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TPAs, Plan Fiduciaries Should React Proactively to U.S. Department of Labor Settlement

In light of the recent settlement between the U.S. Department of Labor (DOL) and a health plan third-party administrator (TPA), plan fiduciaries and TPAs should re-examine, or even re-negotiate, portions of their current TPA...more

Third Party Administrator Update: TPA Regulatory and Legislative Developments

Polsinelli is pleased to share the September 2017 Third Party Administrator Newsletter. The link is provided below. This newsletter covers topics throughout the year that impact TPAs. Please see full Publication below for...more

New Connecticut Insurance Department Bulletin on Data Security Requirements

Connecticut Bulletin MC-23. The Connecticut Insurance Department issued Bulletin MC-23 on June 13, 2017. The Bulletin addresses certification and notice requirements for data security requirements applicable to TPAs and PBMs...more

New Kansas Insurance Department Bulletin Changes TPA Licensing and TPA Renewals

On the heels of the Kansas Legislature’s recent adoption of Senate Bill No. 22 regarding third party administrators, the Kansas Insurance Department issued Bulletin 2017-2 to identify the states the Department has determined...more

Kansas Strengthens Third Party Administrator Laws

Kansas Senate Bill No. 22, which became effective on March 9, 2017, amends the Kansas Third Party Administrator laws and appears designed to make them more robust by incorporating much of the language from the new National...more

New Indiana Insurance Department Bulletin Changes TPA Licensing and TPA Renewals

A recent Indiana Department of Insurance Bulletin announces a change regarding how the Department will issue initial third party administrator licenses and renew existing licenses for nonresident third party administrators in...more

State Insurance Regulatory Actions Serve as Warning

Recent regulatory actions against Zenefits, a cloud-based software company, demonstrate the importance for companies to be properly licensed where they are conducting business. Zenefits has reached regulatory settlements with...more

Pharmacy Benefit Managers Face New Licensing Requirements

Two states recently enacted new pharmacy benefit manager licensing requirements that affect pharmacy benefit managers in Kentucky and New Mexico. It is important for Pharmacy Benefit Managers to ensure they are in compliance...more

12/1/2016  /  Healthcare , Licenses , Pharmacies

Recent Regulatory Actions Against TPAs

Recently, two state insurance departments took action against third party administrators in their respective states based on their failure to be properly licensed. These regulatory actions demonstrate the importance for TPAs...more

Third Party Administrator Update: TPA Regulatory and Legislative Developments

Polsinelli is pleased to share the June 2016 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that impact TPAs. Information specific to Polsinelli's TPA practice is also included....more

TPA Agreement Filing and Compliance Requirements

The NAIC Model Third Party Administrator Act and almost every state that has enacted laws regulating TPAs require such agreements to comply with the following...more

California Division of Workers’ Compensation Takes Action Against TPAs and Will Increase Audits of TPAs in 2016

The Audit and Enforcement Unit of the California Division of Workers’ Compensation (DWC) issued a press release recently indicating it will be conducting more target audits in 2016 to address utilization review (UR)...more

New Legislation To Register and Regulate TPAs Proposed in Washington State

Legislation was recently introduced in the Washington State House of Representatives (HB 2445) and the Washington State Senate (SB 6447) that would require third party administrators to register with the Washington Office of...more

Texas Department of Insurance Takes Action Against Companies For Utilization Review Non-Compliance

In 2015, the Texas Department of Insurance (“TDI”) took action against a number of companies for their failure to be properly licensed as a utilization review agent in Texas, as well as for their failure to comply with other...more

Third Party Administrator Update: TPA Regulatory and Legislative Developments - December 2015

Polsinelli is pleased to share the December 2015 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that effect TPAs. Items discussed in this report include: - State Insurance...more

State Insurance Regulators Take Action Against Unlicensed Third Party Administrators

Recently, two state insurance departments took action against third party administrators operating in their respective states based on their failure to be properly licensed as a TPA. These regulatory actions against...more

New Licensing and Regulatory Requirements for Pharmacy Benefit Managers in Ohio

House Bill 64 recently amended Ohio Revised Code Chapter (ORC) 3959. The relevant code sections amended by House Bill 64 are ORC 3959.111 and ORC 3959.12 and these changes took effect on September 29, 2015. Pursuant to...more

10/8/2015  /  Compliance , Healthcare , Pharmacies

Cybersecurity: Integral to Overall Risk Management for Insurers and TPAs

Recent data breaches have brought cybersecurity to the attention of insurance companies, and serve as a reminder to third party administrators ("TPAs") that cybersecurity issues are a serious compliance and regulatory...more

Missouri Department of Insurance Enters into $1.25 Million Settlement with Nine Affiliated Insurers

Missouri insurance regulators recently announced a $1.25 million settlement with nine affiliated insurance companies as a result of a market conduct examination into their handling of workers’ compensation insurance. ...more

New Washington Rule Clarifies Authority to Issue Penalties Against TPAs

The Washington State Department of Health has promulgated a new rule clarifying the Department's authority to issue civil penalties against health carriers and third-party administrators. This rule, which is outside the...more

New Laws Regulating Pharmacy Benefit Managers In New Mexico, Utah And Washington

This past legislative session, several state legislatures enacted legislative regulating pharmacy benefit managers ("PBMs"). New Mexico, Utah, and Washington all adopted laws requiring licensure or registration of PBMs, in...more

New York Department Of Financial Services Fines Metlife Subsidiaries $60 Million

On March 31, 2014, Benjamin M. Lawsky, Superintendent of the New York Department of Financial Services ("NYDFS") announced an Agreement under which MetLife will pay $60 million for insurance licensing violations by two of its...more

Judge Finds Illinois Insurance Department's Policy Prohibiting Offshoring To Be Improper Rulemaking

On November 27, 2013, the Circuit Court of Cook County, Illinois issued an Order in a lawsuit filed by the American Council of Life Insurers, Inc. ("ACLI") v Andrew Boron, Director of the Illinois Department of Insurance and...more

Third Party Administrator Update - Volume 2, 2013

In This Issue: - Nevada Begins Audits of TPAs - Insurers Challenge Requirement to Use Social Security Death Master File - ACLI Files Lawsuit Regarding Prohibition on Offshoring - Tennessee Modifies...more

Restrictions On Fixed Indemnity Coverage

The Department of Labor Employee Benefits Security Administration issued guidance on the issuance of fixed indemnity insurance on January 24, 2013 in its FAQs about Affordable Care Act Implementation Part XI. These FAQs are...more

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