Alaska — From the Department of Insurance: Hearing Notice: Workers’ Compensation Prospective Loss Cost Filing
Under AS 21.39.043, the director of the division of insurance is required to hold an administrative hearing to discuss whether a workers’ compensation prospective loss cost filing meets the requirements of AS 21.39 and whether the filing should be approved, disapproved, or modified, in whole or in part.
In accordance with AS 21.39.043, a hearing will be held on September 10, 2019 in conference room 102 (Ted Stevens room) located on the 1st floor of the Atwood Building, 550 West Seventh Avenue, Anchorage, Alaska. The hearing will begin at 1:30 p.m. and will end no later than 4:30 p.m. If you are unable to attend the hearing in person and would like to participate by teleconference, please call 1-800-315-6338 and enter the access code 42070 followed by the # (pound sign).
An interested party may participate in the hearing process as follows:
inspect the filing and supporting information and examine witnesses;
present written or oral testimony or evidence at the hearing;
apply for subpoenas to be issued by the director to compel attendance of witnesses and the production of evidence.
An interested party who plans to participate in the hearing should provide notice of participation to the division in advance of the hearing date. To assist in having a productive hearing, the division requests that written testimony and evidence or requests for modifications to the filing that will be presented at the hearing be submitted to the division and to the National Council on Compensation Insurance, Inc. (NCCI) on or before September 3, 2019.
Testimony or evidence presented at the hearing must be limited to whether the filing’s prospective loss costs meet the requirements of AS 21.39 and may include a recommendation for approval, disapproval, or modification.
After the hearing, the director will leave the hearing record open for 10 days, during which time interested parties may submit additional written testimony and documentary evidence concerning the loss cost filing and members or subscribers may submit proposed modifications to the filing.
All such correspondence and documentation must be received by the division no later than 5:00 p.m., September 20, 2019.
All comments, written testimony, requests for modification, notice of participation, and other communication with the division related to this hearing should reference the 2020 NCCI Loss Cost Filing, and be sent to Division of Insurance; Attention: Michael Ricker; P.O. Box 110805; Juneau, AK 99811-0805; fax to (907) 465-3422; or e-mail to firstname.lastname@example.org.
If you are a person with a disability who needs special accommodation in order to participate in the process, please contact Laura Watson at (907) 465-2597 no later than September 4, 2019, to ensure that any necessary accommodations can be provided.
After the hearing, subject to the procedures under AS 21.39.043, the director will issue an order regarding the filing.
Hearing Notice: https://www.commerce.alaska.gov/web/Portals/11/Pub/INS_HearingNotice_2019.08.pdf
Idaho — Medicare Workshop to be Offered in Coeur d’Alene: A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held in Coeur d’Alene on Tuesday, August 27th from 1 p.m. to 3 p.m. at the Kroc Center, 1765 Golf Course Road. Everyone, including caregivers, interested in learning how Medicare works is encouraged to attend.
Medicare workshops are designed to introduce the various parts of Medicare and to share some of the costs and benefits associated with the program. Sessions cover enrollment timeframes for Medigap, Medicare Advantage, prescription drug plans, and how the different parts of Medicare work together.
Staff with the state’s Senior Health Insurance Benefits Advisors (SHIBA) program, a unit of the Idaho Department of Insurance, conduct the workshops. To register for the upcoming session, please contact the SHIBA Helpline at 1-800-247-4422.
Idaho — Additional Special Enrollment Offered: Many Idaho consumers were misled into purchasing what they believed to be comprehensive health insurance plans from a company named “Simple Health”. Due to the deceptive sales practices of Simple Health, these non-compliant ACA plans have left many without coverage. Customers who purchased these Simple Health Plans are being notified that these plans were misrepresented and do not meet the minimum coverage requirements.
The Idaho Department of Insurance and Your Health Idaho, Idaho’s state-based health insurance marketplace, are granting a one-time Special Enrollment Period (SEP) for comprehensive health insurance plans for these Idahoans. According to Your Health Idaho, notifications have also been sent to those affected Idahoans by the Centers for Medicaid and Medicare Services (CMS).
Important notes to consider:
SEP will be available for a limited time. The deadline to complete an application, select a plan, and enroll is September 4, 2019.
To apply for coverage with Your Health Idaho, you will need to provide a copy of the letter you received that states you are eligible for an SEP.
For questions, please contact Your Health Idaho by phone at 1-855-YH-IDAHO (1-855-944-3246); by email at email@example.com; or by mail at Your Health Idaho, P.O. Box 943, Boise, ID 83701.
Montana — Work Comp Claim: The Montana Supreme Court says the state’s workers’ compensation court made the correct decision on Brian Richardson’s work comp claim. Richardson was injured in an altercation involving a psychiatric patient at an emergency department.
The date was November 29, 2006 when he was a security guard at the facility and worked for Securitas. The restraint of patients — the court ruled — was within his scope of employment. Richardson said he was hit several times during the altercation.
On June 17, 2008, Richardson learned he had broken his nose during the fight and it was causing him severe headaches. Surgery was required. After the surgery he learned his health insurance would not pay the full price of the operation.
He filed a work comp claim and was told it was too late to file one. He appealed and lost the appeal. The court agreed with the work comp court that Richardson needed to have filed his claim close to the time of the injury.
Source link: PropertyCasualty360.com
Oregon — Special Notice: Timely consumer disclosures regarding vehicle total loss:
TO: Insurers, insurance producers, and adjusters transacting auto insurance in Oregon
FROM: The Oregon Department of Consumer & Business Services Division of Financial Regulation
SUBJECT: Timely consumer disclosures regarding vehicle total loss
The Department of Consumer and Business Services, Division of Financial Regulation (DFR) is issuing this memorandum to remind auto insurers of their responsibility to provide required disclosures1 regarding a vehicle total loss in a timely manner.
ORS 742.554 states that:
When an insurer declares a motor vehicle a total loss and offers to make a cash settlement to an insured or third-party owner of the motor vehicle, the insurer shall provide the insured or third-party owner:
Any valuation or appraisal reports relied upon by the insurer to determine value; and
A written statement in a form provided by the Director of the Department of Consumer and Business Services that includes:
Information about total loss, vehicle valuation and the duties of the insurer; and
The manner in which and under what circumstances the insured may contact the Division of Financial Regulation of the Department of Consumer and Business Services.
The purpose of the statute is to provide transparency and give consumers the necessary tools to make informed decisions when faced with a vehicle total loss. Giving notice in a timely manner is an important element of the requirement. DFR has encountered instances where insurers failed to make the required disclosures until after the settlement offer. Such practices inhibit consumer choice and violate the insurance code.
Guidance to Insurers
ORS 742.554 requires that total loss disclosures be provided at the time “an insurer declares a motor vehicle a total loss and offers to make a cash settlement.” This means that when a settlement offer:
Is made in writing, the disclosure must be provided simultaneously.
Is communicated to the consumer orally, the disclosure must be provided in writing and mailed or delivered electronically within one business day.
Delaying the disclosure until after the settlement offer is a violation of 742.554 and may result in an enforcement action and civil penalties.
1 The total loss disclosure required under OAR 836-080-0240 can be found on the DFR website: https://dfr.oregon.gov/laws-rules/Documents/OAR/div80-0240_ex1.pdf.
Timely-Total-Loss-Notification.pdf — https://content.govdelivery.com/attachments/ORDCBS/2019/07/29/file_attachments/1256596/Timely-Total-Loss-Notification.pdf
Washington — From the Department of Insurance: Balance Billing Protection Act rule stakeholder draft posted
We are releasing a stakeholder draft of rules to implement the Balance Billing Protection Act (R 2019-04).
OIC is very interested in ensuring that consumers have notice of their rights under the Balance Billing Protection Act at a meaningful time and in a meaningful manner. We are specifically soliciting input on the provisions in the stakeholder draft intended to accomplish this at WAC 284-43B-060. If you have concerns regarding these provisions, please include proposed alternative means to accomplish the goal stated above in your comments.
Comments on the stakeholder draft are due August 16, 2019; please send them to the Rules Coordinator — https://www.insurance.wa.gov/contact-rules-coordinator?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
Stakeholder meeting: August 12, 2019 at 11:00 at the Tumwater office located at 5000 Capital Blvd. SE, Tumwater, WA 98501. Call-in option: 360-407-3780 PIN Code: 734211#
For more information, including the text of the stakeholder draft, please visit the rule's webpage — https://www.insurance.wa.gov/balance-billing-protection-act-r2019-04?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
Confidential Communications stakeholder draft posted
We released a stakeholder draft for the Confidential Communications rule (R 2019-03). This rulemaking is in support of SSB 5889, requiring health carriers to direct all communications regarding sensitive services directly to the protected individual.
Comments on the stakeholder draft are due August 23, 2019; please send them to the Rules Coordinator — https://www.insurance.wa.gov/contact-rules-coordinator?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
For more information, including the text of the stakeholder draft, please visit the rule's webpage — https://www.insurance.wa.gov/contact-rules-coordinator?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
Notice of rulemaking on Confidential Communications (R 2019-03)
We are starting rulemaking on R 2019-03 to require health carriers to direct all communications regarding sensitive services directly to the protected individual.
Comments are due September 16, 2019; please send them to the Rules Coordinator — https://www.insurance.wa.gov/contact-rules-coordinator?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
For more information, including the notice to start rulemaking (CR-101), please visit the rule's webpage — https://www.insurance.wa.gov/confidential-communications-r-2019-03?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=
Washington — Kreidler seeks $1.1 million from sham health care sharing ministry for ripping off consumers: Insurance Commissioner Mike Kreidler is seeking a $1 million fine from Aliera Healthcare, Inc. (Aliera) (PDF, 439KB) and $100,000 from its partner, Trinity HealthShare, Inc. (Trinity) (PDF, 364KB) for selling sham health care sharing ministry memberships in Washington state.
Kreidler ordered the companies in May to immediately stop selling health insurance illegally and halt deceptive business practices. Since August 2018, Aliera and Trinity sold 3,058 policies to Washington consumers and collected $3.8 million in premium.
“Aliera and Trinity promised to provide people with coverage when they needed it only to leave consumers with huge medical bills,” said Kreidler. “I’m taking action today to send a message to all scam artists: if you harm our consumers, you will pay heavily.
“Shopping for health insurance can be very stressful – especially if you have to worry about being ripped off. True insurance companies have to meet rigorous standards before they can sell coverage to consumers. These companies are hiding behind a federal and state exemption that exists for legitimate health care sharing ministries and using it to rake in profit across the country on the backs of vulnerable consumers.”
Aliera, an unlicensed insurance producer in Washington, administered and marketed health coverage on behalf of Trinity HealthShare. Trinity represents itself as a health care sharing ministry. Such ministries are exempt from state insurance regulation and do not have to meet the same consumer protections guaranteed under the Affordable Care Act. This includes providing coverage for anyone with a pre-existing medical condition.
A legal health care sharing ministry is a nonprofit organization whose members share a common set of ethical or religious beliefs and share medical expenses consistent with those beliefs.
Kreidler’s office has received more than 20 complaints from consumers about Aliera. Some believed they were buying health insurance without knowing they had joined a health care sharing ministry. Many discovered this when the company denied their claims because their medical conditions were considered pre-existing under the plan.
“Real health care sharing ministries can offer a valuable service to their members,” Kreidler said. “Unfortunately, we’re seeing players out there trying to use the exemptions for legitimate ministries to skirt insurance regulation and mislead trusting consumers. I want these outfits to know we’re on to them and we will hold them accountable.”
Kreidler’s investigation (PDF, 3.13MB) into Aliera found:
It provides misleading training to sales agents about the nature of its products.
It promotes misleading advertisements to consumers.
It inaccurately represents Trinity’s statement of faith.
It is operating both as an unregistered health care service contractor and an unlicensed discount plan organization.
It is selling insurance without a Washington insurance producer license.
Kreidler’s investigation into Trinity found that it fails to meet key federal and state requirements:
Trinity was formed on June 27, 2018, without any members. Federal and state laws require that health care sharing ministries be formed before Dec. 31, 1999, and their members to have been actively sharing medical costs.
Trinity's bylaws require members to adhere to a Protestant expression of Christian faith. However, its website markets memberships to people of all faiths, and its training materials for producers note that Trinity simply requires a belief in a higher power and a healthy lifestyle.
Both companies have 90 days to request a hearing and appeal Kreidler’s action.
Source link: Washington Department of Insurance