On November 12, 2021, Gov. Burgum signed HB 1511 into law. Under the new law, if a private employer requires employees or independent contractors to be vaccinated against COVID-19 as a condition of employment or contract, the employer must provide an exemption to those submitting proof of COVID-19 antibodies. Such proof shall be valid for six months.

The employer must also provide an exemption for those submitting to periodic testing, providing certification that such immunization would endanger the individual’s health or certification of a religious, philosophical or moral belief opposed to such immunization.

Importantly, the law specifically states that the requirement would not apply to an employer who is required to comply with a related federal law. Thus, large private employers who may be subject to the federal vaccine mandate under the Occupational Safety and Health Administration’s Emergency Temporary Standard would not have to consider conflicting provisions (such as providing an exemption based on proof of antibodies without weekly testing). Those employers would not be subject to the state provisions and would need only comply with the federal mandate.

The law is effective from November 15, 2021, through August 1, 2023. Employers should be aware of this law and consult with employment law counsel about their obligations.

HB 1511 »

On March 24, 2020, the Insurance Department published Bulletin 2020-3, which relates to the expansion of telehealth services. According to the bulletin, carriers are required to relax the guidelines under HIPAA consistent with recent CMS guidance (i.e., serving patients in good faith through everyday communications technologies to include, but not limited to, telephone, FaceTime or Skype). In addition, carriers must start or continue to provide covered services via telehealth visits, including services relating to office visits for patients, physical, occupation, and speech therapy plan evaluation, behavioral health and substance use disorder treatment, diabetes education, and nutrition counseling.

The bulletin does not apply to deferrable elective, chiropractic or dental care, or to acupuncture. The bulletin also states that carriers must expand telehealth and offer coverage for e-visits and virtual check-ins. Finally, the bulletin includes a helpful chart outlining the appropriate codes for use in telehealth claims processing.

Employers should work with their carrier on any questions relating to the appropriate coverage of telehealth under a fully insured plan in North Dakota.

Bulletin 2020-3 »

On March 11, 2020, Insurance Commissioner Godfread released Bulletin 2020-1, in which he requests that insurers waive cost-sharing for CDC-recommended lab testing of COVID-19 so that cost sharing does not serve as a barrier to accessing the tests. Among other things, the bulletin also asks insurers to waive any prior authorization requirements associated with COVID-19 testing or treatment. In the event that an immunization for COVID-19 becomes available, the bulletin also requests that insurers offer the immunization at no cost to participants.

The bulletin will expire on May 1, 2020, unless the Department of Insurance indicates otherwise. Employers should familiarize themselves with this guidance in case employees have questions about the coverage of COVID-19 testing.

Bulletin 2020-1 »

On Sept. 19, 2018, Insurance Commissioner Godfread issued Bulletin 2018-2. The bulletin reminds insurance companies of the North Dakota rules and regulations that apply to short-term, limited duration policies issued in ND. As background, the federal government issued final regulations on short-term, limited duration health plans on Aug. 3, 2018. ND limits such policies to a period of no more than 12 months, which means only one renewal of a six month policy will be allowed.

This bulletin reminds insurers that the Insurance Department will require insurers to refile for all short-term, limited duration policies by Oct. 8, 2018. In refiling, the insurers will have to certify that they have amended these policies to come into compliance with federal and state law.

The bulletin reminds insurers that ND requires these policies to have no more than a 55 percent loss ratio. Additionally, the bulletin provides the state’s required disclosure, which must be in large print and placed on the front cover page of the policy, the certificate of coverage, and the application. The bulletin also identifies the questions that must be answered on the application as well as the requirement for the marketing materials to be filed with the Department by Oct. 8, 2018.

Additionally, the bulletin states that short-term, limited duration policies may only be sold by an appointed producer whose signature and identification number must be included on the application.

This bulletin reminds insurers of the state’s requirements for short-term, limited duration health policies. Employers should be aware that though these plans may be a lower cost option for individuals that just experienced a separation of employment, it doesn’t change an employer’s obligation to make an offer of COBRA (or state continuation), if otherwise required.

Bulletin 2018-2 »

On July 10, 2018, Insurance Commissioner Godfread issued Bulletin 2018-1. This Bulletin requires plans that cover autism spectrum disorder to comply with the federal MHPAEA laws, which require that treatment limitations on mental health/substance use disorders be in parity with treatment limitations imposed on substantially all medical/surgical treatments. The bulletin specifically notifies insurers that they cannot exclude applied behavior analysis (ABA) therapy to treat children with autism spectrum disorder on the basis that ABA therapy is experimental.

Although the insurance carriers will implement this law, employers should be aware of the change. The law is effective Oct. 1, 2018.

Bulletin 2018-1 »

On April 18, 2017, Gov. Burgum signed SB 2052 into law. This law requires health insurers in the state to provide coverage for health services delivered through telehealth. The law describes telehealth as the “use of interactive audio, video, or other telecommunications technology that is used by a health care provider at a distant site to deliver health services.”

This law is effective Aug. 1, 2017.

SB 2052 »

On May 10, 2017, Gov. Burgum signed SB 2231 into law. This law requires benefit plans to provide reimbursement rates for out-of-network air ambulance provider services that are equal to the insurer’s average rates for in-network air ambulance providers. The law further states that insurers can’t use the average of their in-network rates for ambulance providers for the purpose of decreasing contractual rates between insurers and air ambulance providers.

This law is effective beginning on Jan. 1, 2018.

SB 2231 »

On Oct. 27, 2015, the North Dakota Insurance Department (the Department) issued Bulletin 2015-3, which defines “small employer” for health benefit plan purposes as employers who employ an average of one to 50 employees. This clarification comes as a result of the PACE act, which amended the PPACA to remove the provision that would have changed the definition of small group from 1-50 to 1-100.

Insurers may submit small group rate modifications to the Department beginning in the second quarter of 2016.

Bulletin 2015-3 »

On April 13, 2015, Gov. Dalyrmple signed SB 2214 into law. Prior law required employers to notify employees about any security breach. This legislation amends the law to require that any entity that experiences a security breach affecting more than 250 North Dakota residents must disclose that breach to the North Dakota Attorney General by mail or email. The new law requires disclosure of a breach that affects health insurance information, and any employer who experiences such a breach (in either self- or fully insured plans) should disclose the information accordingly. The law was effective Aug. 1, 2015.

SB 2214 »

On April 13, 2015, Gov. Dalrymple signed House Bill 1072 into law. This law requires that copayments, deductibles and coinsurance amounts for patient-administered cancer treatment medications cannot be higher than the amounts for cancer treatment medications that are injected or administered by a health care professional. Insurers may not increase copayments, deductibles or coinsurance amounts for injected or intravenously administered cancer medications or reclassify those benefits to avoid compliance. This law is effective on Aug. 1, 2015.

HB 1072 »