Jennifer Osborn Nix

Jennifer Osborn Nix


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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

11/17/2015 - Compliance Insurance Industry Professional License Regulatory Oversight TPAs

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

5/19/2015 - Cybersecurity Data Breach Data Protection Due Diligence Insurance Industry NYDFS Privacy Laws Technology Third-Party Service Provider TPAs

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

4/17/2015 - Department of Insurance Insurance Industry Settlement Agreements

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

7/24/2014 - Civil Monetary Penalty Department of Health Health Insurance Healthcare Insurance Industry Licenses Licensing Rules Third-Party Service Provider

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

5/16/2014 - Employee Benefits Pharmacies Prescription Drugs

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

4/14/2014 - Department of Financial Services MetLife

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

1/9/2014 - Administrative Remedies Code of Conduct Data Outsourcing Life Insurance Offshore Companies Offshoring Outsourcing TPAs Utilization Review

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

10/18/2013 - Audits Insurance Industry Licensing Rules Offshoring Social Security Third-Party TPAs Workers' Compensation Defense

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

1/30/2013 - Affordable Care Act Employer Group Health Plans Health Insurance Health Insurance Exchanges Indemnity Insurance

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