Rules, Regs & Bulletins
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Recent Compliance Bulletins from Insurance Compliance Insight | from February 9, 2009 Prior Issues |
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Annual Statements
Massachusetts rule 211 CMR
26.00 requires health insurers and
HMOs to provide additional data on annual financial reports.
Washington WAC 284-07-500, -510, -520 and
-530 tell domestic insurers how to
obtain approval to use a permitted accounting practice in
filing annual and quarterly financial statements. The rule is
effective Feb. 21.
Automobile Insurance
An executive
directive from Michigan Gov. Jennifer
Granholm is calling on personal auto carriers to freeze their
rates for the next 12 months. She wants to give the
legislature time to come up with a plan for comprehensive auto
insurance reform. Bulletin
2009-01-INS asks insurers to notify
the insurance department they intend to comply. The
notification – no particular wording or format is required –
may simply convey that the company has determined to impose
the freeze. Send it by e-mail to ratefreezenotice@michigan.gov. The department’s Web site will have a list of
companies that comply with the freeze. (See related
article elsewhere in this edition for more complete
information.)
Data
Calls
Alaska has issued two data
calls:
• Bulletin B
09-02 addresses the annual survey of
health insurance. Instructions and a reporting form are available at the Insurance Department’s Web site.
Reports and negative replies are due by May 1.
• The other deals with the
requirement for insurers writing consumer credit insurance to
file a report with the state every three years. Bulletin B 09-03 lists the requirements for the report, which covers
policies written in 2006, 2007 and 2008. Reports and negative
replies must be filed by May 1 using a form posted
on the department’s Web site.
Hawaii Memorandum
2009-1C contains all of the 2009
filing requirements, and deadlines, for captive carriers. File
in a timely manner: Captives are subject to a $500-a-day fine
after the due date.
Maryland requires third-party payers
– HMOs, health insurers, nonprofit health service plans,
third-party administrators and managed care organizations – to
report claims data twice a year. Information about claims
received July 1 to Dec. 31, 2008 is due March 1, and the
insurance administration wants it filed electronically.
Bulletin
09-01 notes that To complete a claims
data filing electronically, a third-party payers that want to
file electronically must designated a single contact for the
March 1 claims data filing by close of business Feb. 16, and
least 30 days prior to the applicable date for the semi-annual
claims data filing submission thereafter. Instructions and a sample copy of
the form, and a paper form, are on the regulator’s Web site.
Texas has two data calls due
soon:
• Bulletin
B-0004-09 requests rate information
about Medicare supplement policies. Insurers should use
the online rate collection
form.
• Bulletin
B-0005-09 wants data referenced in
Form No. LHL608 (Health Benefit Plan/Provider Contracting
Practices Survey) and Form No. LHL609 (Health Benefit Plan
Issuer Hospital Grid). Data is due by Feb. 27 – and the
department says each day the report is late will be considered
a separate violation. Send the online reporting
form by e-mail to networkadequacy@tdi.state.tx.us.
Health
Insurance
In Bulletin
HC-71, Connecticut answers a number of
questions that have been asked about a new state law that
allows parents to include, on individual or group health
insurance plans, certain unmarried family members until age
26. The law became effective for group policies in effect Jan.
1 and for new individual policies issued on or after Jan. 1
and existing individual policies renewed after that date. One
question specifically addresses the date such family members
lose their eligibility under group and individual plans
(different rules apply).
Massachusetts rule 211 CMR
52.00 requires manages care
organizations to recognize nurse practitioners as
participating providers and primary care providers.
Texas Bulletin
B-0003-09 discusses a state attorney general
opinion issued last year that requires
insurers to provide the same number of outpatient treatment
visits for mental illness as they do for physical illness. To
confirm compliance, the insurance department will conduct data
calls and review forms carriers have on file. It expects
compliance by June 1.
Utah Bulletin
09-01 provides guidance about public
health plans and the coverages they provide.
Wisconsin Governor Jim Doyle is
pushing for passage of a bill that would require insurance
companies to cover autism, Asperger’s syndrome and “pervasive
developmental disorder not otherwise specified.” There are no
coverage limits in the initial version of SB 3, but Doyle has proposed minimum coverage levels of
$60,000 for intensive level services and $30,000 for
post-intensive services. Autism treatment services are already
covered in 19 states: Arizona, California, Connecticut,
Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana,
Maine, Maryland, Montana, New Hampshire, New Jersey, New York,
South Carolina, Tennessee and Virginia.
New York has two fraud bills pending. SB 1335 would make it a crime to act as a runner to recruit clients or patients for attorneys and healthcare providers who file bogus injury claims from staged crashes. AB 2753 would offer tipsters up to 40 percent of the money recovered from fraud convictions they generated.
Two fraud bill are being considered in Maryland. HB 160 would make it insurance fraud to lie about being a licensed agent. Under HB 142, HMOs and third-party administrators will have to have fraud plans.
Rhode Island SB 103 and HB 5194 would allow insurers to void coverage of a scheming spouse who commits insurance fraud, but would protect the innocent spouse’s coverage.
Insurance
Fraud
The
Coalition Against Insurance Fraud says it will ask New Jersey
Gov. John Corzine to conditionally veto SB 787. The group is concerned about
the bill’s “disturbing provision” that could protect shady
medical providers who’ve tried to bilk insurers by illicitly
referring patients to ambulatory surgical centers in which the
providers have a financial interest. The offending provision
retroactively legalizes referrals that, at the time, were
illegal in New Jersey, and the coalition fears that could
undermine ongoing criminal and civil fraud investigations, and
threaten legal actions for then-illegal referrals aimed at
fleecing insurers.
New York has two fraud bills pending. SB 1335 would make it a crime to act as a runner to recruit clients or patients for attorneys and healthcare providers who file bogus injury claims from staged crashes. AB 2753 would offer tipsters up to 40 percent of the money recovered from fraud convictions they generated.
Two fraud bill are being considered in Maryland. HB 160 would make it insurance fraud to lie about being a licensed agent. Under HB 142, HMOs and third-party administrators will have to have fraud plans.
Rhode Island SB 103 and HB 5194 would allow insurers to void coverage of a scheming spouse who commits insurance fraud, but would protect the innocent spouse’s coverage.
Washington WAC 284-23-800, -803 and
-806 sets minimum requirements to be
included in insurers' underwriting guidelines and procedures
for the sale of life insurance policies on the lives of
juveniles. The state wants to prevent the purchase such
policies for speculative or fraudulent reasons (see
related article elsewhere in this edition). The rule goes
into effect Feb. 21.
Minnesota has issued instructions for life insurance
companies that are filing replacement policy pages which
change to the 2001 CSO mortality table.
Producers
Colorado is proposing to hike
licensing fees for insurance producers and agencies, effective
July 1. Details are in Amended Regulation
1-2-10. A hearing, originally
scheduled for March 1, a Sunday, will now be held March
4.
Hawaii now allows individual
producers to update their address information at the National Insurance Producers
Registry. No fee is required.
Hawaii is also addressing the
practice by some producers to change certificates of insurance
in such a way that they are inconsistent with the terms of the
underlying policy. Memorandum
2009-3A says regulators have seen
modifications that include:
• naming as additional insureds
parties that may not be covered under the policy such as,
subsidiaries, affiliates, agents, elected officials,
volunteers, successors, and assigns;
• a guaranty to notify all
additional insureds (named or unidentified) of policy changes
and termination;
• eliminating the phrase “endeavor
to” from the standard policy language regarding the mailing of
notices in the event of a policy cancellation
• an amendment to the insurance
policy to incorporate the indemnity obligation of the contract
between the policyholder and the additional
insured;
• naming additional insureds that
have no real interest in the contract or subject matter of the
contract between the policyholder and the primary additional
insured; and
• statements that the subject policy
is primary and non-contributory when typically most begin
coverage only after the policies of the primary defendants are
exhausted.
The bulletin reminds producers that
certificates of insurance must accurately represent the terms
and conditions of the policies.
Idaho will hold a producer law seminar April 22. Topics include consumer complaints, property & casualty review, the state individual high risk pool, stranger originated life insurance, rebating, insurance legislation and new developments at the insurance department. It counts for four continuing education credits and, best of all, it’s free. Apply by April 15 using the online application form.
An Iowa notice lays
out license renewal requirements for resident producers who
sell only crop insurance. For renewals on and after Jan. 1,
2010, they must be able to show that they have:
• completed all training and
continuing education requirements imposed by the federal Risk
Management Association, if any; and
• completed 18 credits of continuing
education, 3 of which must be in the area of ethics, except
that a producer who is requesting renewal of a producer
license during 2010 must demonstrate that the producer has
completed 9 credits of continuing education, 3 of which must
be in the area of ethics.
New York is circulating a draft of a proposed
regulation that would establish
minimum disclosure requirements relating to the role of
insurance producers and the actual or potential conflicts of
interest created by the compensation they receive. The goal is
greater transparency for their customers.
New York also has a new online
form to be used for questions about
licensing procedures and requirements.
Oregon currently excludes both
insurance producers and insurance consultants from mortgage
lending licensing and regulation requirements, even if the
insurance producer/consultant offers residential lending as
part of his or her service. As a result of a federal law,
The Housing and
Economic Recovery Act of 2008, the
insurance division says it expects the exclusion to be removed
from the Oregon mortgage lender law in the upcoming
legislative session. That proposed legislation, which the
insurance division is supporting, would require:
• license and renew annually through
the Nationwide Mortgage Licensing System &
Registry;
• satisfy an FBI criminal history
review;
• demonstrate financial
responsibility;
• pass a national mortgage
test;
• take 20 hours of pre-licensure
education; and
• take at least eight hours of
continuing education each year.
Washington WAC 284-17, 12-090,
15-010 and 15-080 change the way
agents, brokers, solicitors and general agents are licensed,
and clarify prelicensing and continuing education
requirements. It goes into effect July 1.
Property/Casualty Insurance
Kansas rule KAR
40-3-30 requires fire and casualty
insurers to tell agents about the state’s assigned risk plans,
their availability, eligibility, and other related procedures,
and where to find the forms needed to place risks in the
various Kansas assigned risk plans. Companies have to tells
new agents when they are first appointed and at least annually
thereafter. The rule deletes a requirement that agents
maintain an adequate supply of forms and applies on to agents
certified to write insurance for which an assigned risk plan
is available.
Maryland Bulletin
09-02 replaces Bulletin 08-26 and
tells premium finance companies how to calculate finance
charges. Details are in a Jan. 22
order against nine premium finance
companies.
Rate and
Form Filing
Two states have put out SERFF filing
guidance. Minnesota Bulletin
2009-1 has filing procedures for
long-term care and Medicare supplement insurance. That
requirement starts May 1. In Washington, WAC 284-20, 20B,
-20C, -24 and -58 designates SERFF as
the means by which insurers must file property/casualty,
disability, life and annuity products. The rule went into
effect Feb. 1.
State
Regulation of Insurance
Less than a week after Iowa
insurance commissioner Susan Voss voted against a proposal to
relax life insurers’ capital and surplus requirements, she has
issued Bulletin
09-01, which relaxes those same
standards. The bulletin says domiciled life and
property/casualty companies can now determine the amount of
their deferred taxes according to the lesser of:
• the amount of gross DTAs, after
the application of paragraph 10 a., expected to be realized
within three years (rather than one year) of the balance sheet
date; or
• 15 percent of statutory capital
and surplus (rather than 10 percent) as required to be shown
on the statutory balance sheet of the reporting entity for its
most recently filed statement with the domiciliary state
commissioner adjusted to exclude any net DTAs, EDP equipment
and operating system software and any net positive goodwill;
or
• the amount of gross DTAs, after
application of paragraphs 10 a. and 10 b., that can be offset
against existing gross DTLs.
The changes are effective for
reporting periods ending on or after Dec. 31, 2008 and will
expire Dec. 15, but could be renewed at the commissioner’s
option.
Maryland Bulletin
08-36 says it is keeps the fee
proposed in COMAR 31.10.24 and tells discount medical plan
organizations and discount drug plan organizations how to file
that fee with the insurance administration.
A Minnesota notice has new company
licensing information for risk retention groups, accredited
reinsurers, and foreign surplus lines companies, plus a new
checklist for Minnesota-specific forms for the NAIC's Uniform
Certificate of Authority Application.
New York has revised its rules for the preparation or procurement of investigative
consumer reports.
(Produced
with the assistance of The Clear Report)
Copyright 2009 ProBusiness Publishing
LLC
Publish date Feb 09 2009
Prior Issues
Reprinted with permission from Insurance Compliance Insight.
Copyright © 2009 ProBusiness Publishing LLC
Licensed from ProBusiness Publishing LLC. All rights reserved.