their models. Effective January 1, 2026, developers must post this data transparency on their websites, including a summary of dataset sources, types, and purposes, as well as whether the data includes personal or copyright-protected information. AB 2013
Oklahoma issued a reminder to insurers that decisions supported by AI Systems must comply with all insurance laws, including those addressing unfair trade practices and discrimination. The bulletin highlights the need for fairness, accountability, and transparency in AI Systems and mandates the creation of an AI Systems Program to mitigate risks of adverse consumer outcomes. It also emphasizes due diligence for third-party AI systems, regulatory compliance, and the need for insurers to be prepared for potential oversight and examination regarding their use of AI. Bulletin 2024-11
AUTOMOBILE INSURANCE
North Carolina now requires insurers and their representatives handling claims under private passenger automobile policies to disclose specific information to claimants when recommending a motor vehicle repair service. The disclosure must inform the claimant that they are not obligated to use the recommended service, that the insurer will pay the policy-determined amount regardless of the service used, and whether the insurer has a financial interest in the recommended service. Memorandum dated November 20, 2024
CLAIMS / CLAIMS ISSUES
Arkansas issued guidance requiring property and casualty insurers to complete claim investigations within 45 days of notice of claim, with clear communication regarding any delays. Insurers must inform first-party claimants of claim decisions within 15 working days of proof of loss and provide written reasons for any delays. Failure to comply with these requirements is deemed unfair practice, subject to enforcement actions by the Insurance Commissioner. Bulletin 20-2024
DISCLOSURE REQUIREMENTS
California issued guidance for all admitted insurers conducting property and casualty business subject to Proposition 103 and the CA FAIR Plan, where applicable. This includes submitting complete rate applications for approval, offering the lowest premium for which an applicant qualifies, and ensuring that all products and pricing options are presented to applicants. The guidance also includes public notice requirements for rate changes, mandates prior approval for recouping certain expenses, and transparency in credit card fees and mitigation disclosures. Insurers must address any non-compliant disclosures within six months of the date of this bulletin. Bulletin 2024-14
ELECTRONIC TRANSACTIONS
New Jersey amended the insurance code to permit the electronic delivery of notices and documents related to portable electronics insurance. Insurers must stop electronic delivery if they believe the notice was not received or if the email address is invalid. The law defines portable electronics insurance as coverage for loss, theft, damage, or mechanical failure of portable electronics. SB 1325
HOLDING COMPANIES
Colorado’s Division of Insurance readopted Regulation 3-4-1 with amendments, aligning it with the Insurance Holding Company Systems Act. The regulation introduces exemptions for group capital calculations for smaller systems, refines reporting by requiring only one digital copy, and enhances oversight of cost-sharing agreements between insurers and affiliates. 3 CCR 702-3-4-1
New Mexico amended regulations under the Insurance Holding Company Law. The amendments update definitions and make technical changes to Form B filings and group-wide supervision. They also introduce new provisions for transactions requiring prior notice, including cost-sharing and management services agreements. 13.2.2.1 NMAC
MISCELLANEOUS
Maryland announced a new Pet Insurance Law effective January 1, 2025. HB 647 mandates clear consumer disclosures about policy exclusions, premiums, claim history, and cancellation rights. It also sets rules for coverage, claims payments, waiting periods, and wellness programs, requiring transparency from insurers regarding benefits, eligibility, and fees. Bulletin 24-25, HB 647
Michigan updated the list of municipalities participating in the Fire Insurance Withholding Program, effective January 1, 2025. The program allows certain municipalities to escrow 25% of fire insurance settlements for fire and explosion losses, with larger municipalities allowed to escrow for additional losses, including vandalism and civil commotion. Notice dated December 1, 2024
PHARMACY BENEFIT MANAGERS
Iowa amended Chapter 59, "Pharmacy Benefits Managers," to ensure timely payment of pharmacy claims. The amendment removes a provision that previously prohibited pharmacy benefits managers from retroactively increasing reimbursement for clean claims paid to pharmacies. Rule 191-59.3
PREMIUM TAX
California announced the launch of a new Premium Tax Processing System (PTPS) portal to streamline the online submission of Insurance (Premium) Tax forms. Effective January 31, 2025, all Admitted Insurers and Surplus Line Brokers must use the PTPS for filing their Premium Tax Returns, in line with state tax code requirements. However, for tax years 2023 and earlier, submissions will still be accepted via email until further notice. Notice Dated 12/2/24
PROPERTY INSURANCE
New Mexico now requires residential property and casualty insurers doing business in Fort Bayard and Santa Rita to notify policyholders of changes in Public Protection Classifications (PPC). The changes, effective February 1, 2025, result from a survey by ISO and may affect policyholders' premiums or renewals. Insurers are asked to send a specific notification of the changes within 90 days of the bulletin’s date, November 14, 2024. Bulletin 2024-023 (updated)
New York's Superintendent of Financial Services is to establish standards for hurricane windstorm deductibles, effective February 20, 2025. The amendment mandates insurers to provide specific disclosures to policyholders about these deductibles in homeowners' and dwelling fire policies. AB 2866
SERVICE CONTRACTS / WARRANTY INSURANCE
New Hampshire announced amendments to the Consumer Guaranty Contract Law, effective January 1, 2025, aimed at enhancing consumer protection in service contracts for homes, automobiles, and other products. The amendments expand coverage to include manufacturers' service contracts and require obligors to submit detailed information about administrators and sellers, as well as file service contract language with the DOI for compliance review. The law also strengthens marketing standards, prohibits deceptive practices and the targeting of senior citizens. Bulletin 24-068-AB
SURPLUS LINES
Oklahoma requires surplus lines carriers to report policy and premium information for non-admitted insurance for the year 2024. Insurers must submit this data through the SLIP system. The data is necessary to reconcile the premiums written by non-admitted carriers with the premium reported by surplus lines brokers, self-procuring insureds and risk purchasing groups. First report is due by December 31, 2024. Special Notice dated November 13, 2024
TRADE PRACTICES
Texas released an informal working draft for a new rule under the Texas Administrative Code, focusing on the prohibition of tying arrangements. The proposed rule would prevent insurers or agents from requiring the purchase of both a personal automobile policy and a residential property policy, and applies to all insurers and surplus lines. 28 TAC Chapter 21, Subchapter J, Section 21.1008
WORKERS' COMPENSATION
Alaska’s Department of Labor and Workforce Development and Workers' Compensation Board amended rules to limit fees for medical treatment and services. For services provided between January 1, 2024, and January 1, 2025, fees cannot exceed the 2024 fee schedule. Starting January 1, 2025, fees will be capped at the maximum reimbursement established in the 2025 fee schedule. 8 AAC 45.083
California requires insurers authorized to transact Workers' Compensation insurance to pay assessments for various funds related to workers' compensation and labor enforcement. The assessments, based on direct workers' compensation premiums for Calendar Year 2023, are due in two installments with the first being by January 1, 2025, and the second by April 1, 2025. The notice details the specific assessment factors for each fund. DWC Notice Dated 11/26/24
California's Division of Workers' Compensation updated the Ambulance Services section of the Official Medical Fee Schedule to align with changes in the Medicare payment system. The update will apply to services provided on or after January 1, 2025. Notice Dated 12/4/24
California's Division of Workers' Compensation updated the Notice to Employees Poster (DWC Form 7) to include new language required by the Labor Code. The update clarifies that employees may consult a licensed attorney to understand their rights under workers' compensation laws, and that attorney's fees are typically paid from their recovery. 8 CA ADC 9881.1
Connecticut's Governor announced that workers' compensation insurance rates will be reduced by 6% starting January 1, 2025, following the approval of a 6.1% decrease in voluntary market loss costs and a 6.2% decrease in assigned risk plan rates. This marks the eleventh consecutive year of rate decreases, resulting in over $400 million in savings for employers. Notice Dated November 20, 2024
Florida's Office of Insurance Regulation approved a statewide workers' compensation insurance rate decrease, effective January 1, 2025. The National Council on Compensation Insurance proposed a 1.0% decrease for industrial classes and a 13.9% decrease for “F” classes, both of which were approved following a public hearing. Insurers may file to deviate from the NCCI rates, and affected parties have 30 days to request judicial review. Notice 400361-24
Hawaii's Department of Labor and Industrial Relations updated the Temporary Disability Insurance (TDI), Workers' Compensation (WC), and Prepaid Health Care (PHC) laws for 2025. The maximum weekly wage base for TDI is set at $1,441.72, and for WC, it is $1,787.91, with maximum weekly benefits of $837.00 for TDI and $1,192.00 for WC. Employers must also comply with PHC coverage for employees working 20+ hours weekly, with premium contribution limits set for both TDI and PHC. Notice Dated 12/2/24
Maryland Workers' Compensation Commission published the maximum rate of benefits for 2025. This includes benefits for temporary total disability, permanent total disability, permanent partial disability, and death benefits. Notice dated November 26, 2024
Massachusetts' Workers' Compensation Rating and Inspection Bureau (WCRIBMA) filed a proposal with the Division of Insurance for a 7.1% average rate increase for industrial classes and a 3.7% decrease for F-Classes, effective July 1, 2025. Insurers should use a preliminary endorsement for new and renewal policies until a final decision is made. WCRIBMA Circular Letter 2441
Minnesota's Workers' Compensation Insurers Association (MWCIA) announced changes to workers' compensation insurance rates, effective January 1, 2026. The pure premium base rates (PPBRs) and expected loss rates (ELRs) will be extended to three decimal places, with insurers required to update their systems by July 1, 2025. Circular Letter 24-1853
Nebraska announced that, starting January 1, 2025, the maximum weekly income benefit under the Workers' Compensation Act will increase to $1,130.00 for work-related injuries and illnesses. The minimum weekly benefit remains unchanged at $49.00, and the previous rates will apply to injuries occurring before this date. WC Notice dated November 19, 2024
Nevada implemented amendments to its Administrative Code aimed at improving workers' compensation procedures. These changes include the introduction of an electronic filing system for contested cases, and revised procedures for submitting contested claims, filing and serving documents, simplifying proof of service, and emphasizing document legibility and the redaction of personal information. NAC 616C.275
New Jersey's Compensation Rating and Inspection Bureau announced its new address and relocation to One Newark Center, effective December 16, 2024. Mail should be sent to the new address after this date, but telephone numbers and online services will remain unchanged. Circular Letter 2078
New Mexico's Workers' Compensation Administration announced the publication of its 2025 Health Care Providers' Fee Schedule and Billing Instructions, effective January 1, 2025. The document includes the fee schedule, the director's order, the official response to public comments, and information from previous years. HCP Fee Schedule and Billing Instructions
Vermont amended its Workers’ Compensation and Occupational Disease Rules effective January 1, 2025. Key changes include clarifications on injury reporting, first-aid only claims, temporary disability work search requirements, and pre-authorization for prescription drugs and medical equipment. The amendments also address compensation calculations, opioid prescription compliance, and procedures for disputes and hearings. Labor 94-1 Rule 1.0000
Virginia approved revisions proposed by the National Council on Compensation Insurance (NCCI) to the Experience Rating Plan Manual for Workers' Compensation Insurance in the state. The revisions, submitted on July 24, 2024, are approved for use in new and renewal policies effective on or after July 1, 2025. Admin. Order 12192
Newsletter
Life and Health News November 2023
Life and Health News
November 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!
ACTUARIAL
New York issued a letter to life insurance companies doing business in the state focused on solvency and actuarial opinions and memorandums. Special Considerations Letter dated October 6, 2023
AGENT / PRODUCER CONTINUING EDUCATION
Georgia adopted amendments concerning prelicensing course and provider approval. 120-2-3-.08
Montana amended its rules for continuing education of producers, including removing the definition of proctor, requiring the submission of each course for approval prior to offering, and providing a process for reconsideration of disapproved courses. 6.6.4202
AGENT / PRODUCER LICENSING AND APPOINTMENT
Oklahoma's renewal notice outlines the deadlines and important dates regarding renewal processing. 2023 Appointment Renewal Notification
Oregon's bulletin informs all insurance producers and producer license applicants of the expectations of the Department regarding filing and issuing of licenses. Bulletin 2023-3
Washington promulgated a rule dealing with licensing requirements and procedures. Pre-licensing education is removed as a requirement for a resident producer license. Rule 284-17-001
CLAIMS / CLAIMS ISSUES
Nebraska announced a change to the judgment interest rate which is also used as the interest rate to be added to payment of late death claims. This is effective January 1, 2024. Judgment Interest Rate Notice dated October 6, 2023
CONFIDENTIALITY / PRIVACY
California enacted certain privacy protections for individuals receiving medical treatment related to gender affirming care, abortion, contraception, and related medical treatment. AB 352
California updated the California Consumer Privacy Act to include, in the definition of "sensitive personal information" personal information that reveals a consumer's citizenship or immigration status. AB 947
CREDIT INSURANCE
South Carolina’s Insurance Department published credit accident and health insurance 3 day retro rates sold in conjunction with loans subject to the South Carolina Consumer Protection Code. Order 2023-02
Wisconsin's Department of Insurance published new prima facie credit life and accident and sickness rates for a three-year period beginning January 1, 2024. The credit life rates have a basic loss ratio of 45%. Notice dated September 28, 2023
CYBERSECURITY
Maryland published a bulletin reminding insurers of the obligation to maintain a comprehensive, written information security program and a written incident response plan to respond to a cybersecurity event. Bulletin 23-18
DISCRIMINATION
Michigan expanded its definition of unfair trade practices to include a refusal to insure, to continue to insure or limit the amount of coverage based on race, creed, marital status, sex, national origin, gender identity or expression or sexual orientation. HB 4619
DRUG / PRESCRIPTION COVERAGE
Alaska published a bulletin advising insurers of expectations given the intermittent retail pharmacy closures. The department expects insurers to suspend network requirements until 11-27-2023. The department also expects insurers to allow refills for longer supplies - insurers are to cover a 90-day supply for individuals who are impacted by a pharmacy closure. Bulletin B23-06
HEALTH INSURANCE - COMPREHENSIVE
Colorado issued a bulletin reminding carriers of their obligation to provide coverage for COVID 19 vaccines. Bulletin B-4.135
Illinois published a bulletin reminding insurers of their obligation to cover certain preventive services and specifically mentions the vaccine for RSV. Bulletin 2023-14
Massachusetts published a bulletin communicating updates to its policy on reimbursement to providers delivering telehealth services at parity with in-person services. Bulletin 379
Nevada issued guidance to health insurers regarding their obligation to provide coverage for COVID-19 vaccines, including the recently updated mRNA COVID-19 vaccine without cost sharing. Bulletin 23-002
Wyoming's Insurance Commissioner reminded health insurance carriers of their obligation to provide COVID-19 vaccines including the recently updated mRNA COVID-19 vaccine without cost-sharing. Memorandum dated October 3, 2023
HOLDING COMPANIES
North Carolina amended the standards and management sections of its Insurance Holding Company law. SB 452
IIPRC / INTERSTATE COMPACT
Wyoming passed a regulation opting out of the provisions of the Interstate Insurance Product Regulation Compact (IIPRC) with regard to group and individual disability income insurance as well as disability income buy-sell policies. The Commissioner finds that the protections to Wyoming citizens are not adequate. Chapter 68
MISCELLANEOUS
California amended the existing law requiring the license number of an organization to appear adjacent to or on the line below the organization's name. The amendment clarifies that the license number of an organizational licensee shall appear adjacent to or on the line below the organization's name if the email is sent from the organization and not an individual licensee and the communication involves an activity for which a license is required. AB 1578
The Federal Center for Medicare and Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) regarding the No Surprises Independent Dispute Resolution (IDR) partial re-opening of dispute initiation. As a result of a federal lawsuit some federal IDR functions were suspended but are now being resumed. CMS Notice dated October 6, 2023
Louisiana rescinded bulletin 2018-02, regarding reporting mandatory contacts. The bulletin was formalized by Regulation 117. Bulletin 2018-02 -R (Rescinds Bulletin 2018-02)
Montana adopted the updated rules needed to implement HB 836, providing for a "regulatory sandbox" waiver. The rules address the process to apply for a waiver, requirements for reporting and the process for revocation of the waiver. 6.6.9001
PHARMACY BENEFIT MANAGERS
Arkansas published a bulletin reminding pharmacy benefit managers of the need to submit a certification by January 1 of each year, certifying compliance with the Arkansas Pharmacy Benefit Manager Share the Savings Act. The act requires PBMs to pass along the benefit of rebates. Bulletin 16-2023
South Carolina issued a data call to all Pharmacy Benefit Managers licensed in the state. Notice of PBM Data Call
PRE-EXISTING CONDITIONS
Michigan amended its law to prohibit a health insurer from limiting or excluding coverage by imposing a preexisting condition exclusion. The bill spells out certain exceptions. HB 4620
REINSURANCE
New Mexico adopted regulations to conform with established national standards governing reserve financing arrangements for term and universal life insurance policies. The regulation outlines the valuation used for purposes of calculation and outlines the actuarial method to establish the required level of primary security for each reinsurance treaty subject to the regulation. Regulation 13.9.21.1+ NMAC
West Virginia published a list of active accredited and trusted reinsurers in the state. Notice dated September 30, 2023
Newsletter
Life and Health News October 2023
Life and Health News
October 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!
AFFORDABLE CARE ACT
The Federal Department of Labor, Health and Human Services and Treasury issued FAQs on September 27, 2023, regarding transparency in coverage under the Affordable Care Act. FAQs About Affordable Care Act Implementation Part 61
AGENT / PRODUCER LICENSING AND APPOINTMENT
California enacted legislation requiring agent examinations be provided in additional, specified languages. The Commissioner will be required to report annually on the number of applicants taking the exam in each language and the pass rate. AB 451
The Texas Insurance Department amended a regulation regarding offenses and criteria to consider when licensing an individual with a criminal background. 28 TAC s 1502
CONFIDENTIALITY / PRIVACY
California enacted an amended privacy law allowing for an abbreviated privacy notice when certain conditions are met. SB 793
Delaware adopted the Delaware Personal Data Privacy Act. New protections include, among other things, the right of the consumer to confirm whether or not a business is processing the consumer's personal data, to correct or delete data, to obtain a copy or summary of the data and to delete data. The law establishes duties for companies. The law also includes an opt-out right. HB 154
CREDIT INSURANCE
Wisconsin Insurance Commissioner announced new prima facie credit life and credit accident and health rates effective for a three-year period beginning January 1, 2024. Bulletin dated September 28, 2023
DISASTER / CATASTROPHIC EVENT
Oregon's Insurance Commissioner issued a bulletin specifying expectations of health insurers with regard to medical claim payments for insureds affected by wildfires and other declared emergencies in Oregon going forward. Bulletin DFR 2023-2
DISCRIMINATION
Colorado adopted a regulation requiring all life insurers utilizing external consumer data and information sources (ECDIS), algorithms and predictive models using ECDIS, to adopt a risk-based governance and a risk management framework designed to determine whether the use of these tools results in unfair discrimination based on race and to remediate if discrimination occurs. 3 CCR 702-10; Regulation 10-1-1
FILING REQUIREMENTS / PROCEDURES
Delaware amended its regulations pertaining to rate and form filings, including adding a requirement that filings be submitted to the department no less than 60 days prior to the proposed effective date. The commissioner may extend the review up to 90 days by giving notice within 45 days of receipt of the filing, and the filing will not become effective until the later of department approval or the expiration of the extended time period. HB 228
Illinois issued a bulletin reminding Accident and Health and Managed Care providers of the requirements of filing annual network adequacy filings. The bulletin further reminds carriers of the importance of the accuracy of their provider directories. Bulletin 2023-10
FRAUD / ANTI-FRAUD
California enacted an amendment relating to false and fraudulent insurance claims. The amendment requires the insurer to provide the fraud warning on a form used when the person applies for a policy, seeks to amend insurance coverage, or furnishes information relating to underwriting criteria affecting premium or eligibility for coverage, under an existing policy, instead of when that person applies for a policy or seeks to make a change to an existing policy. SB 743
HEALTH CARE EXCHANGE / MARKETPLACE
Rhode Island issued state-specific requirements for carrier notices of renewal and discontinuance in the Rhode Island Individual and Small Group Markets. Bulletin 2023-03
HEALTH INSURANCE - COMPREHENSIVE
Maryland's Insurance Administration informed carriers that the CARES Act requires coverage for COVID-19 vaccines, without cost-sharing, from an in-network provider no later than October 3, 2023. Bulletin 23-13
Nevada's Insurance Commissioner issued a bulletin reminding insurance companies of their obligation to provide COVID-19 vaccine coverage, including mRNA COVID-19 vaccine without cost-sharing obtained from a network provider. This is effective beginning October 3, 2023. Bulletin 23-002
MARKETING
Illinois adopted the Consumer Fraud and Deceptive Business Practices Act, which prohibits a business from sending a letter or postcard if the letter or postcard does not include the proper disclosures. All disclosures and disclaimers appearing on a postcard or letter must be conspicuously located at the top of the postcard or letter, be easily readable in clear and unambiguous language, and be printed in at least 14-point bold-face font in a black-outlined box. SB 1440
MEDICARE SUPPLEMENT INSURANCE
Oklahoma amended its Medicare Supplement regulations to create new enrollment opportunities for Medicare Supplement policyholders. Bulletin 10-2023
MENTAL HEALTH PARITY
Oklahoma made changes to its mental health parity law. The changes deal with denials of mental health and substance use disorder claims. Bulletin 11-2023; Senate Bill 557
MISCELLANEOUS
Kentucky adopted regulations establishing standards of conduct for agents and broker-dealers and describing a number of acts which will be considered unacceptable conduct or practices. 808 KAR 10:440
Maryland amended its regulations pertaining to the Prescription Drug Affordability Board. Amendments are intended to methods for paying the assessment, requesting an exemption from the assessment, address reconsideration of an exemption request and to clarify that health benefit plans are subject to the assessment. 14.01.02
New York revised its general business law to raise the maximum fine for persons violating the law regulating telemarketing to $20,000 for each violation. AB 4456
The U.S. Department of Treasury's Financial Crimes Enforcement Network (FinCEN) published a Small Entity Compliance Guide. This guide helps businesses determine if they are required to report their beneficial ownership information to FinCEN. FinCEN Notice dated September 18, 2023
PHARMACY BENEFIT MANAGERS
South Carolina amended its laws relating to Pharmacy Benefit Managers (PBM) and Pharmacy Services Administrative Organizations (PSAO). PSAOs must be licensed by January 1, 2024, in order to do business in the state. PBMs are prohibited from committing several additional acts included in Section 38-71-2230. Bulletin 2023-06; Section 38-71-2230
Tennessee's Department of Commerce and Insurance addressed concerns regarding the submission of wholesaler information by a pharmacy or pharmacy benefit manager (PBM) as part of the pharmacy's claim for reimbursement. Bulletin 23-05
REINSURANCE
New Jersey's Department of Insurance, Office of Solvency Regulation published a list of qualified accredited reinsurers. Notice dated September 1, 2023
REPORTS - DATA CALLS & OTHER REPORTS
Montana revised its regulation pertaining to Small Insurer Health Carriers to eliminate certain data reporting requirements. ARM 6.6.5050
RESERVE VALUATION
Kentucky adopted regulations pertaining to the valuation of life insurance and annuity reserves. The regulation sets out the framework for valuation standards and conditions under which the department actuary may verify insurance company reserves. 806 KAR 6:072
New York issued a Special Considerations Letter relating to December 31, 2023, reserves and other solvency issues. Special Considerations Letter dated September 8, 2023
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