Insurance Compliance Services... Your Outsourcing Resource

News & Events

Delaware Issues Guidance Regarding Tobacco Cessation as Preventative Service Coverage

Delaware issued Bulletin No.72 on September 30, 2014. The purpose of this bulletin is to inform all insurance companies that write health
insurance coverage in Delaware that health plans will be considered to be in compliance with the ACA preventive services requirements if they cover screening for tobacco use and two quit attempts per year. The guidance also reiterates that plans must not include cost-sharing for these treatments, and that plans should not require prior authorization for any of these treatments. Bulletin No. 72 can be found by clicking here.

Pennsylvania Provides Clarification of External Review Process

Notice 2014-11 issued September 27, 2014 explains that health insurance issuers are required to comply with the federal external review process. The notice explains which issues are still reviewed by the state, and clarifies that a "denial of a benefit" includes a denial of a pre-service authorization involving medical judgment. It also clarifies that "failures to provide or make payment in whole or in part for a benefit" include circumstances in which a contractual issue relates to the amount of payment, such as, but not limited to, situations in which claimants are getting less than 100% of their claims (including co-pay) paid by their issuers. Notice 2014-11 concludes that consumer complaints relating to pre-service authorization denials based on medical judgment, as well as consumer complaints relating to the amount of a payment should be handled pursuant to the federal external review process. It also lists the types of complaints that should continue coming to the Pennsylvania
Insurance Department. Notice 2014-11 can be found by clicking here.

Maryland Amends Health Information Exchanges

Effective October 1, 2014, amendments were made to Maryland Health General § 402.2. The regulations adopted under this section shall (1) Govern the access, use, maintenance, disclosure, and re-disclosure of protected health information as required by state or federal law, including the federal Health Insurance Portability and Accountability Act and the federal Health Information Technology for Economic and Clinical Health Act; and (2) Include protections for the secondary use of protected health information obtained or released through a health information exchange. For more information please click here.

Maryland Announces SERFF Public Documents to be Available via Maryland Insurance Administrative Website

Maryland Bulletin 14-21 dated September 18, 2014 announces that, effective November 1, 2014, the Administration will make certain form and rate filings available through SERFF using a link on the Administrative website. The bulletin addresses confidential documents and explains how life and health forms will be handled differently than property and casualty forms. The Maryland bulletin can be found by clicking here.

Maryland Amends Unfair Trade Practices Restrictions Relating to Premiums and Charges

Effective October 1, 2014, amendments were made to Maryland Insurance § 27-216 (b)(3)(ii). The Insurance Commissioner, when reviewing
certain administrative expenses submitted by an authorized insurer that are associated with late payments or installment payments, to include in the review the cost incurred by an authorized insurer or a certain vendor to accept late payments or installment payments by credit card, debit card, electronic funds transfer, or electronic check payment; and generally relating to the review of administrative expenses by the Maryland Insurance Commissioner. For more information please click here.

New Jersey Issues Bulletin Regarding Federal Guidance on Compliance with Mandated Infertility Benefit

On August 14, 2014, New Jersey Bulletin 14-09 explains the state law regarding mandatory coverage for medically necessary expenses incurred for the diagnosis and treatment of infertility, including 4 completed egg retrievals per lifetime. It further provides that the federal DOI advised that the limit of four completed egg retrievals per lifetime is impermissible preexisting condition exclusion under HIPAA. The bulletin advises carriers to file an amendment to policy forms to amend the provision.

Please click here to learn more.


Conferences and Events

No events
P.O. Box 905 Doylestown, PA 18901 phone: 215.230.7960 fax: 215.230.7961