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Life and Health

Compliance Connections

Disclaimer This presentation is intended to provide a general

educational overview of insurance regulatory topics.

The materials contained herein are not intended nor

should they be construed to provide specific legal or

regulatory guidance. The content of this presentation

and any related discussion represents the views and

perspectives of the speaker(s) and do not in any way

constitute official interpretations or opinions of the

Missouri Department of Insurance. Legal or regulatory

counsel should always be consulted to review specific

questions or issues of regulatory compliance.

Page 4: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Panelists

Mary Mealer, Life and Health Manager, Market Regulation Division Jessica Schrimpf, Life and Health Manager, Consumer Affairs Division

Page 5: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Life and Health Product Filings

Page 6: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

What’s New in Life and Health Filings?

• http://insurance.mo.gov/industry/filings/lh/index.php

• Deferred Annuity Template and Filing Instructions

• Medicare Supplement

New MS 375 worksheet and updated Checklist

Loss Ratio Test Demo

http://insurance.mo.gov/industry/filings/lh/index.php

Page 7: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

What’s New in Life and Health Filings?

• Medicare Supplement Changes with MACRA

• New Health Codes: SERFF filing guidelines

H21-H24

• State Specific Field: variations

• New Filing Rule

• Dual Regulation on Health Products

Page 8: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Life and Health Filing Stats

September 2015: 2016

New 282 344

Pages: 17,697 18,478

Objections 191 355

Closed Ratio 52.6 39.69

Page 9: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Life and Health Consumer Complaints

Page 10: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Consumer Affairs

• Initial formal response to DIFP provided to Consumers

• Follow-up responses: DIFP deadlines

• Checklist documentation: not applicable

• Working on implementing last sessions legislation. Please monitor the website for updates.

Page 11: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Consumer Affairs Stats

# of Complaints by Year

January 1 to October 1

• 2013 = 682

• 2014 = 1,146

• 2015 = 1,143

• 2016 = 1,008

Page 12: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Consumer Affairs Stats Complaint Reasons

2013 2014 2015 2016

Claim Denial: 331 Claim Denial: 397 Claim Denial: 455 Claim Denial: 481

Claim Delay: 154 Delays/No Response: 217

Claim Delays: 203 Coverage Question: 256

Underwriting: 102 Premium Notice/Billing: 205

Coverage Question: 201

Claim Delays: 143

Claim Delays: 135 Premium Notice/Billing: 165

Premium Notice/Billing: 115

Involuntary Term by Plan: 127

Delays/No Response: 139

Medical Necessity:108

Premium Refund: 111 Cancellation: 122

Cancellation: 103 Premium Refund: 117

Page 13: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Contact Information

Mary Mealer [email protected]

Jessica Schrimpf [email protected]

mailto:[email protected]

Page 14: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Attendee Submitted Question

• Received one comment prior to Summit:

Why does MO Rate and Form require certain forms to be filed under each TOI it will be used when other states allow one filing under the “other” TOI?

Page 15: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

Page 16: Life and Health - Missouri Department of Insurance · educational overview of insurance regulatory topics. The materials contained herein are not intended nor should they be construed

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