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Around the PIA Western Alliance States

Posted By Administration, Wednesday, September 6, 2017

Idaho — Medicare workshop offered in Lewiston: Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance, is offering a Medicare Workshop, on Tuesday, September 19 at the Community Action Partnership, 124 New 6th Street, Lewiston, from 2:00 to 4:00.

 

This workshop is especially designed for:

  People who are turning 65 or otherwise approaching Medicare eligibility

  Caregivers

  Anyone who would like to learn more about how Medicare works

 

Presenters will explain some of the vocabulary that is associated with Medicare and introduce the various parts of Medicare. Attendees will learn about:

  Important timeframes for enrolling in Medicare

  Enrollment periods for MediGap, Medicare Advantage and Medicare Prescription Drug Plans

  How the different parts of Medicare work together – and when they don’t

 

Anyone interested in attending this workshop is encouraged to contact SHIBA at 1-800-247-4422 to RSVP.

 

Nevada — No Pot in Casinos: The Nevada Gaming Commission is saying no to the use of pot in casinos. The reason being given is since it is still illegal according to the federal government it will not be allowed.

Commissioner Tony Alamo said, “On one hand you have the gaming industry and on the other hand you have the marijuana industry … The two shall not meet.”

They are — however — discussing bringing marijuana into casinos as third-party businesses. No decision was made.

 

New Mexico — Insurance Fraud Case: Health insurer Lovelace Inc. has settled with the state over a fraud case. The state accused the company’s parent Ardent Health Services and its former head Cigna of illegally and fraudulently collecting $142.6 million from Medicaid.

No announcement has been made but the state is said to have settled for far less than that amount.

Source link: Insurance Business America

 

Oregon — The Kicker: You will get a Tax Refund Kicker this year. The average refund will be $227.

 

INCOME GROUP    ADJUSTED GROSS INCOME      KICKER SIZE

Bottom 20%              Under $10,700                                              $5

Second 20%             $10,701 - $25,300                                        $35

Middle 20%               $24,301 - $46,400                                        $98

Fourth 20%               $46,401 - $85,500                                        $205

Next 15%                   $85,501 - $172,500                                     $441

Next 4%                     $172,501 - $389,400                                   $1,090

Top 1%                      Over $389,401                                              $4,902

 

Average: $59,700

Average kicker: $227

 

Median: $30,000 - $35,000

Average kicker: $89

 

Oregon — From the Department of Insurance: Recently, the Division of Financial Regulation (DFR) requested advice from the Department of Justice (DOJ) regarding common law employee requirements for group health plan purchases. This request was in response to concerns raised with DFR that insurers could apply the standard differently; for instance, allowing an employer to access the small group market simply by offering coverage to at least one eligible common law employee, where another insurer might be requiring that the common law employee be enrolled in the group health plan.

DOJ’s advice concluded that under both the federal Employee Retirement Income Security Act (ERISA) and the Small Business Health Options Program (SHOP), if an employer purchases a plan with the intent to obtain coverage for the employee under the plan, the plan must have at least one common law employee enrolled as a participant. A participant is considered a common law employee if the employer has the authority to direct and control the manner in which the services are performed by the individual. DFR is bound to follow and apply this advice to insurance participants in the small group market.

As a result of this clarification, existing employer groups that do not have at least one common law employee enrolled in coverage — the affected groups — may lose eligibility to continue purchasing a group health benefit plan.

The requirement to have at least one common law employee enrolled in coverage applies “on the first day of the plan year.” Accordingly, carriers may not terminate an affected group in the middle of a plan year based solely on the absence of an enrolled common law employee.

However, at the time of an affected group’s renewal, an Oregon insurance carrier may require an affected group to demonstrate the existence of at least one enrolled employee at the start of the plan year. If the group is unable to do so, the insurance carrier may refuse to renew the affected group on a group health benefit plan. If the non-renewing carrier offers individual health benefit plans, the carrier must simultaneously offer each member of the affected group the opportunity to purchase any of the carrier’s individual health benefit plans.

Any former members of an affected group that lose coverage in this scenario will qualify for a special enrollment period based on a loss of minimum essential coverage. Accordingly, all insurance carriers that offer Oregon individual health benefit plans must accept any former enrollee of an affected group who applies for individual coverage within 60 days of the non-renewal.

DFR expects that insurance carriers will implement the DOJ interpretation in a manner consistent with this guidance.

For further information, please see the DOJ memo at: http://dfr.oregon.gov/business/insurance-industry/health-ins-regulation/Pages/regulatory-guid.aspx. If you have any questions please contact Rick Blackwell, Policy Section Manager at 503-947-7056 or richard.Y.Blackwell@oregon.gov

 

Regulatory Guidance: Common Law Employee Requirements for Group Health Plan Purchases

Recently, the Division of Financial Regulation (DFR) requested advice from the Department of Justice (DOJ) regarding common law employee requirements for group health plan purchases. This request was in response to concerns raised with DFR that insurers could apply the standard differently; for instance, allowing an employer to access the small group market simply by offering coverage to at least one eligible common law employee, where another insurer might be requiring that the common law employee be enrolled in the group health plan.

DOJ’s advice concluded that under both the federal Employee Retirement Income Security Act (ERISA) and the Small Business Health Options Program (SHOP), if an employer purchases a plan with the intent to obtain coverage for the employee under the plan, the plan must have at least one common law employee enrolled as a participant. A participant is considered a common law employee if the employer has the authority to direct and control the manner in which the services are performed by the individual. DFR is bound to follow and apply this advice to insurance participants in the small group market.

As a result of this clarification, existing employer groups that do not have at least one common law employee enrolled in coverage — the affected groups — may lose eligibility to continue purchasing a group health benefit plan.

The requirement to have at least one common law employee enrolled in coverage applies “on the first day of the plan year.” Accordingly, carriers may not terminate an affected group in the middle of a plan year based solely on the absence of an enrolled common law employee.

However, at the time of an affected group’s renewal, an Oregon insurance carrier may require an affected group to demonstrate the existence of at least one enrolled employee at the start of the plan year. If the group is unable to do so, the insurance carrier may refuse to renew the affected group on a group health benefit plan. If the non-renewing carrier offers individual health benefit plans, the carrier must simultaneously offer each member of the affected group the opportunity to purchase any of the carrier’s individual health benefit plans.

Any former members of an affected group that lose coverage in this scenario will qualify for a special enrollment period based on a loss of minimum essential coverage. Accordingly, all insurance carriers that offer Oregon individual health benefit plans must accept any former enrollee of an affected group who applies for individual coverage within 60 days of the non-renewal.

DFR expects that insurance carriers will implement the DOJ interpretation in a manner consistent with this guidance.

For further information, please see the DOJ memo at: http://dfr.oregon.gov/business/insurance-industry/health-ins-regulation/Pages/regulatory-guid.aspx. If you have any questions please contact Rick Blackwell, Policy Section Manager at 503-947-7056 or richard.Y.Blackwell@oregon.gov

 

2018 Workers' Compensation Premium Assessment Rates

Each year, the Department of Consumer and Business Services adopts by rule the workers’ compensation premium assessment rate that is paid by employers to fund workers’ compensation and workplace safety and health programs. The rule also adopts the rate for an additional amount that is collected from all self-insured employers and self-insured employer groups to fund the Self-Insured Employers Adjustment Reserve and the Self-Insured Employer Group Adjustment Reserve. These funds ensure worker benefits are available in the event of a financial failure of a self-insured employer or self-insured employer group.

Before recommending the 2018 rate, the department must analyze financial data and review and authorize a proposed workers' compensation pure premium rate filing by the National Council on Compensation Insurance. The proposed premium assessment rate for 2018 is expected to remain unchanged at 6.8 percent.

Additional assessments to fund the Self-Insured Employer Adjustment Reserve and Self-Insured Employer Group Adjustment Reserve are also expected to remain unchanged. These are preliminary rates and are subject to change during the rulemaking process.

This rulemaking will adopt the assessment rates that will be in effect from Jan. 1, 2018, to Dec. 31, 2018.

A hearing on the proposed workers' compensation premium assessment rates will be held at 3 p.m. on Thursday, Sept. 21, 2017, in Room B (Basement) of the Labor & Industries Building, 350 Winter St. NE, Salem, Oregon.

Written testimony will be accepted through 5 p.m. Friday, Sept. 29, 2017 by the Director's Office of the Department of Consumer and Business Services, 350 Winter St. NE, P.O. Box 14480, Salem, OR 97309-0405.

Text of the proposed rules, as well as the other rulemaking documents, can be found at http://www.cbs.state.or.us/external/dir/wc_cost/rulemaking.html.

Address questions to Heather Welburn, Rules Coordinator; phone 503-947-7872; fax 503-378-5969; or email heather.welburn@oregon.gov.

 

Washington — From the Commissioner’s Office: Notice of rulemaking on adjusting geographic rating areas

We are starting rulemaking (R 2017-11) to revise the current geographic rating areas for individual and small-group health plans as established in WAC 284-43-6680 and 284-43-6700 in order to more accurately reflect the current risk pool.

Comments are due October 6, 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/adjusting-geographic-rating-areas-increase-market-stability-r-2017-11?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=

 

Notice of rulemaking on updates to pharmacy benefit manager rules

We are starting rulemaking (R 2017-12) to revise current and/or add sections to WAC 284-180, regarding pharmacy benefit managers (PBMs) to include minor technical additions that the OIC has identified are necessary to fully implement 2016 c 210 §§ 1 and 2 through 7.

For example, the OIC will require each PBM to provide the name of the person who will serve as the single point of contact between the PBM and the OIC.

Comments are due October 6, 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/update-pharmacy-benefit-manager-rules-r-2017-12?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=

 

Solvency and filings requirements rule stakeholder draft posted

We released a stakeholder draft for the Service-contract providers and protection-product-guarantee providers: Solvency and filings requirements rule (R 2016-23). Over the years there have been issues that have arisen regarding the requirements for solvency and filings required by service contract providers and protection product providers In addition legislative amendments to 48.110 RCW, which regulates these providers, have resulted in several incorrect statutory citations contained in rules chapter 284-20C WAC regarding the filing of motor vehicle service contract forms. This proposed rulemaking will consider clarifying some of these requirements and corrects the language and references, so they better reflect the current language in chapter 48.110 RCW.

Comments on the stakeholder draft are due September 22, 2017; please send them to rulescoordinator@oic.wa.gov.

For more information, including the text of the stakeholder draft, please visit the rule's webpage: https://www.insurance.wa.gov/service-contract-providers-and-protection-product-guarantee-providers-solvency-and-filings?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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