Jennifer Osborn Nix

Jennifer Osborn Nix works diligently for insurance companies, third-party administrators, and other regulated entities to further their goals and help them remain compliant within the 50-state regulatory scheme. She focuses on insurance regulatory and compliance issues, with a primary emphasis on life and health insurance matters.

Jennifer works with many regulated entities, including many in the health care sector, who rely on her for research, advice, strategic counsel, and licensing. These include:

• Insurance Companies and Health Maintenance Organizations (HMOs)
• Third Party Administrators (TPAs) 
• Preferred Provider Organizations (PPOs) 
• Independent Practice Organizations (IPOs) 
• Clinically Integrated Networks (CINs) 
• Accountable Care Organizations (ACOs) 
• Agents and Agencies 
• Utilization Review Organizations (UROs) 
• Discount Medical Plan Organizations (DMPOs) 
• Pharmacy Benefit Managers (PBMs)

Jennifer is well versed in state health insurance laws and regulations, particularly mandated benefits, and association group insurance laws, as well as federal laws affecting the sale of health insurance, such as PPACA, HIPAA, and ERISA. She also has significant experience with unfair trade practice laws and advertising and marketing requirements, including telemarketing requirements. She regularly handles many types of insurance-related matters, including licensing and registrations; market conduct examinations; audits; national research and compliance projects; contract drafting and review; policy form filing; discontinuance and nonrenewal; and Violent Crime Control Act Issues.

Jennifer has assisted heavily regulated insurance entities comply with privacy requirements since the enactment of Gramm Leach Bliley. She has helped prepare privacy policies, manuals, and training, provided HIPAA advice, and drafted business associate agreements or privacy provisions for many clients. She has also advised clients regarding insurance regulatory data security requirements.

• Research numerous compliance issues under the ACA for clients marketing traditional health insurance plans, marketplace plans, excepted benefit plans and discount medical plans, and analyzed application of provisions to the various plans, including application of MLR requirements. Contacted HHS on behalf of a national health insurer regarding an MLR issue under the ACA and engaged in favorable discussions regarding the required protocol for the company to follow.
• Provide ongoing support for insurer and health care clients regarding application of health insurance laws, licensing laws, and marketing requirements under state insurance laws and the ACA.
• Review, revise, and file health insurance policy forms on behalf of clients, including traditional health insurance policies, excepted benefit plans, and Medicare Supplement plans.
• Drafted and filed amendatory endorsements and conducted national nonrenewal and market exit of grandfathered health insurance plans on behalf health insurance company.
• Analyzed application of state insurance laws for large health organizations contemplating forming clinically integrated networks or accountable care organizations in various states to determine whether state insurance laws may require licensure or registration. Assisted other entities forming provider networks to comply with preferred provider organization (PPO) licensure or registration requirements.
• Provide ongoing regulatory and compliance advice and counsel to national third party administrator clients. For example, quickly evaluated an RFP being submitted by our client to determine what aspects involved licensable TPA work for delegation purposes; researched application of Violent Crime and Control Act to determine whether potential employees of a TPA in numerous states were subject to the act.
• Provide regulatory advice and counsel to a national pharmacy benefit manager (PBM), including assistance with licensing, compliance, contract drafting and negotiations, and regulatory inquiries.
• Provide licensing and regulatory advice and counsel to national DMPOs, including review of sales and marketing materials.
• Provide licensing and regulatory advice and counsel to national utilization review entities.
• Provided regulatory advice and counsel to national long-term care insurer with respect to multiple market conduct examinations.
• Assisted national property and counsel insurer with respect to a Missouri market conduct examination.
• Led team that updated national health insurer’s compliance database to incorporate all state mandated benefits and to address jurisdictional issues.
• Conducted review of national health insurer’s sales and marketing materials, including field-created ads, on a 50-state basis.