Arizona Clarifies 2025 Health Insurance Denial Rules: Medical Directors Still Accountable
AZ| The Arizona Department of Insurance and Financial Institutions issued Regulatory Bulletin 2025-06 to clarify compliance requirements for health care insurers regarding direct denials of prior authorization requests on the basis of medical necessity, reflecting changes enacted by H.B. 2054 effective September 26, 2025. Main Points: Click here to see AR Bulletin 2025-06
Illinois Sets Transparency Standards for Public Access to Health Insurance Drug Formularies
IL| Company Bulletin 2025-16 issued by the Illinois Department of Insurance outlines the requirements for submitting and publicly posting standard drug formularies for health insurance products in Illinois. The bulletin provides guidance to all health insurance issuers regarding initial and ongoing filing obligations, specifies submission methods, and emphasizes transparency and accessibility requirements for public postings. […]
The Excess Lines Association of New York Announces Voluntary Withdrawal from their List of E&S Insurers
NY| Bulletin No. 2025-19, from The Excess Lines Association of New York (ELANY), notifies interested parties that American Western Home Insurance Company has voluntarily withdrawn its eligibility as an excess line insurer in New York. ELANY will only process policies, endorsements and stamp only submissions for policies effective on or before September 17, 2025. Click […]
Massachusetts Sets January 2026 Deadline for Pharmacy Benefit Manager Licensing Compliance
MA| The Massachusetts Division of Insurance Bulletin 2025-04, establishes the licensing requirements for Pharmacy Benefit Managers (PBMs) operating in Massachusetts for the 2026 calendar year, pursuant to Chapter 342 of the Acts of 2024 and M.G.L. c. 176Y. All PBMs must obtain a license from the Division of Insurance by January 1, 2026, to legally […]
Oregon Health Plans Must Cover COVID-19 Vaccines With No Out-of-Pocket Costs in 2025
OR| Oregon Department of Consumer and Business Services – Insurance Division Bulletin 2025-06 clarifies and reaffirms the requirement for all health benefit plans in Oregon, including grandfathered plans, to provide coverage for FDA-approved COVID-19 vaccines and their administration without cost-sharing or network restrictions, in line with prior guidance and statutory obligations. Key Points: Click here […]
Arkansas Insurers Alert: Compliance Deadline for ARRUA Fee Approaching December 31, 2025
AR| The Arkansas Insurance Department has issued Bulletin No. 11-2025, announcing that all licensed property insurers, farmers mutual aid companies, and related associations in Arkansas must pay an annual assessment to the Arkansas Rural Risk Underwriting Association (ARRUA) for 2025, as authorized by state law. This $200 assessment per company is to fund expenses, including […]
DC Requires Health Insurers to Fully Cover All ACIP-Recommended Vaccines With No Cost-Sharing
DC| Bulletin 25-IB-003-09/17 from the DC Department of Insurance, Securities and Banking instructs insurers offering health benefit plans in the District of Columbia to continue providing coverage for all ACIP-recommended vaccines (as of December 31, 2024), including COVID-19 vaccines, without cost-sharing or obstructive management in individual, small, and large group markets. This interpretive guidance clarifies […]
New Mexico Health Insurers Must Maintain Immunization Coverage Standards Through 2026
NM| The New Mexico Office of Superintendent of Insurance issued Bulletin 2025-009 to clarify requirements for health insurers and HMOs regarding immunization coverage for the 2025 and 2026 plan years. Insurers must provide immunization coverage based on Advisory Committee on Immunization Practices (ACIP) guidelines in effect at the time their rates were filed and approved, […]
Producers Urged to Confirm Compliance with New Oklahoma STLDI Guidelines
OK| The Oklahoma Insurance Department Bulletin No. 2025-08 informs health insurers and HMOs about federal changes affecting enforcement of Short-Term Limited Duration Insurance (STLDI) plans. Following federal guidance that deprioritizes enforcement of strict 2024 federal duration limits, Oklahoma carriers may now follow state law, allowing STLDI policies for up to three years if approved by […]
Wisconson Statewide Guidance: No Cost-Sharing Allowed for COVID-19 Vaccine Coverage in Health Plans
WI| Governor Tony Evers has directed the Office of the Commissioner of Insurance to clarify that both health insurers and governmental self-funded health plans in Wisconsin must comply with coverage requirements for COVID-19 vaccinations. Following a standing medical order issued by the State Epidemiologist authorizing COVID-19 vaccines for eligible recipients, and consistent with Wisconsin’s anti-discrimination […]