Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:
ID 8-2022: Behavioral Health Parity rules, 2021 Or. Laws ch. 629
Amend Rules: 836-053-0012, 836-053-0320, 836-053-1403, 836-053-1404, 836-053-1405, 836-053-1407, 836-053-1408
Rules summary: Removes the definition of “mental or nervous condition.” Adds a definition for “behavioral health condition”, changes wording from “mental health condition” to “behavioral health condition” and updates the version of the diagnostic materials used for the purpose for defining terms. Adds LGBTQ+ as a category in which insurers must report on their efforts to address enrollees network adequacy needs, including various types of essential community providers in its network. Updates statutory citations. Removes the definition of “chemical dependency.” Adds definitions for “Behavioral health condition” and “Generally accepted standards of care.” Updates requirements for coverage of behavioral health conditions to comply with statute, and adds additional requirements for medical necessity, utilization or other clinical review, including level of care placement decisions. Amends terminology to replace the word “mental” with “behavioral” and remove the terms “nervous” and “chemical” from the rule. Requires insurers to provide enrollees with the process and guidelines used to conduct medical necessity, utilization or other clinical determinations of benefits for behavioral health conditions.
Filed: December 22, 2022
Effective: January 1, 2023
Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:
ID 9-2022: Medicare Supplement Insurance proposed rule amendments
Amend Rules: 836-052-0138, 836-052-0142, 836-052-0143, 836-052-0156
Rules summary: Rule allows guaranteed issue of Medicare Supplement policies to individuals who qualify for Medicare by reason of disability and move to Oregon from a state that does not permit Medicare Supplement policies to be issued to persons under age 65. Rule adds guaranteed issue for individuals who lose Tricare that supplements Medicare to the current rule and removes outdated “conversion” and “portability” plans from the types of plans that supplement Medicare. Rule extends the guaranteed issue window for the birthday rule to include the period 30 days prior to the person’s birthdate. Requires commissions or other compensation to an insurance producer or other representative for the sale or renewal of a guaranteed issue Medicare supplement policy or certificate to be made on the same basis as for any other Medicare supplement policy or certificate.
Filed: December 22, 2022
Effective: January 1, 2023
Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:
ID 10-2022: Establishing Uniform Standards for Term and Universal Life Insurance Reserve Financing Agreements
Amend Rules: 836-012-0200, 836-012-0210, 836-012-0220, 836-012-0230, 836-012-0240, 836-012-0250, 836-012-0260, 836-012-0270
Rules summary: Provides a reference to the relevant statute through which the rules can be adopted. Adds definitions for the following terms: “actuarial method,” covered policies,” “non-covered policies,” “required level of primary security,” primary security,” “other security,” “valuation manual,” “director,” and “NAIC.” Describes the purpose and intent of the rules. Clarifies that the rules apply to reinsurance treaties that cede liabilities pertaining to covered policies issued by any life insurance company domiciled in Oregon. Describes situations in which the rules do not apply. Specifies the actuarial method to establish the required level of primary security for each reinsurance treaty subject to the rules. Outlines the requirements for covered policies to obtain credit for reinsurance at the inception date and on an on-going basis as well as steps for remediation. Requires insurers to comply with and not avoid the requirements of the rule.
Filed: December 27, 2022
Effective: January 1, 2023
Washington — Removing language concerning prohibiting use of credit history rulemaking (R 2022-08): We adopted R 2022-08, a rule removing language concerning prohibiting use of credit history on January 6, 2023. The rule takes effect on February 6, 2023. On August 29, 2022, the Thurston County Superior Court issued an order invalidating R 2021-07, which temporarily prohibited insures from using consumer credit histories to set rates for all homeowners, renters, and auto insurance.
The purpose of this rule is to align the Washington Administrative Code with the Court’s ruling. This rule will repeal WAC 284-24A-090 and amend WAC 284-24A-050, restoring the language to its state prior to the R 2021-07 rulemaking.
For more information, including the adopted rule (CR-103) and the concise explanatory statement, please visit the rule’s webpage.
Washington — Kreidler issues $55,500 in fines for violations in December: Insurance Commissioner Mike Kreidler issued fines in December totaling $55,500 against insurance companies, producers, brokers, and individuals who violated state insurance laws and regulations.
Insurance companies
LifeWise Assurance Company, Mountlake Terrace, Wash.; fined $25,000 (order 22-0672).
LifeWise didn’t provide the required transparency tools for student insurance plans, failed to explain the internal review officer will accept additional information for up to five business days, and failed to process two appeals within the required 30-day timeframe.
Aetna Life Insurance Company, Hartford, Conn.; fined $25,000 (order 22-0685).
Aetna violated RCW 48.43.785(1) by denying 7,867 insurance claims for personal protective equipment.
Insurance educators
FPA of Oregon and SW Washington, Provider #30333; fined $750 (order 22-0675).
FPA, an insurance education provider, issued attendance certificates that did not comply with Washington regulations, issued credits to producers that didn’t sign attendance registers, and submitted false class date information on an attendance roster.
Parker Smith & Feek, Provider #2332; fined $1,000 (order 22-0661).
Parker Smith & Feek, an insurance education provider, failed to keep attendance reports as required under Washington regulations, gave credits to producers that didn’t attend courses or respond to the number of polls for Washington producer education courses, and failed to conduct polls for courses as required under Washington regulations.
Producers & brokers
Fitts Agency, Inc., Tuscaloosa, Ala.; fined $250 (order 22-0717).
Rogue Risk LLC, Watervliet, NY; fined $250 (order 22-0719).
Raashawyn Bush, Mountain Home, Idaho; $250 fine (order 22-0487).
Whittier Olds, Missoula, Mont.; $250 fine (order 22-0689).
D&G Sayles Corporation, Glen Rock, NJ; fined $500 (order 22-0680).
Marco Antonio Reyes-Santos, Lincolnwood, Ill.; fined $250 (order 22-0667).
Anna Alicia Geisen, Peoria, Ariz.; fined $250 (order 22-0701).
Janna Swopshire, Las Vegas, Nev.; fined $250 (order 22-0493).
Get Logan Inc., New York, NY; fined $250 (order 22-0700).
Melissa Jo Brady, Coolidge, Ariz.; fined $500 (order 21-0800).
Garrity Sullivan and Donnelly Agency, Inc., Worcester, Mass.; fined $250 (order 22-0679).
Brandon Lewandowski, Garfield Heights, Ohio; fined $500 (order 22-0643).
Washington — Notice of correction to the 2022 Health Plan Prior Authorization Report: The 2022 Health Plan Prior Authorization Report has been updated. The table reporting 2021 Outpatient Medical-Surgical prior authorization requests for Carrier A has been updated from the original report released on January 1, 2023. The total number of prior authorization requests and the percentage of approved requests has been corrected.
View the report on the legislative and commissioner reports webpage.
Washington — New report on utilities’ liability market reveals increased costs, coverage exclusions: The Office of the Insurance Commissioner (OIC) recently delivered a report to the state Legislature and Governor on the liability insurance market for electric utilities in Washington.
Most did not report any challenges in obtaining coverage over the past five years. This type of insurance provides a utility with liability coverage if it causes an injury or damage to someone’s property.
The utilities that did report issues, however, said they saw significant changes over the last five years:
Liability insurance costs increased dramatically.
Wildfire exclusions were added.
The number of companies willing to provide coverage decreased.
Washington — Premium change transparency (R 2022-01) fourth prepublication draft posted: We have posted a Fourth Draft for the Premium Change Transparency rulemaking (R 2022-01). The purpose of the Fourth Draft is to encourage engagement and coordinate our efforts on perfecting the rules for all interested parties.
These rules will seek to improve insurer 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 increasing policyholder premiums at renewal.
We are also scheduling the next interested party meeting to discuss the Fourth Draft:
When: Thursday, February 2, 2023, at 10:00 AM – 11:30 AM
Where: Virtual Meeting – Zoom
Comments on the Fourth Draft are due by close of business (5:00 PM) on Thursday, February 2, 2023; please send comments to RulesCoordinator@oic.wa.gov.
For additional information, including the text of the Fourth Draft, please visit the rule’s webpage.
