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Around the PIA Western Alliance States

Posted By Administration, Tuesday, July 11, 2017

California — Jones & Fossil Fuel Investments: Officials from a number of states are looking at ways to convince California Insurance Commissioner Dave Jones to do away with a policy that pressures insurance companies to divest themselves of fossil fuels and coal industry investments. Jones thinks those investments important because fossil fuel overuse is blamed for global warming.

Those — like Oklahoma Attorney General Mike Hunter and 11 other attorneys general — say this just confuses consumers and it is not a regulator’s business to introduce politics into insurance investments. He and the others — including Kentucky Governor Matt Bevin — sent a letter to Jones asking him to reconsider.

Oklahoma Insurance Commissioner John Doak — along with five other state insurance commissioners — also sent Jones a similar letter.

A “ham-handed extremist environmental policy” is how Hunter describes Jones’ policy. “One in every four Oklahomans work in the energy industry, and the California Insurance Commissioner’s threats stand to harm families, businesses and insurance carriers in our state. This misguided policy is negligent, politically driven, unrelated to insurance regulation and is risking a certain lawsuit,” Hunter said.

Source link: Insurance Business America


California — Work Comp Payments: The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) issued a report last week on the costs of workers’ compensation in 2016.

In 2016:

  $4.8 billion — or 57% of total loss payments — was for medical services

  In 2015 those figures were $4.9 billion and 59%

  $3.6 billion — or 43% of total loss payments — went for indemnity benefits

Click here to access the entire report.

Source link: Insurance Journal


California — Transgendered Vets: This came to Weekly Industry News from the California Department of Insurance.

An amicus brief filed yesterday by attorneys general from nine states and the District of Columbia on behalf of transgender veterans unfairly denied health care relies on regulations issued by California Insurance Commissioner Dave Jones.

The amicus brief in Fulcher v. Secretary of Veterans Affairs, which is before the U.S. Court of Appeals, defends transgender veterans' access to health care. Currently, transgender veterans are being denied medically necessary care by the U.S. Department of Veterans Affairs that every major medical association, including the American Medical Association and American Physiological Association, agrees is medically necessary and proven to improve and save lives.

"The discriminatory policy of the Veteran's Administration should be rescinded," said Insurance Commissioner Dave Jones. "We must defend the rights of transgender veterans who are denied access to health care services."

California state law prohibits discrimination by private insurers and in Medi-Cal coverage. In 2012, Jones issued the first regulations in the United States prohibiting health insurers from continuing practices limiting or denying health coverage for transgender policyholders simply based on their gender identity or expression. The department concluded that blanket exclusions targeting transgender persons while providing the same treatments and services to non-transgender policyholders was prohibited by California law.

"Today, when a transgender Californian purchases health insurance, they have equal access to medically necessary treatment."

The California Department of Insurance also conducted the first government-sponsored economic impact assessment in the United States related to transgender health insurance coverage. The assessment concluded removal of the discriminatory exclusions would have an insignificant and immaterial impact on premiums and that the benefits for transgender Californians were significant.

After the Department of Insurance regulations were adopted, the Department of Managed Health Care applied virtually identical rules to the managed care companies they regulate. Additionally, CalPERS, which manages health benefits for over 1.4 million members and their families, used the Department of Insurance analysis to require coverage be free from discriminatory exclusions.

Since then, 13 states and the District of Columbia have used the department's analysis and regulations as the basis for eliminating this type of discrimination. Just last year, when the U.S. Department of Health and Human Services issued federal regulations banning the practice, they relied heavily on the department's work on the issue.


Nevada — Legal Pot Sales Booming: Nevada just became the fifth state to legalize the use of recreational marijuana. Shops opened to throngs of people eager to sample the wares. In Las Vegas one of the stores reported helping 1,000 customers during the first two days. 

Source link: Insurance Journal


Oregon — A New Transportation Plan: The Oregon Legislature has passed a transportation bill — House Bill 2017 — that will add $5.3 billion in gas taxes and other taxes.

Here is what House Bill 2017 does:

  Creates a 0.1 percent payroll tax

  Increases gas tax by 10 cents

  4 cents in 2018, two cent increases in 2020, 2022 and 2024

  Registration and title fee surcharges of $13 effective January 1, 2018

  A tax called a privilege tax of 0.5% on the retail price of a new motor vehicle with a gross weight of 26,000 pounds or less

  Put a tax in place of 0.5% of the retail price for a new motor vehicle purchased outside of Oregon and brought into the state

  Put a $15 excise tax in place on the sales of bicycles value at $200 or more


Oregon — Non-Gender Driver’s Licenses: The Oregon Legislature has said yes to a new class of driver’s license where the recipient does not have to list gender on the license. It’s called an “enhanced” license and gives the person applying the option of choosing an X rather than M or F.

The passage of the bill and signing into law by Oregon Governor Kate Brown makes the state the first in the union to set up a third gender option for non-conforming or non-binary people.

Basic Rights of Oregon co-executive director Nancy Haque said, “Our lives are so gendered, which is why it’s important that driver licenses and other forms of IDs recognize people who are non-binary. Removing barriers for people is critical to helping all of us live healthy, productive lives.”

The new policy went into effect on July 3rd. Experts say California could be the next state to make this change.

Source link: Salon


Oregon — From the Oregon Department of Insurance: DCBS posts preliminary rate decisions for 2018 health plans

Oregonians can now see the state’s preliminary decisions for rates for 2018 individual and small employer health insurance plans. The Department of Consumer and Business Services, Division of Financial Regulation must review and approve any rates before they can be charged to policyholders.

The preliminary rate decisions are for small businesses and individuals who buy their own coverage rather than getting it through an employer.

In the individual market, the division has issued preliminary decisions for seven companies with average rate changes ranging from a 1.6 percent decrease to a 14.8 percent increase. Under the preliminary decisions, Silver Standard Plan premiums for a 40-year-old in Portland would range from $355 to $452 a month.

Rates are required to reflect the average cost of providing health care to a member in Oregon’s health insurance market. The division has determined that the average cost of paying claims in the individual health insurance market in 2016 was $384 per member per month; in 2015, the average cost of paying claims was $385 per member per month. Health insurance companies are required to justify any differences to this average in their rate filings.

These preliminary decisions will undergo continued review and discussion through public hearings being held in Salem and streamed online July 10-11. The public comment period also will remain open through Tuesday, July 11. There will be a dedicated public comment period during each public rate hearing. For a schedule of hearings and to submit comments online, visit www.oregonhealthrates.org .

Final decisions are expected to be announced Thursday, July 20.

Please follow this link for more information and the entire news release:



Financial Reports

The Oregon Division of Financial Regulation, Insurance Institutions section recently published Reports of Financial Examination on the following companies:

  Atrio Health Plans, Inc.

  Dentists Benefits Insurance Company

  MODA Health Plan, Inc.

  Oregon Dental Service

  Samaritan Health Plans, Inc.

  TDC National Assurance Company

To view or download these reports, please visit our website at: http://dfr.oregon.gov/business/report-data/Pages/examination-reports-insurer.aspx


Oregon Division of Financial Regulation Bulletin DFR 2017-04: Clarifying Coverage for Marijuana Items and Activities

Property and casualty insurance policies commonly include public policy clauses or exclusions for illegal substances or illegal activities. Because the production, processing, sale, and use of medical and recreational marijuana are legal in Oregon, but are prohibited by federal law, general exclusionary language may not be sufficient to clearly define what is covered in a policy. To provide certainty to insurers and insureds, property and casualty insurance policies should explicitly state whether marijuana items and marijuana activities are covered or excluded, and whether marijuana activities are considered illegal activities under the policy.


Although the federal Controlled Substances Act prohibits the possession and production of marijuana, Oregon law permits the possession of marijuana items and engaging in marijuana activities, within limits defined by statute. Because these items and activities are permitted by Oregon law, insurers may provide coverage for marijuana items and activities within state boundaries.

This bulletin takes effect June 29, 2017.

Please visit the division's website for more details: http://dfr.oregon.gov/laws-rules/Pages/bulletins.aspx


Washington — From the Washington Department of Insurance: Changing language in WAC 284-50-330(8) to align with RCW 48.20.420 (R 2017-08) expedited rule adopted

The Office of the Insurance Commissioner proposes an expedited rule on Changing language in WAC 284-50-330(8) to align with RCW 48.20.420 (R 2017-08). The rule will updating the language in WAC 284-50-330(8) to align with the language used in RCW 48.20.420, replacing the use of the term "mental retardation" with "developmental disability".

This rule is being proposed using an expedited rulemaking process that will eliminate the need for the Commissioner to hold a public hearing. If you object to the use of the expedited rulemaking process, you must express your objection in writing by September 5, 2017 and submit it to rulescoordinator@oic.wa.gov.

For more information, including the expedited rule (CR-105), please visit the rule's webpage: https://www.insurance.wa.gov/changing-language-wac-284-50-3308-align-rcw-4820420-r-2017-08?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=


Notice of rulemaking on Optimizing prior authorization, also known as gold carding

We are starting rulemaking (R 2017-07) to help ensure a level playing field for consumers and providers. Some carrier-provider efforts to optimize prior authorization are not transparent and have the potential to discriminate against consumers and providers.

The rulemaking team would like to gather information to inform the development of the rule. Each carrier may define gold carding differently so we are interested in understanding all unique carrier-provider arrangements that impact prior authorization. To the extent possible, stakeholders are encouraged to answer the following questions:

  What specific standards do carriers use to determine the eligibility of providers to participate in a gold carding program?

  How do you define gold carding?

  If you have a gold carding program, what’s the process by which a participating provider gets prior authorization?

  What consumer and provider protections do you recommend for gold carding programs?

Comments are due August 18, 2017; please send them to rulescoordinator@oic.wa.gov.

For more information, including the notice to start rulemaking (CR-101), please visit the rule's webpage: https://www.insurance.wa.gov/optimizing-prior-authorization-also-known-gold-carding-r-2017-07?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=

Tags:  Around the PIA Western Alliance States  Insurance Content  Insurance Industry  Insurance news  Weekly Industry News 

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