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News & Events

COVID-19 State Regulatory Reaction

Many states have been issuing emergency alerts, orders, and bulletins requiring insurers to comply with new emergency regulations regarding COVID-19 (coronavirus outbreak). The situation is changing daily.

At least 49 jurisdictions have published advisory notices/regulations and or declared a public health emergency or a national disaster emergency. They are : AL, AK, AZ, CA,CO, CT, DE, DC, FL, GA, HI, IL,IN. KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM , NY, NC, ND, OH, OK, OR , PA, PR, RI, SC, SD, TN, TX, UT, VT, WA, WV, WY.

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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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DOL Fiduciary Rule Updates

Final Rule: 29 CFR Parts 2509, 2510 and 2550

Published: April 6, 2016

Takes Effect: April 10, 2017

Full Compliance By: July 1, 2019

UPDATED:  The Department of Labor has granted an 18-month extension for compliance with the new fiduciary rule. The new effective date is now July 1, 2019. During the extended period, fiduciary advisers have an obligation to give advice that adheres to "impartial conduct standards". Such standards require advisers to:

  • Adhere to a best interest standard when making investment recommendations,
  • Charge no more than reasonable compensation for their services, and
  • Refrain from making misleading statements.

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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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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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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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