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California - AB72: Health Care Coverage - Out-of-Network Coverage

The California Department of Insurance (DOI) AB 72, requires a health care service plan or health insurance policy issued, amended or renewed on or after July 1, 2017 to provide that if an insured received covered services from a contracting health facility, and in the process received covered services provided by a non-contracting individual health professional, then those services must be paid at the “in network cost-sharing amount”.

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New Mexico - Bulletin 2016-019: Requirement to Update all Non-Compliant Forms

The New Mexico Office of Superintendent of Insurance (SOI) issued Bulletin 2016-019 published August 22, 2016 and updated September 15, 2016 announcing that all life and health insurance forms must be brought into compliance with the NM Insurance Code (NMSA 1978 § 59A-1-1 et seq) and all related Bulletins no later than January 1, 2017.

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New York Network Filings now Submitted via the Provider Network Data System

Per instruction from the NY Department of Financial Services (“DFS”) beginning October 1, 2016 insurers, including stand-alone dental and vision insurers, can no longer submit their PPO networks to the New York Department of Financial Services (DFS) via SERFF and instead must submit their PPO Networks via New York’s Provider Network Data System (PNDS).

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Stop Loss Comes Under Scrutiny

Washington is the latest state to scrutinize Stop Loss insurance and on March 3, 2016, issued a document entitled “Stop Loss Provisions General Objections”. This document provides direction regarding attachment points, experience rated refunds, claims denial provisions and terminology.

In March 2015 the NAIC, concerned that there may be an increasing number of small businesses setting up self-funded medical plans as a result of the Affordable Care Act, released a draft White Paper to examine the issue. Self-funded plans are exempt from state insurance regulation so the review focused on the stop loss insurance purchased to protect the plans. The resulting white paper, “Stop Loss Insurance, Self-Funding and the ACA”, outlines the impact the ACA has on the small employer market and the risks of self-funded medical plans and then discusses regulatory options.

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DOL Fiduciary Rule Exemptions

Final Rule: 29 CFR Parts 2509, 2510 and 2550

Published: April 6, 2016

Takes Effect: April 10, 2017

Full Compliance By: January 1, 2018

There has been much discussion over the Department of Labor’s changes to its rule regarding fiduciaries with respect to retirement investment advice to plan sponsors, plan participants and IRA owners. The rule’s changes will directly affect the way an annuity producer does his or her business.

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Important 2016 Updates to the NAIC Product Coding Matrix

Life, Accident & Health and Credit

The Operational Efficiencies (EX) Working Group of the Speed to Market (EX) Task Force for Life, Accident & Health and Credit met on July 7, 2015. As a result of that meeting changes are being made to the 2016 Uniform Transmittal Documents and the Uniform Product Coding Matrix for Life, Accident & Health, Annuity and Credit. Please click here to view the link for the Life, Accident & Health, Annuity and Credit product coding matrix.

Property & Casualty

The Operational Efficiencies (EX) Working Group of the Speed to Market (EX) Task Force for Property & Casualty met on July 9, 2015. As a result of that meeting changes are being made to the Property and Casualty Uniform Product Coding Matrix for 2016. Please click here to view the link for the Property and Casualty product coding matrix.


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