Ethics and Compliance - Going Above the Bottom Line

New Washington rules, WAC 284-07-100 to -230, are intended to strengthen the independence of certified public accountants auditing insurer financial statements, establish more control and independence by the Audit Committee of insurer boards of directors, and require insurers with $500 million or more in direct and assumed premiums to prepare an annual management report of internal control over financial reporting. The rules go into effect Nov. 15.

Delaware Auto Bulletin 16 tells of the annual auto insurance rate survey. Auto insurers that had more than 0.01 percent of private auto market share in Delaware in 2008 are required to complete the 2009 survey by Nov. 16. The requirement is listed in Regulation 610. All survey materials and instructions are available online.

A Maryland Insurance Administration report about pay-as-you-drive insurance recommends that the state meet with insurance carriers to discuss offering it in the state.

In Georgia Directive 09-EX-1, commissioner John Oxendine says he expects insurers to promptly pay covered claims resulting from recent flooding in the state and to be lenient in dealing with affected individuals and businesses. “There will be increased claims activity and insurers are asked to prepare accordingly,” he says. “Also, we expect that insurers will settle claims in a timely manner and work closely with us in order to help individuals affected by these natural disasters.”

• Bulletin 09-10, Genetic Information Nondiscrimination Act (Public Law 110-233, effective May 21, 2008) and Idaho Code section 41-1313, Unfair Discrimination;

It doesn’t appear to be an official request – there is no bulletin on the subject, for example – but the Illinois Insurance Department is asking insurers in a press release to provide first-dollar coverage for H1N1 flu shots. The department notes that the federal government is providing the H1N1 vaccine to doctors, clinics, and health departments free of charge, and the department thinks it would be pretty nice if health insurers didn’t ask individuals to bear out-of-pocket costs for co-pays and deductibles, and to cover the administration of the shot even if it would not otherwise be covered.

Maryland Bulletin 09-25 requires the use of a uniform credentialing form developed by CAQH for use by health insurers, HMOs and other entities. The provider credentialing application is available online.

Missouri Bulletin 09-03 summarizes the requirements for health benefit plans to cover, or offer coverage, for mental health and chemical dependency/substance use disorder benefits, in light of both state and new federal requirements.

• permit a young adult who has “aged off” his or her parent’s group or group remittance health insurance policy or contract to independently purchase coverage through the parent’s group policy or contract through the age of 29 (the “young adult option”); and

• offer group, group remittance or individual policy or contract holders an option to include a young adult through the age of 29 as a dependent under family coverage (the “make available option”).

New York Circular Letter 23 gives guidance and clarification about a new law that extends, to 36 months, the period of continuation coverage under a group or group remittance contract.

In Bulletin B-0040-09, the Texas Insurance Department “strongly encourages” group and individual health benefit plan issuers to consider covering the full cost of the administration of the seasonal influenza vaccine, including co-payments, co-insurance and deductibles, and to also cover the cost of the vaccine. It also suggests carriers create or update their business continuity plans to account for a flu pandemic.

A Wisconsin Oct. 1 bulletin summarizes the emergency rule requiring health insurers to continue coverage of federal assistance eligible individuals when the group health policy coverage was or would otherwise terminate on or after June 30. Health insurers are required to identify employer group health plans that ended on or after June 30, and were not replaced, and to ask employers to provide the required notice of assistance to eligible individuals, or provide the notice themselves if the employer does not do so, by Nov. 1.

A bill pending in the Massachusetts legislature, HB 1866, would make it a crime for businesses to post an invalid or phony workers’ compensation certificate in their workplaces. The bill targets dishonest companies that post a false certificate to avoid buying workers’ comp coverage for their employees.

A Wisconsin Sept. 29 bulletin discusses replacements of life insurance policies and annuities. It explains rule Ins. 2.07, which applies to all such transactions on or after Nov. 1.

Florida has ordered insurers to comply with a new state law, HB 675, that requires insurers to offer Medicare supplement policies for individuals under 65 years of age who are eligible for and enrolled in Medicare by reason of disability or end-stage renal disease. Insurance companies that have not yet filed rates or had their rates approved must use their current rates in place for the same Medicare coverage offered for those 65 years of age.

Hawai’i has posted two sets of new exhibits to HAR Chapter 12, Medicare Supplement Insurance Minimum Standards. The first set, Exhibit A and Exhibits B-F, are in effect until June 1, 2010. The second set, also labeled Exhibit A and Exhibits B-F, will be effective for policies written on and after June 1, 2010. The effective date is on each page of each exhibit.

Alaska Bulletin B 09-08 says the state will start using the NAIC/National Insurance Producer Registry Attachments Warehouse to streamline the filing of license documents and make it easier for producers to acquire multistate licenses. Arkansas, in Bulletin 13-2009 ICI, Sept. 28, 2009)., and Idaho, in a Sept. 22 press release, recently said the same thing (

Florida says in an Internet notice that it may take up to 20 business days to process produce license applications submitted after Sept. 21. Computer system changes are the culprit. Log on to the state’s MyProfile page to check the status of any application.

An Oct 1 notice is a reminder that Iowa has stopped mailing a paper renewal reminder notice for a producer’s insurance license. Reminders will only be sent by email, but to get them producers need to send a request with their email address and National Producer Number to producer.licensing@iid.iowa.gov.

• Pre-licensing hours go from 15 to 20 hours for each class of insurance; 7.5 must be completed in a classroom setting. The exception is for CE for the motor vehicle class of insurance. It increases from 7.5 to 12.5 hours, with five hours required to be completed in a classroom setting.

• Candidates will be required to show proof of pre-licensing completion at the test centers before they will be allowed to sit for the exam.

Michigan says in a Sept. 21 memorandum it wants to move producer communications from paper to email. The Insurance Department says its goal is to eliminate the use of paper notification by Dec. 31, 2011. After that, licensees will no longer receive the following items by mail:

Illinois Bulletin CB 2009-06 announces a change in the state’s credit scoring rules that applies to when insurers must provide adverse action notices. Specifically, carriers will no longer be required to provide a notice if an applicant or insured doesn’t receive the best rate, tier, company or coverage. That had been required by Bulletin CB 2003-03. Going forward, notices won’t be required if the rate, tier, company or coverage is the same that would be provided to someone with a neutral score. Carriers will be expected to document and defend their decisions.

Kansas has three new regulations dealing with controlled insurance programs providing coverage for general liability or workers compensation, or both:

Mississippi has amended an earlier directive, Bulletin 2009-6, dealing with commercial buildings using light weight truss construction. The amended guidance provides specifications for the emblems that must be displayed, as required by SB 2487.

New rules for the National Flood Insurance Program went into effect Oct. 1. They modify the Flood Insurance Manual, the Transaction Record Reporting and Processing Plan and the Edit Specifications document. The increase in rates, the standard deductibles and the basic insurance limits that will result in an average premium increase of 8 percent.