Zoning In - Summer 2025

Northeast Zone

Maine

HP 1038 enacts a new section 24-A MRSA §4350-F that addresses “spread pricing prohibitions” and applies to contracts entered into or renewed on or after January 1, 2026. Definitions in this new section include “pharmacy benefits management fee” and “spread pricing” with the latter defined as “any amount charged or claimed by a pharmacy benefits manager in excess of the ingredient cost for a dispensed prescription drug plus the dispensing fee paid directly or indirectly to any pharmacy or pharmacist on behalf of the health plan, less any pharmacy benefits management fee.”

24-A MRSA §4350-F includes the following requirements:

• Spread pricing prohibited. A carrier or pharmacy benefits manager may not, either directly or through an intermediary, agent or affiliate, engage in, facilitate or enter into a contract with another person involving spread pricing in this State.

• Annual certification of compliance. Beginning December 31, 2026 and annually by December 31st thereafter, a carrier, or a pharmacy benefits manager under contract with a carrier, operating in the State shall certify to the superintendent that it has fully complied with the requirements of this section throughout the prior calendar year. The certification must be signed by the chief executive officer or chief financial officer of the carrier or pharmacy benefits manager.

Additional statutory provisions address penalties, exemptions and repeal date.

Massachusetts

The Massachusetts Division of Insurance issued PC Filing Guidance Notice 2025-R which addresses the “Mandatory Flood Exclusion Disclosure” and the submission of new mandatory disclosures relating to flood coverage. It further indicates that this disclosure should be provided upon issuance and upon any subsequent renewals.

This Notice also indicates that “effective for all policies issued or renewing January 1, 2026, carriers are to submit for the Division's review a separate disclosure notice clearly identifying that the home or dwelling insurance policy issued for delivery in Massachusetts does not cover loss from flooding. The notice shall be printed and included as a separate, stand-alone document, with the delivery of the policy, OR included in the policy packet, as its own individual page, positioned immediately after the declarations page.” Furthermore, the notice shall be consistent with the standards outlined in M.G.L. c. 175, §2B, including being no less than 10-point type, and shall contain the following language:

“IMPORTANT POLICYHOLDER NOTICE. THIS POLICY DOES NOT COVER DAMAGE FROM FLOOD. FLOODING OFTEN OCCURS OUTSIDE OF IDENTIFIED HIGH-RISK FLOOD AREAS AND PROPERTY OWNERS MAY WANT TO CONSIDER PURCHASING FLOOD COVERAGE.

POLICYHOLDERS MAY BE ABLE TO PURCHASE AN ENDORSMENT TO ADD FLOOD COVERAGE TO THEIR EXISTING POLICY IF THEY DO NOT HAVE COVERAGE ALREADY OR PURCHASE A STAND-ALONE FLOOD POLICY FROM A COMPANY OFFERING PRIVATE FLOOD INSURANCE OR FROM THE NATIONAL FLOOD INSURANCE PROGRAM. YOUR INSURANCE AGENT OR THE MASSACHUSETTS DIVISION OF INSURANCE CAN PROVIDE YOU WITH INFORMATION ABOUT FLOOD INSURANCE.”

Additionally, the Division expects all disclosures to be submitted by September 1, 2025, via SERFF with a Filing Description field beginning with the phrase “IN RESPONSE TO: Filing Guidance Notice 2025-R.” Disclosure filings should not be combined with other form/rule/rate changes.

Southeast Zone

Georgia

Effective January 1, 2026, SB 35 amends Georgia Insurance Code Section 33-24-46(d)(1) by increasing the minimum of days’ notice required that an insurer must provide to a policyholder for the nonrenewal of certain property insurance policies. Specifically, the days’ notice is changing from 30 to 60 days’ notice. This amendment becomes effective on January 1, 2026, and applies to policies issued, delivered or renewed on or after such date.

Louisiana

Advisory Letter 2025-02, dated June 20, 2025, serves to notify all property and casualty insurers, producers, public adjusters, and persons transacting business involving any post-loss benefits under residential or commercial insurance policies, that Assignment of Benefit (“AOB”) agreements are prohibited in the State of Louisiana. This Advisory Letter states that La. R.S. 22:1275 “expressly prohibits the solicitation or acceptance of any assignment, in whole or in part, of post-loss insurance benefits under residential or commercial property insurance policies.” Additionally, applicable definitions and exemptions are addressed. The Louisiana Department of Insurance (“LDI”) indicates that it “has received reports indicating that some policyholders, particularly residential homeowners, as well as certain insurers and service providers, remain unaware of the statutory prohibition. The LDI emphasizes that no person or entity may solicit or accept an assignment of post-loss insurance benefits under a residential or commercial property insurance policy. Any attempt to enforce such an agreement is legally void. Service providers, including but not limited to contractors, public adjusters, and appraisers, must not use AOB agreements as part of their business practices.”

South Carolina

The South Carolina Department of Insurance issued a “Notice of Liability Data Call” and a “Data Call Relating to Paid Family Leave Insurance, Title 38, Section 103” on July 1, 2025. Excel files of completed reports should be submitted via email to the respective email addresses detailed in each Notice by August 31, 2025.

Virginia

SCC Notice dated May 14, 2025 provides “Guidance on PANDAS/PANS mandated coverage”. Referencing Chapter 8 of the 2025 Acts of the Assembly (HB 1641), this Notice mentions the required coverage for the prophylaxis, diagnosis and treatment of Pediatric Autoimmune Neuropsychiatric Discords Associated with Streptococcal infections (“PANDAS”) and Pediatric Acute-Onset Neuropsychiatric Syndrome (“PANS”) beginning January 1, 2026. This Notice further mentions that the Virginia Bureau of Insurance (“Bureau”) finds that most of the services required by this new law are already provided as Essential Health Benefits (“EHB”) by a majority of carriers in the individual and small group markets in Virginia.

The Notice also provides the following specific information:

• The Bureau understands that Intravenous Immunoglobulin Therapy (“IVIG”) for prophylaxis, diagnosis, and treatment of PANDAS and PANS is not routinely covered by carriers as an EHB. Therefore, Qualified Health Plans (“QHPs”) in the individual and small group market (those plans offered through the exchange and the plan's mirrored off-exchange plan) must not include costs attributed to IVIG for prophylaxis, diagnosis, and treatment of PANDAS and PANS as part of the requested premium for 2026.

• The law also prohibits carriers from denying, limiting, or delaying coverage for the reasons stated in Section 38.2-3418.22 C of the Code of Virginia (effective on July 1, 2025). Even though these provisions may require carriers to approve claims that might have been denied before, these provisions do not require specific benefits to be provided that are in addition to EHB. Therefore, expenses attributed to services required by this subsection will not be defrayed and do not need to be removed from premium.

• The Bureau will perform an actuarial assessment to determine a “per member per month” (“PMPM”) amount that carriers with QHPs in the individual and small group markets will be paid during 2026. Premium rates for non-QHPs (i.e., plans not offered through the individual or small group health benefit exchange) may include costs for this benefit as well as other benefits mandated by Chapter 8 of the 2025 Acts of Assembly.

• The Bureau asked carriers in their rate filings to break out and report any amounts attributable to mandated non-EHBs. The Bureau has a process whereby it will annually assess carriers' expenses for any mandated non-EHBs and may adjust the PMPM payment made to carriers based on this assessment.

Midwest Zone

Illinois

The stated purpose of the newly adopted Part 2300 of the Illinois Administrative Code is as follows: “This Part is to prescribe the standard template for drug formularies, which health insurance issuers must post on their public websites for health products that they offer in this State.” Adopted on June 6, 2025, Part 2300 provides for applicable definitions, applicability, standard template specifics and various filing issues including the following:

• Section 2030.40, titled “Standard Drug Formulary Template” sets forth minimum standards, and unless otherwise noted, applies to all health product formularies subject to Section 155.37 of the Code. A health insurance issuer or its designee may implement additional provisions exceeding these requirements.

• Section 2030.50, titled “Filing Requirement” specifies that by October 1, 2025, a health insurance issuer that maintains drug formularies must submit all drug formularies for health products in which it has enrolled a covered individual for review for compliance with this Part. The filing must be submitted to the Department through SERFF.

Indiana

Bulletin 278  (dated June 10, 2025) and Bulletin 279 (dated June 26, 2025) address the “reporting of ownership information” with specific reference to the new reporting requirements set forth in Pub. L. 239-2025 (HB 1666) applicable to insurers, TPAs, and PBMs. Beginning July 1, 2025, and each July 1 thereafter, each insurer, TPA, and PBM doing business in Indiana shall file with the Department a report that includes specific information detailed in the Bulletins, with Bulletin 279 providing the link to the HEA 1666 Ownership Information Form on the Department’s website.

Nebraska

LB 474 adds a new subsection 15 to § 44-502 of the Nebraska Insurance Code that pertains to required provisions in life insurance policies as follows: 

(15)(a) For policies issued or delivered in this state on or after January 1, 2026, a provision that, at least fifteen days prior to termination or lapse by reason of default in payment of any premium due on such policy, a notice will be sent electronically or mailed to the last-known address of the owner and any assignee on record with the company.

(b) For policies issued or delivered in this state on or after January 1, 2026, an assignee shall have the same legal standing as the owner with respect to subdivision (15)(a) of this section.

Oklahoma

Effective November 1, 2025 SB 1050 amends the time limits for insurers and health care providers to request refunds on paid claims. Insurers now have six months, reduced from 12 months, and health care providers have 12 months, reduced from 18 months, to make these requests after a claim is paid out. 

Western Zone

Idaho

The Idaho Department of Insurance provides “Guidance Concerning Outlines of Coverage and Summaries of Benefits and Coverage” in its Bulletin 25-04, dated May 22, 2025. Specifically, this Bulletin permits carriers to provide the Summary of Benefits and Coverage (“SBC”), introduced under the Affordable Care Act (“ACA”), to satisfy Idaho's statutory requirement to provide an Outline of Coverage  (“OOC”). This Bulletin indicates that the Department finds that SBCs provide information substantially similar to that required for an OOC under state law. It further states that, “effective immediately, carriers of health benefit plans may satisfy the OOC requirement under Idaho Code § 41-4205(1) by providing insureds and prospective insureds with an SBC that fully complies with 45 C.F.R. § 147.200 and subsequent related guidance.”

Nevada

Effective October 1, 2025, SB 166 amends Nevada Insurance Code Section 687B.383. In general, 687B.383 relates to provisions that prohibit insurers from taking certain actions against a property insurance policyholder due to the breed of dog that is harbored or owned on the property. The amendment expands the prohibition against an insurer from canceling, refusing to renew, refusing to issue, or increasing the premiums or rates for insurance policies based on the breed or mixture of breeds of dogs harbored or owned on the applicable property. The amendment does this expansion by removing the limitation that a dog breed must be the sole basis for such actions. Additionally, the amendment extends the applicability of the citation to policies that cover multi-family residential dwellings.

Texas

SB 1238, effective September 1, 2025, sets forth prohibited insurance discrimination on the basis of an insured's marital status following the death of the insured's spouse. Section 544.002, Insurance Code, is amended by adding Subsections (d) and (e) which read as follows:

(d) Notwithstanding Section 544.003, an insurer may not:

(1) refuse to continue to insure or provide coverage to an individual or limit the amount, extent, or kind of coverage available to an individual because the individual is widowed or the individual's marital status otherwise reflects the death of a spouse; or

(2) charge an individual who is widowed or whose marital status otherwise reflects the death of a spouse a rate that is different from the rate that would be charged if the individual's marital status was married.

(e) Subsection (d) may not be construed to prohibit a title insurance company or title insurance agent from imposing a reasonable requirement on a widowed insured or widowed individual seeking insurance coverage for the purpose of determining heirship, probate matters, or other similar issues in the same manner as an insured or individual who is not widowed.

---

Kathy Donovan is Senior Compliance Counsel, insurance with Wolters Kluwer Financial Services. Kathy has more than two decades of experience in insurance compliance. Her expert commentary on legal and regulatory issues affecting the insurance industry is widely published and she is a regular presenter at various industry events.