Around the PIA Western Alliance States

California — Lara acts to protect abortion coverage: As part of his ongoing effort to protect access to reproductive health care services and abortion coverage in California, Insurance Commissioner Ricardo Lara today issued a Bulletin to remind insurers of their current obligations to cover abortion care and abortion-related services, and to alert insurers to both recent and soon-to-be-enacted changes in California state law.

“Defending all people’s right to health care, including the right to reproductive freedom, is a top priority for me and the California Department of Insurance,” said Commissioner Lara. “I want to make sure consumers and insurers have accurate information relating to abortion coverage and access in California and know that the Department of Insurance is there to protect consumers’ access to reproductive health services.”

California law is clear that abortion care is basic health care and covered by most health insurance. Commissioner Lara’s Bulletin explains that new and existing laws mandate insurance companies provide this coverage in three key areas:

Abortion coverage is a medically necessary basic health care service: Health insurance policies that cover basic health care services must cover medication abortion when dispensed by a provider and surgical abortion. As of July 1, 2022, large group health insurance policies now have to cover basic health care services pursuant to Senate Bill 280 (Limón, Chapter 636, Statutes of 2021), a measure that Commissioner Lara sponsored last year.

Medication abortion dispensed by pharmacies is medically necessary: Pursuant to Insurance Code section 10123.201, health insurance policies that cover outpatient prescription drugs must cover medically necessary prescription drugs, including abortifacient prescription drugs intended to induce an abortion when dispensed by a pharmacy.

Patient cost sharing and treatment limitations for abortion services will be illegal in new year: Beginning January 1, 2023, Senate Bill 245 (Gonzalez, Chapter 11, Statutes of 2022), will prohibit the imposition of any patient cost-sharing requirement on any abortion or abortion-related service covered by a health insurer. In addition, health insurers are prohibited from imposing utilization management on abortion and related services. SB 245 applies to both medication and surgical abortion. Commissioner Lara supported this measure in the legislative process.

“I was proud to partner with Insurance Commissioner Lara last year to ensure all health insurance policies in California cover reproductive services,” said Senator Monique Limón, who authored SB 280, which now requires large group policies to cover basic health care services including abortion.“Now more than ever it is important to protect all Californian’s access to affordable and accessible reproductive care.”

“The recent decision by the U.S. Supreme Court to take away the constitutional right to abortion after nearly 50 years of settled law is a devastating blow to reproductive freedom in our country,” said Senator Lena Gonzalez, who authored SB 245. “It is truly saddening to witness us move backwards as a nation, but in California, we will keep fighting. That is why I am so proud that my bill, the Abortion Accessibility Act (SB 245), is now law and will be implemented by all state-licensed health care service plans and disability insurance policies to ensure access to legal, affordable abortion care. I pledge to continue the fight and engage in further dialogue with stakeholders, partners, and community members to protect the reproductive rights of all Californians.”

Commissioner Lara encourages all insurers who issue or administer health insurance policies, except for specialized health insurance policies, to come into compliance with the new SB 245 statute before the start of the new year. He also encourages insurers to start making any necessary policy form filings with the Department to speed implementation. The Department will rigorously enforce this statute immediately upon its effective date, which is upon issuance or renewal of policies on or after January 1, 2023.

Idaho — Public Meeting to Receive Comments on Proposed Rules: The Idaho Department of Insurance will hold a public meeting to receive comments on proposed rulemaking procedures on Tuesday, July 26, 2022, from 2:00 pm to 3:30 pm (MT). Both in-person and phone or virtual participation are available.

These rules are being presented for authorization as part of the DOI’s plan to review each rule every 5 years, consistent with the Governor’s Executive Order 2020-01: Zero-Based Regulation. Of note are proposed changes to IDAPA 18.02.03 intended to provide greater transparency to auto insurance policyholders regarding their underinsured motorist coverage.

It is anticipated that rulemaking stakeholders will propose and advocate for rulemaking changes as part of the negotiated rulemaking process. The DOI intends to carefully consider all changes presented by the public and may propose certain changes so long as they are consistent with the rules’ statutory authority and the Governor’s Executive Order.

The following rule chapters are germane to this rulemaking:

* 18.02.02 – Automobile Insurance Policies;

* 18.02.03 – Certificate of Liability Insurance for Motor Vehicles;

* 18.07.01 – Rules Pertaining to Acquisitions of Control, Insurance Holding Company Systems and Mutual Insurance Holding Companies;

* 18.07.02 – Reserve Liabilities and Minimum Valuations for Annuities and Pure Endowment Contracts;

* 18.07.03 – Valuation of Life Insurance Policies Including the Use of Select Mortality Factors;

* 18.07.08 – Property and Casualty Actuarial Opinion Rule;

* 18.07.09 – Life and Health Actuarial Opinion and Memorandum Rule; and

* 18.08.02 – Fire Protection Sprinkler Contractors.

Proposed rules and notices are published in the July 6, 2022 Idaho Administrative Bulletin – https://bit.ly/3Jep95h

Additional information will be posted to the same website as the rules progress.

In-person participation for the public meeting is available at:

Department of Insurance

700 W. State St., 3rd Floor Conference Room A

Boise, ID 83702

Phone or virtual participation is available at:

Join by phone at: 1-720-650-7664 (USA Toll Free)

Join by Webex at: https://bit.ly/3oyCsnu

Meeting Number (Access Code): 2451 825 4219

Meeting Password: fN4m3AqFSr3

About the Department of Insurance

The Idaho Department of Insurance has been regulating the business of insurance in Idaho since 1901. The mission of the Department is to serve and protect Idahoans by equitably, effectively and efficiently administering the Idaho Insurance Code and the International Fire Code. For more information, please visit us at : https://bit.ly/3PvfGJb or email us at consumeraffairs@doi.idaho.gov

Washington — Premium change transparency (R 2022-01) second prepublication draft posted: We have released a Second Draft for the Premium Change Transparency rulemaking (R 2022-01). The purpose of the Second Draft is to encourage engagement with interested parties and coordinate our efforts on optimizing the rules for all. 

These rules will seek to improve transparency in insurance pricing and rating by defining the scope of insurer responsibility to provide policyholders with Premium Change Notices and fair explanations communicating the specific factors impacting policyholder premiums. The premium change notices required by these rules must be provided by the insurer to the policyholder with transparent information indicating the exact premium changes related to renewals.

Comments on the Second draft are due by close of business (5:00 PM) on Wednesday, August 3, 2022; please send comments to RulesCoordinator@oic.wa.gov.

A prepublication draft meeting will be held, via Zoom, on August 3, 2022 at 9:00 a.m. If you are interested in joining the meeting, please register for the meeting via Zoom — https://bit.ly/3J4wFQh

For more information, including the text of the stakeholder draft, please visit the rule’s webpage.

Washington — Notice of rulemaking on Small pharmacies reporting requirements: reimbursement appeals (R 2022-07): We released a notice to start rulemaking (CR 101) Small Pharmacies Reporting Requirements: Reimbursement Appeals rule (R 2022-07). The process for small pharmacy reimbursement settlements with pharmacy benefit managers has changed such that initial intake of appeals to OIC are no longer handled by the Hearings Unit. The tier II review of appeals are conducted by an Administrative Law Judge at the Office of Administrative Hearings.

We scheduled an interested parties meeting through Zoom on August 10, 2022 at 11:00 a.m. If you are interested in joining the meeting, please register for the meeting via Zoom — https://bit.ly/3J4wFQh

Comments are due August 15, 2022; please send them to rulescoordinator@oic.wa.gov.