Insights

On January 31, 2025, the California Department of Insurance issued a notice providing additional guidance related to AB 1048 (2023 Session). AB 1048 prohibits preexisting condition exclusions under group dental insurance policies. The prohibition includes maximum benefit limits, limits on frequency, and number of visits based on the treatment or diagnosis of a dental condition prior to the insured's effective date. Additionally, AB 1048 prohibits a waiting period provision for dental policies i

On January 31, 2025, the Commissioner of Insurance released Directive 225 regarding coverage for fertility preservation under La. R.S. 22:1036.1, which requires insurers to cover all standard fertility preservation services. In particular, the directive emphasizes that the statute’s definition of “standard fertility preservation services” includes all healthcare services associated with the preservation of standard fertility oocyte and sperm preservation procedures. This includes but is not nec

On March 24, 2025, Gov. Glenn Youngkin signed HB 1828/SB 1436, which prohibits insurers and HMOs from charging cost-sharing for diagnostic and supplemental breast examinations, including those using diagnostic mammography, MRI, or ultrasound. The law defines diagnostic breast examinations to include medically necessary and appropriate examinations used to evaluate a detected or suspected abnormality. Supplemental breast examinations are defined as those used to screen for breast cancer based on

The 2025 legislative session in Colorado runs from January 8 through May 7. Rulemaking from administrative agencies occurs throughout the year. Important updates taking effect or finalized in the first quarter of 2025 for employee benefits are detailed below. On January 1, 2025, Amended Regulation 4-2-50 Concerning Pediatric Dental Coverage Requirements, which was adopted by the Colorado Division of Insurance (DOI) on October 11, 2024, took effect. The new rule prohibits health insurance carrie

On March 24, 2025, the Commissioner of Insurance released Bulletin 2025-01, which provides guidance for the calculation and reporting of dental loss ratios under the Dental Healthcare Services Plans Act, which became effective on January 1, 2025. The bulletin includes a link to the Department’s Dental Loss Ratio Reporting Workbook, which serves as a recommended guideline for compliance reporting as mandated by the Act. While the bulletin is directed to health insurance issuers and health mainte

On March 12, 2025, Gov. Tate Reeves signed SB 2415, which extends the requirement for health insurance coverage and group health plans to cover services provided via telemedicine to the same extent that they would be covered if provided in person. This requirement, enacted in 2022 to expand access to telemedicine in response to the COVID-19 pandemic, had been scheduled to expire on July 1, 2025. It will now expire three years later, on July 1, 2028. While the legislation purports to apply to bo

In Oregon, rulemaking from administrative agencies occurs throughout the year. Important employee benefits updates that took effect or were finalized in the first quarter of 2025 are detailed below chronologically. On December 23, 2024, the Oregon Division of Financial Regulation (DFR), Department of Insurance (DOI) finalized ID 41-2024 2025 Gender-Affirming Treatment Rule. The rule states that a carrier offering a health benefit plan may not deny, limit coverage, or impose additional cost-shar

In March 2025, Gov. Cox signed the following bills into law: SB 196 Physical Therapist Practice Amendments: The new legislation expands the definition of primary healthcare to include services provided by physical therapists. It also prohibits insurers from charging higher premiums or copays if a patient selects a physical therapist (or other qualified provider) as the primary care provider, including where an accident or health insurance policy requires a primary care provider or physician to

On March 21, 2025, Gov. Glenn Youngkin signed HB 2097/SB 1314, which updates the existing mandated coverage requirements for prostate cancer screenings. As enacted, the law requires insurers and HMOs in Virginia to cover prostate cancer screening for individuals age 50 and over, as well as individuals age 40 and over who are at high risk for prostate cancer without charging cost-sharing. The law also amends references to American Cancer Society guidelines to reflect updated tests and guidelines