

State-by-state variations of laws, compliance protocols, industry transparency, and general regulatory culture can lend one the impression that keeping up with industry changes is a little bit like herding cats. So, what better way to wrangle some of the more localized insurance news than in a Regulatory Roundup?
On an ongoing basis, in no particular order or rank, we’re wrestling the various regulatory changes, compliance actions, and commissioner decisions into our roundup. As a disclaimer: There’s a lot going on at any given time in these here United States, so this isn’t a comprehensive picture of state-level action by any means. Think of it as, instead, a sampler platter of regulation.
Also important to note: If we’re recapping interpretations of legal decisions, this is some armchair insurance speculation and not at all legal advice. If you need legal advice, get a lawyer.
Michigan sees implementation of PBM regulations
A Michigan law that became effective Jan. 1, 2024, increases the duties of pharmacy benefit manager (PBM) businesses.
PBMs act as an intermediary between health insurers and pharmacies, negotiating reimbursement rates and standardizing formularies for the parties they work with. Advocates of these businesses say their perspective and expertise make it easier for health insurers or group benefit plans to do business with pharmacies, while critics say they add an unnecessary administrative layer that further muddies the water of our already murky health care system.
The Michigan law requires PBMs to file with the state as a third-party administrator, complete with a certificate of authority. Further, PBMs will need to complete a PBM-specific application, pay $5,000, and undertake the state’s requirements for reporting pharmacy network adequacy.
“DIFS’ new PBM licensure authority is another tool that can help protect Michiganders from the high cost of prescription drugs,” said Michigan Department of Insurance and Financial Services Director Anita Fox in a news release from DIFS and the governor’s office.
The state joins several others, including Florida and Oklahoma, in increasing scrutiny and regulation of PBMs, a trend we expect to continue.
Wisconsin study reveals gaps in health network adequacy
The Wisconsin Office of the Insurance Commissioner completed its study of the health insurance market in the state.
Early findings say the health insurance market has expanded in Wisconsin, growing by 8 percent in the two-year span of 2019 to 2021. Yet, more than 300,000 residents remain uninsured.
The most recent study focused on network adequacy, and found health insurers are falling short of federal standards in more than half of the state’s 72 counties. Areas of the highest concern are pediatrics, OB/GYN access, mental health, and behavioral health services.
“These reports have helped us understand health plan designs, consumer experience, and enrollment,” said Insurance Commissioner Nathan Houdek. “As the 2024 Open Enrollment period is under way, the findings of these reports continue to guide and inform our work to increase access to health care in Wisconsin.”
Vermont updated retaliatory fees
Retaliatory fees are pretty common in areas like licensing and appointments. And Vermont, which bases its fees off a nonresident’s domicile state, has released its list of retaliatory fees, mostly for nonresident insurance producer and nonresident adjuster licenses.
It isn’t the only state that assesses retaliatory fees.
But, please, could we stop?
Retaliatory fees make it difficult to do business across state lines. They make it hard to predict expenses for carriers, agencies, and producers. And they’re kinda contrary to the spirit of cooperation we like to see in the industry.
If you’d like to learn more about retaliatory fees, start here.
Other state regulatory changes
Alaska officials announced that pharmacies have reversed their staffing shortages in the state to the degree that the Division of Insurance repealed Bulletin B23-06 effective Nov. 28, 2023.
Colorado Division of Insurance officials sent out a reminder on World AIDS Day, Dec. 1, 2023, to remind consumers to check with their insurers on HIV treatment and prevention based on this handy state guide. The state also updated its Gender-Affirming Care Insurance Coverage Guide for 2024.
Delaware officials reissued a bulletin to remind property and casualty insurers in the state to submit their action plans to resolve any issues with their reporting for geographic allocation of premiums. The state requires insurers to report where in the state they are doing business, which lets the state analyze coverage gaps and areas with high-risk concentrations for specific insurers.
Hawaii Commissioner Gordon Ito announced nonresident independent adjusters (who were temporarily authorized to work in the state in the aftermath of the Maui Island Wildfire in August 2023) can apply to extend their operations as communities continue to recover.
Illinois updated its bond requirement for public adjusters (resident and nonresident) from $20,000 to $50,000.
Iowa has announced the state’s appointment renewal dates. Terminations are due Dec. 27, 2023, and appointment invoices will be open from Dec. 5 to March 15, 2024.
Kansas reminded carriers the state appointment season is in full swing from the beginning of January to March 1, 2024.
Louisiana closed a round of home fortification grants that allowed applications for 750 grants, each up to $10,000 for home hardening such as roof repair or replacement. The applications opened Nov. 27, 2023, and closed the same week.
Michigan Department of Insurance and Financial Services Bulletin 2023-22-INS allows cities to escrow 25 percent of fire insurance settlements for losses to city property. The city can withhold up to $15,520 from residential judgments in 2024.
Minnesota issued a bulletin to advise health insurers that the state prohibits denying coverage or health benefits on the basis of gender identity or gender expression.
Oklahoma Commissioner Glen Mulready issued a news release to honor former Commissioner Gerald Grimes, who served for 16 years in the state, and who died in early November 2023.
Oregon has updated its annuity training requirements to include best interest standards training from the NAIC’s Best Interest Standard for Annuities training. Producers who’ve taken the previous four-hour best-interest course have to take a one-hour update by June 30, 2024, and all annuity training after that’ll be a four-hour training.
New Hampshire is going to begin checking CE compliance for licensees with a designated home state license in the state if the applicant is reinstating a license within two years of its expiration.
New York has overhauled its approach to cybersecurity and data protection, with new requirements for insurance-adjacent businesses to maintain full inventories of information systems and submit a written certification each April 15th that the entity complies with New York’s cyber laws.
Washington adopted the Consolidated Health Care rules (R2023-07) to the state’s administrative code that conforms the state’s health care regulations to legislation on matters like emergency conditions, prior authorization, hearing aids, telemedicine, carrier contract reporting, abortion, and breast exams. If you’re a health insurance carrier or benefit manager, you might want to do a deeper dive on the state’s information page.
While these points of interest aren’t comprehensive, our knowledge of insurance producer and variable lines broker license and compliance maintenance is. See how AgentSync can help make you look smarter today; head over to the Compliance Library and wrastle up some state-by-state regulation and more jurisdictional updates.