On September 6, 2022, the Department of Insurance issued Bulletin No. 2022-10 to announce the indexed increase in the annual maximum benefit for behavioral therapy coverage. The bulletin was directed at HMOs and carriers writing insurance in the state.

State law requires that an annual adjustment of the maximum benefit for behavioral therapy coverage be made to reflect any change from the previous year in the Consumer Price Index. Accordingly, the department determined that the maximum benefit for coverage for behavioral therapy shall be increased to $67,300 for the calendar year beginning January 1, 2023.

Although the guidance is directed at insurers, employers that sponsor group health plans may also want to be aware of this announcement.

Bulletin No. 2022-10 »

On June 8, 2022, the Department of Insurance issued Bulletin Number 2022-02 to announce an extension of transitional relief for certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows the recent CMS extension of the federal nonenforcement policy concerning specific ACA compliance requirements for these plans.

On November 14, 2013, CMS announced a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This nonenforcement policy provided relief from certain market reforms, including prohibitions of coverage exclusions based on pre-existing conditions and requirements to cover essential health benefits and limit annual out-of-pocket spending.

Under the policy, state authorities could permit health insurance issuers to continue coverage that would otherwise have been cancelled for failure to comply with the ACA requirements. The Department of Insurance has historically allowed insurers the option to continue such coverage. Bulletin 2022-02 represents the most recent extension of this policy and applies to renewals for plan or policy years beginning on or after October 1, 2022, and will remain in effect until CMS announces that all such coverage must come into compliance with the specified requirements.

Accordingly, small employers who are currently covered by such grandmothered policies issued in the state should be aware of the bulletin. These employers should work with their advisors and insurers regarding possible renewal of the coverage.

Bulletin 2022-02 »

On December 31, 2021, the Department of Insurance issued Bulletin No. 2021-09 regarding compliance with the Consolidated Appropriations Act, 2021 (CAA), which includes the No Surprises Act (NSA) and transparency provisions. The stated purpose of the bulletin is to inform insurers, pharmacy benefit managers, independent review organizations and other third-party service providers of the CAA requirements.

The bulletin outlines the NSA surprise billing prohibitions, the independent dispute resolution process and other patient protections. It explains that insurance policy forms must comply with all applicable NSA provisions. Accordingly, forms may require amendments and submission for approval in accordance with the designated process. Further, insurers are required to complete a certification confirming that all policy forms comply with the applicable provisions of the CAA effective January 1, 2022. This certification is provided on the last page of the bulletin. The guidance also references the transparency requirements, including the requirement for insurers to disclose certain compensation arrangements effective December 27, 2021.

The bulletin further explains that enforcement of the CAA provisions generally follows the enforcement provisions of the ACA. In other words, the federal DOL will enforce provisions of the CAA as they relate to self-insured plans, and the states will regulate fully insured plans and other licensees engaged in the issuance or servicing of health insurance coverage.

Although the bulletin is directed at insurers, employers who sponsor fully insured plans should be aware of this guidance.

Bulletin 2021-09 »

On August 31, 2021, the Department of Insurance issued Bulletin No. 2021-07 to announce the indexed increase in the annual maximum benefit for behavioral therapy coverage. The bulletin was directed at HMOs and carriers writing insurance in the state.

State law requires that an annual adjustment of the maximum benefit for behavioral therapy coverage be made to reflect any change from the previous year in the Consumer Price Index. Accordingly, the department determined that the maximum benefit for coverage for behavioral therapy shall be increased to $62,100 for the calendar year beginning January 1, 2022.

Although the guidance is directed at insurers, employers that sponsor group health plans may also want to be aware of this announcement.

Bulletin No. 2021-07 »

On January 19, 2021, the Department of Insurance issued Bulletin Number 2021-01 to announce a one-year extension of the renewal policy with respect to certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows an extension by CMS of the federal non-enforcement policy concerning specific ACA compliance requirements for these grandmothered plans, as reported elsewhere in this edition of Compliance Corner.

On November 14, 2013, CMS issued a letter outlining a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This non-enforcement policy provided relief from certain market reforms, such as the prohibition of coverage exclusions based on pre-existing conditions and non-discrimination based on health status. Under the policy, state authorities could allow health insurance issuers to continue eligible coverage that would otherwise have been cancelled for failure to comply with the ACA requirements.

The department originally announced the state’s intent to allow insurers to continue such coverage via Bulletin 2013-12 issued on November 19, 2013. The transitional policy has been extended by CMS and the department every year since the initial announcement.

Accordingly, small employers who are currently covered by grandmothered policies issued in South Carolina should be aware of the most recent non-enforcement extension. This type of coverage may now be renewed for plan or policy years beginning on or before October 1, 2022, so long as no such coverage extends beyond December 31, 2022. Affected employers should work with their advisors and insurers regarding possible renewal of the coverage.

Bulletin 2021-01 »

On March 25, 2020, Gov. McMaster issued Bulletin 2020-2 in an effort to provide relief to residents impacted by the coronavirus (COVID-19) pandemic. The bulletin is directed at the insurance industry, including insurers, HMOS and other licensed or authorized entities and individuals.

The bulletin follows the declaration of a State of Emergency on March 13, 2020. Due to the significant disruptions and health concerns resulting from the COVID-19 crisis, state resident and insureds have been substantially impacted.

The bulletin advises the insurance industry to work with directly impacted citizens and businesses to provide relief, including extension of premium payment deadlines and waivers of related late fees, as well as allowing additional time before nonrenewals or cancellations become effective. The communication also requests waivers with respect to limitations on the use of out-of-network providers and time limitations to allow for early prescription refills. The memo further advocates for increased access to medical care via telehealth.

The memo is directed at insurers, but employers should be aware of this communication.

Bulletin 2020-2 »

On February 19, 2020, the Department of Insurance issued Bulletin Number 2020-01 to announce a one-year extension of the renewal policy with respect to certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows an extension by CMS of the federal non-enforcement policy with respect to specific ACA compliance requirements for these grandmothered plans.

As background, on November 14, 2013, CMS issued a letter outlining a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This non-enforcement policy provided relief from certain market reforms, such as the prohibition of coverage exclusions based on pre-existing conditions and non-discrimination based on health status. Under the policy, state authorities could allow health insurance issuers to continue eligible coverage that would otherwise have been cancelled for failure to comply with the ACA requirements. The Department originally announced the state’s intent to allow insurers to continue such coverage via Bulletin 2013-12 issued on November 19, 2013. The transitional policy has continually been extended by CMS and the Department since the initial announcement.

Accordingly, small employers who are currently covered by such grandmothered policies issued in South Carolina should be aware of the most recent non-enforcement extension through December 31, 2021. These employers should work with their advisors and insurers regarding possible renewal of the coverage.

SC DOI Bulletin »

On July 24, 2019, the South Carolina Supreme Court announced that the state will no longer permit common-law marriages. However, valid common-law marriages in effect prior to July 25, 2019, will continue to be recognized.

In repudiating the common-law marriage doctrine, South Carolina follows other states, including Alabama, Georgia, and Pennsylvania. The court determined that many of the original reasons for the doctrine, such as the protection of child support and inheritance rights, no longer depend upon marital status. The opinion also acknowledged the lack of clarity regarding common-law marriage requirements, which resulted in confusion and litigation. Accordingly, the decision was intended to promote predictability by requiring couples wishing to be married to comply with the statutory requirements.

The court’s ruling will affect benefit administration not only within South Carolina, but also beyond the state’s borders, as South Carolina residents may work in or move to other states. Affected employers will need to consider the change when administering leaves, including those under the Family and Medical Leave Act (FMLA). The FMLA permits leave to care for a spouse or stepchild with a serious health condition. The FMLA recognizes a spouse or stepchild of a common-law marriage that was validly entered into pursuant to state law.

Following the decision, an employee claiming a common-law spouse under South Carolina law for benefit purposes would need to establish that the common-law marriage occurred prior to July 25, 2019. The employer can request reasonable documentation (such as an affidavit that marriage requirements were satisfied) to support such a claim. After July 25, 2019, employees entering South Carolina marriages must satisfy the statutory requirements and obtain a valid marriage certificate.

Opinion No. 27908 »

On September 13, 2019, the Department of Insurance issued Bulletin Number 2019-9, which relates to the maximum benefit for coverage of behavioral therapy for autism spectrum disorder. The purpose of the bulletin is to announce that the annual adjustment of the maximum benefit coverage of behavioral therapy for autism spectrum disorder is increased from $57,300 to $58,300 for the calendar year beginning January 1, 2020. Although the bulletin is directed towards insurers, South Carolina employers should be aware of the new maximum benefit for behavioral therapy.

Bulletin Number 2019-9 »

On March 28, 2019, the South Carolina Department of Insurance (DOI) published Bulletin 2019-01, Addendum F to Bulletin 2013-12. The purpose of the bulletin is to advise carriers of the DOI’s intent to continue to permit the renewal of coverage pursuant to the CCIIO’s latest transitional policy extension for grandmothered plans in the individual and small group markets.

According to the bulletin, the transitional policy permits carriers in the individual and small group markets to renew certain non-grandfathered policies that would otherwise be deemed to be out of compliance with the ACA. Such coverage may now be renewed for plan or policy years beginning on or after October 1, 2020, so long as no can early renew or amend the coverage term in order to permit small employers to maintain such coverage until December 31, 2020.

Bulletin 2019-01 »