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Around the PIA Western Alliance States

Posted By Staff reporter, Tuesday, March 19, 2019

 

Idaho

PTSD Comp Bill

 Idaho Governor Brad Little has signed a bill into law to give workers’ compensation to first responders who suffer from post-traumatic stress disorder. The responders — says the bill — must prove they have a mental injury related to an event they experience while on the job.

 

The new law says the responder must be “examined and subsequently diagnosed with post-traumatic stress injury by a psychologist” or similar medical professional. Clear and convincing evidence of PTSD must be demonstrated to get the designation.

 

Source link: Business Insurance

 

Medicare Workshops to be Offered in Burley

 A pair of Medicare Workshops for individuals turning 65 and those approaching Medicare eligibility will be held Monday, March 18, at the Burley Public Library, 1300 Miller Ave., Burley. 

 

The first of the two free sessions will run from 1 to 3 p.m., followed by an evening workshop from 5 to 7 p.m. Caregivers, those interested in learning how Medicare works, and individuals not eligible for Medicare are encouraged to attend and learn about other health plan options from a local enrollment counselor.

 

The Medicare workshops will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program.  Topics to be covered include:

 

  Timeframes for enrolling in Medicare

  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

 

To register for either workshop, please contact the SHIBA Helpline at 1-800-247-4422.  Walk-ins are also welcome.

 

New Mexico

Recreational Marijuana: The New Mexico Senate is rapidly acting on a recreational marijuana bill passed by the House. If passed by the Senate and signed into law by the governor, it will be legal to possess up to an ounce of marijuana to use recreationally. You must — however — be 21 or over.

There will be an up-to-17% tax on the sale of pot to consumers.

 

Source link: Insurance Journal

 

Oregon

Health Care Funding

 Governor Kate Brown signed House Bill 2010 into law. The bill is the first piece of her priority legislative proposal for sustainable, long-term health care funding to ensure Oregonians have access to affordable health coverage.

 

“House Bill 2010 is a significant step forward in ensuring every single Oregon has access to affordable health coverage,” said Governor Brown. “But HB 2010 only covers a portion of what we need for our health care system. So, as we celebrate today, we need to immediately turn our focus to filling the rest of the Oregon Health Plan funding gap.”

 

House Bill 2010 includes:

 

  A hospital assessment, generating $98 million for the Oregon Health Plan (Oregon's Medicaid program)

  A health insurance assessment and managed care tax, generating $334 million for the Oregon Health Plan and the Oregon Reinsurance Program, which helps stabilize insurance rates for individuals who buy coverage through the private market

  To provide the rest of the needed funding, Governor Brown has proposed an $2-per-pack increase in the cigarette tax, a tax on e-cigarettes, and the creation of an assessment on employers that do not provide affordable coverage to their workers.

 

“Securing this funding package will ensure Oregonians continue to get the health care coverage they need to thrive and will enable a balanced budget for the Oregon Health Plan for the next six years,” Governor Brown said.

 

Washington

Costco & $3.6 Million in Taxes

 NW Re Limited, of Phoenix, has settled (PDF, 3.6 MB) with Washington state Insurance Commissioner Mike Kreidler to pay $3.6 million in unpaid premium taxes, penalties, interest and a fine. NW Re’s sole insured and parent company is Costco Wholesale Corp., headquartered in Issaquah, Wash.

 

NW Re self-reported its unauthorized activity in December 2018 as part of Kriedler’s project to identify all captives that insure assets in Washington state. It provided deductible reimbursement for Costco’s liability and workers’ compensation from 2000 until 2019 without authorization.

 

It paid $2.4 million in unpaid premium taxes and $1.2 million in fines, tax penalties and interest on March 8.

 

Kreidler announced a project in December 2018 to identify all captives doing business in Washington state. Captives must self-report before June 30, 2020 to be eligible for reduced fines and premium tax penalties.

 

Fines and penalties increase every six months for captive insurers that fail to self-report, starting July 1, 2019. Captives that do not self-report before June 30, 2020, will face the maximum fines and tax penalties.

 

Kreidler’s office has collected about $4.4 million in agreements with captive insurers. He reached a settlement of $876,820 with Cypress, the captive insurer for Microsoft Corp., in August 2018.

 

State law requires that when risk is insured in Washington state, it be done through an admitted insurer or through an unauthorized insurer placed through a licensed surplus line broker. State law also requires insurance companies to pay a 2 percent tax based on their written premiums. The tax revenue is sent to the state general fund to pay for government operations. 

 

Source link: Washington Department of Insurance

 

Opioid Lawsuit

 Washington State has become the 10th state to sue the major distributors of opioids. The suit accuses the distributors of making billions off the sale of opioids while all the while ignoring the thousands becoming addicted to the drugs.

 

Washington Attorney General Bob Ferguson filed the suit last week in King County Superior Court. The suit involves:

 

  McKesson Corp.

  Cardinal Health Inc.

  AmerisourceBergen Drug Corp

 

Washington is also one of many states suing Purdue Pharma.

 

Ferguson contends the drug firms brought oxycodone, fentanyl and other opioids into the state and failed to comply with requirements that spots suspicious orders destined for the illegal drug market. “For years these companies illegally shipped suspicious orders into our state,” Ferguson said. “Their conduct, put quite simply, fueled the state's opioid epidemic.”

 

Ferguson notes that between 2006 and 2017 over 8,000 people in Washington died from opioid overdoses, auto crashes or shootings. While all that was happening, he said the drug distributors continued to pour more than two-billion pills into the state.

 

As it stands now there are over 1,000 lawsuits filed against the manufacturers, distributors and others involved in the crisis.

 

Source link: Q13 FOX

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

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Around the PIA Western Alliance States

Posted By Administration, Tuesday, March 12, 2019

Arizona — Uber Not Criminally Liable for Crash: Yavapai County prosecutors are not going to go after Uber for the March 2018 crash in Tempe that killed a pedestrian. However, it is recommended that the vehicle’s “driver,” Rafaela Vasquez be referred to Tempe’s police department for another look.

He was looking at a TV show when the crash occurred and could end up being prosecuted for vehicular manslaughter.

California — Russian River Flood Information: In the wake of record rains and recent flooding Insurance Commissioner Ricardo Lara dispatched Department of Insurance staff to Sonoma County to assist with recovery efforts. With many Californians not aware that traditional homeowners insurance does not cover flood damage, he urged homeowners to consider purchasing flood insurance.

Department staff are available to answer questions through Saturday, March 9 at the Local Assistance Center in Guerneville or by phone at 800-927-4357 following the winter storms and Russian River flooding that inundated 2,600 homes and businesses and damaged or destroyed many automobiles.

“Climate change is driving more extreme weather events than ever, including floods,” said Insurance Commissioner Ricardo Lara. “We want to make sure people have the coverage they need before the next storm puts their home at risk. Having flood insurance may be the difference between recovering quickly from a catastrophic event or suffering devastating financial losses.”

Flood insurance is available through the Federal Flood Insurance Program and must be in force for 30 days prior to a flood, in most cases.

February was the sixth wettest month on record, and it is not too late for homeowners to assess their risk for flooding and ensure they have the coverage they need to protect their home which is typically a family’s most valuable financial asset.

The department has a number of resources to help consumers with insurance coverage or claim questions. Consumers with questions or needing assistance should call the consumer hotline at 800-927-4357.

Source link: The California Department of Insurance

 

Idaho — Medicare Workshop to be Offered in Genesee: A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Wednesday, March 13, from 5:15 p.m. to 6:30 p.m. at the Genesee Community Library, 140 E. Walnut, Genesee.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

  Timeframes for enrolling in Medicare

  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

To register for the workshop, please contact the SHIBA Helpline at 1-800-247-4422.

 

Montana — Tester & Asbestos Ban: Montana Senator Jon Tester and eight other U.S. Senators have sponsored a bill to ban the mining, importation, use and sale of asbestos. A companion bill was introduced in the House. The number of co-sponsors there totals 21.

Experts say this one has a much better chance of success than previous bills.

In his support of the bill, Tester said, “Montanans know all too well the lasting damage of asbestos exposure — just ask folks in Libby and Troy. Banning this harmful substance will protect our families and prevent future suffering and loss of life.”

More than 200 deaths in Troy and Libby have been linked to asbestos.

He’s joined by Oregon Senator Jeff Merkley who added, “It's outrageous that in the year 2019 asbestos is still allowed in the United States. While the EPA fiddles, Americans are dying.”

While asbestos is illegal in 60-some countries, it is still legal in the U.S.

Source link: Independent Record

 

Oregon — Prescription Transparency: The Department of Consumer and Business Services is ready to hear about prescription drug price increases from consumers, health insurance companies, and drug manufacturers.

The Prescription Drug Price Transparency Act (HB 4005), from the 2018 Legislative Session, established Oregon’s drug price transparency program. The new law requires prescription drug manufacturers and health insurance companies to report specific drug price increases to the department’s Division of Financial Regulation.

The program staff are ready to hear from consumers as well.

All Oregonians are encouraged to report an increase in the cost of their prescription drugs to the division one of three ways:

Email rx.prices@oregon.gov

Call 888-877-4894 (toll free)

Visit dfr.oregon.gov/drugtransparency (online reporting form available later this month)

We are excited to bring one of the nation’s first prescription drug price transparency programs to Oregonians,” said Andrew Stolfi, insurance commissioner. “It will help people better understand why drug prices increase, and help legislators make informed decisions on how to control rising costs.”

Consumer reports and the pricing of new prescription drugs will be made available as soon as information is received and reviewed. Insurer and drug manufacturer price increase reports will be available later this fall.

The division will provide annual reports to Oregon State Legislature based on the information provided by consumers, and the data reported by health insurers and prescription drug manufacturers.

This program is designed to report drug price increases only. If a consumer has a problem with their health insurance or prescription drug coverage they should contact our consumer advocates at 888-877-4894 (toll-free). To learn more about Oregon’s Prescription Drug Price Transparency Program, visit dfr.oregon.gov/drugtransparency.

 

Washington — From the Department of Insurance: Surprise billing occurs when you're treated for an emergency or scheduled procedure at an in-network hospital or surgery facility and are seen by an out-of-network provider. In addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and what they believe the service was worth.

Some types of providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your insurer even though they provide services at an in-network hospital or facility. This practice is also called “balance billing,” however, some balance billing is not a surprise. For example, if you're treated by a provider that you know is not in your plan's network, you shouldn't be surprised to receive a bill for their services, on top of what your plan covers.

Kreidler's proposed legislation - 2SHB 1065/SB 5031 (www.leg.wa.gov) passes the House of Representatives

Commissioner Mike Kreidler has proposed legislation that would prevent people from getting a surprise medical bill when they seek medical services from an in-network facility, but are treated by an out-of-network provider. If an insurer and provider cannot agree on a price for the covered services, they can go to binding arbitration but cannot bill the consumer for the amount in dispute.

His bill passed the House on March 4 with a strong bipartisan vote of 84-13. It's now in the Senate and must be voted out of the Senate Health and Long Term Care Committee by April 3.

Tell us about your surprise bill

If you or someone you know has received a surprise bill, we’d like to hear from you. Email us your story. We may also follow-up with you to see if you'd like to file a complaint about your surprise billing issue.

See what happened to Jamie Hansen of La Center, WA when she sought emergency care for her son, Ryan.

Source link: Washington Department of Insurance

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

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Around the PIA Western Alliance States

Posted By Staff reporter, Tuesday, March 5, 2019


 

California

PG&E & The Camp Fire: Shares in PG&E stock continue to plummet. News now is the utility delayed a safety overhaul of the high-voltage utility pole suspected of starting the Camp Fire in Paradise, California.

It killed 86 people and destroyed almost every dwelling in the town.

A filing with the Federal Energy Regulatory Commission says the plans to replace components on that line have been in the works since 2013. It was supposed to spend $30.3 million to fix the clearance issues but did not.

Source link: Insurance Journal

 

Idaho

Medicare Workshop: A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Wednesday, March 6, from 10:30 a.m. to noon at The Bridge at Sandpoint, an assisted living community, 1123 N. Division St., Sandpoint.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

 •  Timeframes for enrolling in Medicare

  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

 

To register for the workshop, please contact the SHIBA Helpline at 1-800-247-4422, or The Bridge at Sandpoint at 208-263-1524.

 

Nevada

Speed Cameras: We all hate speed cameras. Apparently, so do a lot of legislators in Nevada. Senate Majority Leader Kelvin Atkinson worries a bill to allow cities to install them will see them installed in poorer, low-income communities rather than higher-income areas.

 

Department of Public Safety spokeswoman Amy Davey says the system reduces crashes and serious injuries and will only be installed for traffic lights and speeding.

 

Source link: Insurance Journal

 

Oregon

Dennis Richardson: On Tuesday, February 26th Oregon Secretary of State Dennis Richardson's courageous battle with cancer came to a close. Dennis passed away at his home surrounded by family and friends.

From his service in Vietnam as a combat helicopter pilot to his 30-year legal career and 19 years in public service, this father of nine and grandfather of 31 found great joy in serving and taking care of others.

As Secretary of State, Dennis was fiercely dedicated to accomplishing the work the people of Oregon elected him to do. Upon taking the reins of this office in January 2017, Dennis' visionary leadership built on the strengths of the 227 Secretary of State staff members. Together, Dennis and this dedicated team of public servants improved the program business practices of Audits, Elections, Archives, Corporations and Small Business, and the three Administrative Services Divisions of the agency. He also brought many professional and personal gifts and experience to this office. Dennis' focus on transparency, accountability, and integrity coupled with his uncompromising work ethic inspired staff to "up their games" to move mountains.

If you spent time with Dennis, it wouldn't be long before he shared with you his personal motto of "Pro Tanto Quid Retribuamus," which means: Having been given much, what will you give in return? This philosophy influenced every aspect of Dennis' life and became the hallmark by which many knew him. His challenge to us in the Secretary of State's office is to give our very best to each other and to Oregon each and every day.

Dennis leaves a legacy of always aiming high, expecting excellence, moving fast, and doing what is right for the people. It has been an honor and a privilege to work with such an incredible leader and wonderful friend. He will be greatly missed.

 

Oregon

From the Department of Insurance: The Oregon Division of Financial Regulation recently adopted the following rule:

 ID 02-2019: Establishment of Oregon Prescription Drug Price Transparency Program

Rules affected: OAR 836-053-0473, 836-200-0500, 836-200-0505, 836-200-0510, 836-200-0515, 836-200-0520, 836-200-0525, 836-200-0530, 836-200-0535, 836-200-0540, 836-200-0545, 836-200-0550, 836-200-0555, 836-200-0560

 Rule Summary:

Adopt additional requirement to include an appendix with specified information regarding prescription drug costs in rate filings for individual or small employer health benefit plans.

 Filed: February, 2019

Effective: March 1, 2019

Documents:

Permanent Administrative Order

Summary of Testimony and Hearing Officer's Report

For more information, please visit the Division's website:

https://dfr.oregon.gov/laws-rules/Pages/adopted-rules.aspx

 

Revisions to Workers’ Compensation Insurance Test Audit Program

 

Rules affected: OAR 836-043-0125, 836-043-0130, 836-043-0135, 836-043-0145, 836-043-0150, 836-043-0155, 836-043-0165

 

Need for Rules:

ORS 737.318 directs the Department of Consumer and Business Services (DCBS) to establish and administer a continuing test audit program for workers’ compensation insurers. The proposed rule makes adjustments to the test audit program to better meet the needs of Oregon’s workers’ compensation insurance market.

 

The number of insurance policies audited is determined by a risk-based formula that takes into account the premium size of the insurer and the error rates found in past audits. The proposed rule:

 

  Simplifies the program by reducing the number of premium size tiers used to categorize insurers.

  Reduces the audit rates for insurers who meet the test audit performance standard of 20% error rate for the premium size tiers greater than $2,500.

  The proposed rule adjusts the formula for determining an insurer’s error rate by giving equal weight to the statewide error rate and the insurer’s specific error rate and excluding payroll reports and non-productive audits.

  Improves the error rate and test audit standards by including only the policies in which insurer the insurer performed an audit.

Insurers that do not meet test audit performance standards are required to meet with the DCBS director or a designee to report on its remediation plans. Performance standards vary by the number of policies audited. The proposed rule would simplify the program so that there are fewer tiers used to determine performance standards.

The proposed rule also makes technical changes relating to forms provided by DCBS, the timing and manner of reports provided to DCBS, and the frequency of examinations of the audit program.

 

Filed: February 26, 2019

 

Public hearing: March 25, 2019, 10:00 a.m.

 

Last day for public comment: April 1, 2019, 5 p.m.

 

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

 

For more information on this proposed rule, please visit the Division's website:

dfr.oregon.gov/laws-rules/Pages/proposed-rules.aspx

Tags:  Around the PIA Western Alliance States  insurance content  insurance news 

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Around the PIA Western Alliance States

Posted By staff reporter, Tuesday, February 26, 2019

 

Arizona

Hand Held Cellphones

 People who’ve lost love ones because of auto crashes caused by people on their cellphones want the Arizona Legislature to ban hand held phones in automobiles. They’ve been ignored year after year. Not this year. The Senate Transportation and Public Safety Committee has passed a bill banning the use of hand held phones while driving.

The vote was nearly unanimous.

As it stands now, texting and phone calling while driving is illegal for teens. It may soon be — if the wave continues — be so for adults, too. Several cities in the state have enacted the ban as well.

AAA of Arizona and the American Property Casualty Insurance Association (APCI) did a survey and 86% said they support a ban.

Source link: Arizona Center

 

California

Lobbying

 Last year in California — unions, businesses and local governments — spent $361 million — lobbying government. Governor Gavin Newsom got about $50 million.

Pacific Gas & Electric (PG&E) spent $9.9 million. Western States Petroleum Association gave $7.9. Edison International gave $4.2 million and the California State Council of Service Employees put out $4.1 million.

The $361 million is an increase of 5% and $60 million more than what was spent in 2014.

 

Here’s the amount spent on lobbying state government by each sector in 2018:

Government — $54.9 million

Health — $42. 2 mllion

Utilities — $35.6 million

Manufacturing / Industrial — $26.5 million

Finance / Insurance — $23.7 million

Education — $19.3 million

Oil and Gas — $18.2 million

Professional / Trade — $15.2 million

Labor unions — $12.3 million

Other — $112.8 million

 

Source link: Sacramento Bee

 

Idaho

Auto Phone Ban: The Idaho Senate has killed a ban to use handheld cellphones in autos. The worry was farmers in aging pickups might be too affected.

Really.

Republican Sen. Jim Rice of Caldwell is bill’s sponsor. He said, “What this does is it actually protects the primary liberty that we exercise on our roads. The primary purpose on our roads is to exercise our right to travel. … That’s what we design roads for, that’s what their primary use is.”

 

Source link: Idaho Press

 

Oregon

Greenlick Out as Chair

 Rep. Mitch Greenlick is a Portland area Democrat who has chaired the House Committee on Health Care for a long time. Last week he attacked two people testifying. It appalled fellow committee members and caused House Speaker Tina Kotek to remove him from the chairmanship of the committee.

He has also been taken off of the House Conduct Committee. Greenlick chaired that one, too.

Lake Oswego Democrat Rep. Andrea Salinas is the temporary chair of the health committee. In her news release on the matter Kotek said, “Representative Mitch Greenlick made a serious mistake during Tuesday’s House Committee on Health Care when he made demeaning comments toward two individuals who were testifying before his committee. We must always strive to do what is best for the people of Oregon and the Legislature as an institution.”

 

Source link: The Lund Report

 

Washington

Kreidler Disciplines and Fines

Insurance Commissioner Mike Kreidler disciplined and issued fines in January totaling $5,900 against insurance companies, agents and others who violated state insurance regulations.

Insurance companies

Pacific Blue Health Network, New York City; ordered to cease and desist from selling insurance without a certificate of authority, order 19-0057

Lincoln National Life Insurance Co., Fort Wayne, Ind.; ordered to cease and desist selling insurance through unlicensed producers, order 19-0033

 

Agents and brokers

 

Kreidler disciplined the following insurance producers for violating insurance regulations in their dealings with policyholders:

Gregory D. Lone, East Wenatchee, Wash.; fined $3,000, order 18-0443

American Insure All Agency, Inc., Lynwood, Wash.; fined $1,000, order 18-0466

Jeff D. Graham, Puyallup, Wash.; license revoked, order 18-0496

Chandler Parker Widman, Spokane Valley, Wash.; license revoked, order 18-0532

PBI Insurance Agency LLC, Clackamas, Ore., and Jeremy Lowell Rugg, Wilsonville, Ore.; license revoked, order 19-0009

Luke Smith, Clackamas, Ore.; license revoked, order 19-0010

Kreidler disciplined the following insurance producers for violating state licensing laws:

Raymand Luther McGee, Seattle, license revoked, order 18-0516

Leon Brooks, Spokane Valley, Wash.; license revoked, order 19-0035

Tamara Reinecke Wong or Wong & Associates, Portland; fined $250 and license suspended, order 18-0508

Nikia V. Jones, Chicago; license revoked, order 18-0510

Miranda Eaddy, Windsor, Conn.; license revoked, order 18-0511

D Juane Antoinette Anthony, Las Vegas; license revoked, order 18-0521

Stephanie L. Bale, Lockport, N.Y.; license revoked, order 19-0001

Paul McCaskill, Carrollton, Texas; license revoked, order 19-0003

Deborah Lynn Miner, Woodstock, Ill.; license revoked, order 19-0004

Christopher Lee Pounds, Overland Park, Kan.; license suspended, order 19-0006

Justin David Mann, Phoenix; license revoked, order 19-0011

Brent D. Mann, Chandler, Ariz.; license revoked, order 19-0012

Tracy Lawrence, Creve Couer, Mo.; license revoked, order 19-0021

Higginbotham Insurance Agency., Inc.; Fort Worth, Texas; fined $250, order 19-0036

 

Other organizations

 

Regence BlueShield continuing education, Seattle; fined $1,400, order 18-0518

 

Source link: Washington Department of Insurance

 

 

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Around the PIA Western Alliance States

Posted By staff reporter, Tuesday, February 19, 2019

 

 

California

Mudslides: Heavy rains last week in California caused floods and mudslides around the state. The effect is called the Pineapple Express. Homes have been swept away and motorists got stranded in their vehicles.

 

More rain is predicted and with that — more flooding is expected.

 

Source link: Insurance Journal

 

 

Wildfire Starter Sentence to Prison

Brandon McGlover has pleaded guilty to starting nine fires in July of 2018. Those fires destroyed 13,000 acres, destroyed seven homes and caused 7,000 people to flee for their lives in Idyllwild, Anza and Sage, California.

 

He used a can of WD-40 and a lighter to set the fires.

 

McGlover was sentenced to 12-years and four-months in prison. He will be required to register as an arsonist for the rest of his life and will be required to pay restitution to his victims.

 

His victims were allowed to comment at his sentencing. One woman — whose husband died of a heart attack while they were fleeing — made an impassioned plea for a harsh sentence. Her statement was written since she was too upset to make it herself.

 

Others who lost everything in the fires made similar statements.

 

Source link: MSN

 

 

Cease and Desist Order

 The California Department of Insurance (CDI) issued a Cease and Desist Order effective immediately upon NexGen Insurance Services, Inc., Riverstone Capital, LLC dba Riverstone Capital Insurance Services, LLC and its owner/operators Travis O. Bugli, James C. Kelly and Robert M. Clarke.

 

A joint investigation by CDI and the U.S. Department of Labor (DOL) revealed that NexGen and Riverstone have been operating as an unauthorized MEWA (Multiple Employer Welfare Association), an arrangement that offers or provides health and welfare benefits to employers and their employees.

 

The Cease and Desist Order alleges that NexGen and Riverstone were marketing, soliciting, and selling purported “self-insured” health plan arrangements to employers, not health insurance, in violation of California law. NexGen and Riverstone failed to pay medical provider claims totaling approximately $24 million dollars, exposing employers and their employees to risks and significant financial liabilities. The investigation revealed NexGen’s and Riverstone’s business practice of pooling and commingling contributions received from its employer clientele into its own corporate accounts.

 

“This company and its owners misrepresented their ability to pay medical claims, putting employers and their employees in immediate danger,” said Insurance Commissioner Ricardo Lara. “We took action to stop these illegal practices and ensure the safety of California workers and employers.”

 

Under CDI’s Cease and Desist Order, NexGen and Riverstone are to immediately stop operating any MEWA directly or indirectly or acting as an insurance agent, producer, insurer, or any other capacity in the State of California for which they do not hold a valid license, permit, or Certificate of Authority to do so. The companies are to immediately cease and desist from receiving any money, commission, fee, rebate, payment, remuneration, or any other valuable consideration whatsoever, directly or indirectly, in connection with any MEWA transactions.

 

Source link: California Department of Insurance

Tags:  9 state alliance  Around the PIA Western Alliance States  insurance content  insurance industry  weekly industry news 

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Around the PIA Western Alliance States

Posted By staff reporter, Tuesday, February 12, 2019

Around the PIA Western Alliance 

Arizona


Uber Crash Lawsuit: Last year Elaine Herzberg was hit and killed by an autonomous vehicle owned by Uber. The suit isn’t against Uber, but against the city of Tempe.

Herzberg’s husband and daughter each want $5 million in damages and say the city of Tempe created a dangerous situation when it installed a brick pathway across the median where people aren’t supposed to be crossing.

 

Source link: Insurance Journal

 

Idaho

From the Idaho Department of Insurance

A tip from a social media post helped lead to an insurance fraud conviction for a Bingham County resident.  Danielle Collins was sentenced in Bingham County District Court last week after pleading guilty to one count of insurance fraud following an investigation conducted by the Idaho Department of Insurance.

In court proceedings, Collins admitted to purchasing car insurance after damaging her vehicle.  She was placed on three years of supervised probation by Judge Darren B. Simpson and ordered to pay $800 in fines, $245 in court costs, $500 to the Public Defender’s office, and $536 in restitution to the DOI.  She also must complete 100 hours of community service.

Court records show Collins purchased an auto policy through Progressive Insurance on August 25, 2017.  Three days later she submitted a claim for an accident in which her vehicle sustained damage to its front end and both driver’s side tires.  However, Progressive officials discovered a Facebook post dated days prior to the reported date of the accident and claim submission in which Collins asked her friends and followers, “Who gets not one but two flat tires?? Meeee!!  The social media gaffe helped DOI investigators close the case against Collins.

“This is an example of how insurance fraud comes in all shapes and sizes,” said Director Dean Cameron.  “I’m proud of the work of our investigators because every case of fraud, no matter how big or small, adds up and becomes costly for all Idaho consumers.”

 

Medicare Workshop to be Offered in Idaho Falls

A free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Thursday, February 14, from 2 to 4 p.m. at the Idaho Falls Senior Center, 535 W. 21st St., Idaho Falls.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

 

  Timeframes for enrolling in Medicare

  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

 

To register for the workshop, please contact the SHIBA Helpline at 1-800-247-4422.

 

Montana

Minimum Wage

Montana Democrat Rep. Mary Ann Dunwell of Helena wants the state’s minimum wage to go up from $8.50 an hour to $15. If her bill — HB 345 — gets passed, the wage will go to $12 an hour on July 1st of this year, and rise to $15 on July 1st in 2020.

The AFL-CIO and the Montana Federation of Public Employees and the Montana Department of Labor and Industry are supporting the bill.

Opposing the bill is the Montana Retail Association and the Montana Restaurant Association.

Source link: Independent Record

 

Oregon

Marijuana Audit

An audit done by the secretary of state’s office has found the inspections conducted in Oregon’s marijuana industry and not up to speed. The state says the testing system is weak and threatens consumers with contaminants.

Just 3% of the retailers have been inspected and just one-third of the state’s marijuana growers. Also — the report said — marijuana regulators are not doing much to address the black market sales.

However, so far, the legal pot market has generated $207 million in taxes for the state coffers.

 

Oregon’s Innovation Hub

The Department of Consumer and Business Services’ Division of Financial Regulation has opened its Innovation Hub to help insurance, financial, and technology companies bring innovative products, services, and tools to Oregonians.

Experts, thought leaders, and businesses are encouraged to visit dfr.oregon.gov/innovation to connect with the division’s Innovation Liaison and learn more about Oregon’s Innovation Hub.

“We want to engage and collaborate with businesses that are poised to leverage technology in a way that will benefit Oregonians.” said Andrew Stolfi, division administrator. “The Innovation Hub is here to help the businesses we regulate deliver emerging products, and services to Oregon consumers.”

The Innovation Liaison helps companies navigate regulatory guidelines in a way that enables new technology flourish within the state. The liaison helps the division develop and maintain a structure that that can adapt to innovation both now and in the future.

For more information or to connect with the Innovation Liaison visit dfr.oregon.gov/innovation

 

 

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Around the PIA Western Alliance States

Posted By Staff reporter, Tuesday, February 5, 2019

 

California

Lara Testifies in Congress

 [As] the U.S. House of Representative Committee on Ways and Means [held] hearings, Insurance Commissioner Ricardo Lara provides testimony to protect Americans with pre-existing conditions:

“Passage of the Affordable Care Act (ACA) was one of the most significant legislative acts in the last fifty years. The ACA has directly improved the health and economic security of millions of Californians—both those who were uninsured prior to the passage of the ACA and those whose individual or group health insurance coverage was improved. 

California decided to go "all in" with regard to implementing the Affordable Care Act. Since its passage in 2010, we have seen a dramatic decrease in the number of Californians who lack health insurance coverage. The uninsured rate went from 17.2 percent in 2013 to a new historic low of 7.2 percent in 2017.

Before the passage of the ACA, people were routinely denied health insurance coverage due to preexisting conditions such as asthma, cancer, or heart disease. Others were sold coverage that excluded care for their preexisting conditions. After January 1, 2014 when the guarantee issue provision of the ACA went into effect, many individuals gained affordable, comprehensive coverage. The California Department of Insurance heard from numerous people with preexisting conditions who had previously been denied health insurance coverage and were grateful that they could now buy health insurance for the first time in years.

An estimated 5.9 million Californians have preexisting conditions, so the repeated efforts to repeal the ACA in 2017 and 2018 caused distress and concern for the millions of people with preexisting conditions and their families. During the time the Congress was considering repeal of the ACA, the Department and I heard from people who were very afraid that they would not be able to buy health insurance in the future and would not be able to get the medical care they need. In addition to the millions of Californians who already have preexisting conditions, any one of us may find ourselves with a preexisting condition in the future, and could find ourselves uninsurable in the future without the protections in the ACA. These protections are a promise we have made to the American people, one which we should never break. I will stand up against any attempts to weaken or dismantle the Affordable Care Act given what is at stake for Californians who rely upon its protections.”

 

Source link: California Department of Insurance

 

Pot Tax Cuts: The sale of cannabis products are slower than anticipated. Sales are down. More importantly — for the state, that is — tax revenues aren’t up to expectations.

 

California Treasurer Fiona Ma says the solution is tax cuts for marijuana businesses. The cuts are needed — as opponents noted — because the state put very high taxes onto pot growers and sellers. They warned it would cause prices to rise, sales to fall and would send consumers scurrying back to the black market.

How bad is it? The marijuana taxes fell $101 million short of what was expected.

In her comments on the issue — and the bill designed to fix the problem — Ma said, “This is anywhere from a $6 billion to a $20 billion industry in California. So we want to help them … get into the regulated market and come in from the gray market.”

If the bill passes, the new law will give those in the cannabis business a three-year tax break and will reduce the excise tax from 15% to 11% and will suspend taxes for pot growers completely through 2022.

Currently growers are taxed at a $148 per pound rate.

 

Source link: Press Democrat

Tags:  Around the PIA Western Alliance States 

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Around the PIA Western Alliance States

Posted By staff reporter, Tuesday, January 29, 2019


 

California

Montecito Mudslides: Edison International says poorly designed and maintained debris basins are the reasons for the deadly mudslides that hit Montecito last year.

Over 20 people died. Damages to property is estimated at between $177 million and $204 million. The mudslides happened on January 18, 2018 when the first heavy rain of the season hit the top of the mountain above the city and loosed tons of mud and boulders onto the city.

Edison International has been sued for causing the mudslides because its equipment may have been responsible for the fire at the top of the mountain. The company — and its subsidiary Southern California Edison — countersued and blamed the city, the county and its inadequate infrastructure, and how that infrastructure was maintained.

In its complaint, Edison said, “With this cross-complaint we seek to ensure that there is a comprehensive review of the role many parties may have played in the large and tragic losses suffered by the community during the Montecito mudslides,” the company said. “It is well known that the Montecito area has always been at high risk for mudslides and debris flows. We believe that city, county and state governments, including flood control, water and transportation agencies, failed to ensure that Montecito’s infrastructure was adequate to reduce the impact of such natural disasters.”

 

Source link: Insurance Journal

 

Idaho

Medicare Workshops to be Offered in Bonners Ferry: A series of three (3) free Medicare Workshop for individuals turning 65 and those approaching Medicare eligibility will be held Friday, February 1 at the Fry Healthcare Education Center, located across from the main hospital building of the Boundary Community Hospital, 6640 Kaniksu St., in Bonners Ferry.  Workshops will be held at 2:30, 4:30 and 6 p.m.

Caregivers and all those interested in learning how Medicare works are encouraged to attend.

The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance.  SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

  Timeframes for enrolling in Medicare

  Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

To register for the workshop, please contact the SHIBA office at 1-800-247-4422.

 

Washington

Wildfire Mitigation Plan: Public Lands Commissioner Hilary Franz has unveiled a 10-year, $55 billion wildfire control plan and given it to the Legislature. The plan will add 30-full time and 40 seasonal firefighters to the Department of Natural Resources. It also adds two helicopters to the firefighting air fleet.

A wildfire training academy that can be used by other agencies will also be set up.

Source link: Claims Journal

 

Commissioner’s Legislative Priority

Click here for Washington Insurance Commissioner Mike Kreidler’s legislative priorities.

Actions by the Commissioner

Insurance Commissioner Mike Kreidler issued fines in December 2018 totaling $192,050 against insurance companies, agents and brokers who violated state insurance regulations.

Insurance companies

Accordia Life and Annuity Co., Des Moines, Iowa; fined $130,000, order 18-0250

Kreidler received 57 complaints about the company in 2016 and 2017 and started an investigation into its practices. The law violations included:

 Failure to maintain full and adequate records of more than 8,600 customer accounts.

Underpaid interest on the death benefit of a policy and failed to correct the problem until the consumer complained to Kreidler’s office. State law requires that insurance companies pay 8 percent interest.

Failed to provide annual statements to 21 consumers.

State Farm Life Insurance Co., fined $10,000, order 18-0410

The company failed to pay the correct amount of interest on death benefits to 1,251 Washington consumers. State law requires that insurance companies pay 8 percent interest.

Kreidler fined the following companies for violating Washington state insurance regulations:

    GPM Health and Life Insurance Co., Spokane, Wash.; fined $2,000, order 18-0468

    Monterey Insurance Co., Monterey, Calif.; fined $30,000, order 18-0490

    American Automobile Insurance Co., Earth City, Mo..; fined $10,000, order 18-0494

    Unified Life Insurance Co., Dallas; fined $4,500, order 18-0529

 

Agents and brokers

Kreidler revoked the licenses of the following insurance producers:

  Romaine Smith, Prosser, Wash.; license revoked, order 18-0146

  Francisca Yadira Rios, Pasco, Wash.; license revoked, order 18-0507

  Jacqueline Cone, Washougal, Wash.; license revoked, order 18-0515

  Jodi S. Campbell, Lonoke, Ark.; license revoked, order 18-0475

  Gary M. Enciso, Long Beach, Calif.; license revoked, order 18-0476

  Rachel Glover, Collins, Iowa; license revoked, order 18-0477

  Drucilla Clorene Wilson, Las Vegas; license revoked, order 18-0479

  Paul B. Wells, Las Vegas, license revoked, order 18-0498

  Deandre Maze-Carter, Phoenix; license revoked, order 18-0499

  American Underwriting Services LLC, Kennesaw, Ga.; license revoked, order 18-0503

  Romeo Evan Fulton, North Riverside, Ill.; license suspended, order 18-0504

  James Luis Vasquez, Bothell, Wash.; revocation rescinded, license surrendered, order 18-0480

 

Kreidler fined the following insurance producers for violating state laws:

  David M. Connolly and David Connolly Insurance Agency, Silverdale, Wash.; fined $500, order 18-0355

  Ryan M. Focht, Pullman, Wash.; fined $500, order 18-0482

  Alina Frenkel, Bellevue, Wash.; fined $500, order 18-0483

  Robert L. Johnston, Spokane, Wash.; fined $500, order 18-0491

  Paul F. Dent and Griffin Mac Lean, Inc., Bellevue, Wash.; fined $1,000, order 18-0488

  John C. Haskell, Jr., Mill Creek, Wash.; fined $250, order 18-0397

  Xandrea Powell, Suwanee, Ga.; fined $250, order 18-0395

  Terran Watters-Fletcher, Lawrencville, Ga.; fined $250, order 18-0401

  Benchmark Administrators LLC, Wayzata, Minn.; fined $250, order 18-0429

  Lawrence M. Koresko, Collegeville, Penn.; fined $250, order 18-0436

  George Lewis Kengle, Springfield, Ore.; fined $250, order 18-0478

  Thomas A. Dus, Elyria, Ohio; fiend $500, order 18-0506

 

Continuing education providers

  Risk & Insurance Managers Society of Washington, Seattle; fined $800, order 18-0513

 

 

 

 

Source link: Washington Department of Insurance

Tags:  Around the PIA Western Alliance States  insurance content  insurance news  Weekly Industry News 

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Around the PIA Western Alliance States

Posted By staff reporter, Tuesday, January 22, 2019

California

Lara & Federal Shutdown: Insurance Commissioner Ricardo Lara strongly urges that insurance companies assist Californians who are affected by the Federal Government shutdown and may face delays in paying premiums or cancellation of policies. The Commissioner is asking insurers to be patient and work with these California residents during this difficult time.

 “The Federal shutdown is putting Californians at unnecessary risk of losing insurance coverage over late or unpaid bills,” said Commissioner Lara. “I am asking insurers to partner with me to protect our federal workers and contractors in California to give them some peace of mind during this time of uncertainty.”

The partial shutdown of the Federal Government is negatively affecting many California consumers, specifically those employed by the Federal Government and contractors who are not being paid their regular salary or receiving reimbursements when normally due. This delay in payment affects these consumers’ ability to pay their bills on time including insurance coverage, mortgages or other loans.

Commissioner Lara asks insurers to take into consideration the difficulties California consumers are facing and will continue to face until the current shutdown has ended. He urges insurers to relax due dates for premium payments, extend grace periods, waive late fees and penalties, allow forbearance with regard to the cancellation/non-renewal of policies, allow payment plans for premium payments, and exercise judicious efforts to assist affected policyholders and work with them to make sure that their insurance policies do not lapse.

Source link: California Department of Insurance

Idaho

Medicare Workshops: Free Medicare Workshops for individuals turning 65 and those approaching Medicare eligibility have been scheduled in two Idaho cities.

The first is Thursday, January 24 from 2:30 p.m. to 4 p.m. at the Syringa Hospital Soltman Center, 600 W. Main St., Grangeville, Idaho. 

The second is Monday, January 28, from 6 p.m. to 7:30 p.m. at the St. Joseph’s Regional Medical Center, 415 6th St., Lewiston, Idaho.

Caregivers and all those interested in learning how Medicare works are encouraged to attend.

 The workshop will be led by Senior Health Insurance Benefits Advisors (SHIBA), a unit of the Idaho Department of Insurance. SHIBA presenters will introduce the various parts of Medicare and explain some of the vocabulary associated with the program. 

Topics to be covered include:

• Timeframes for enrolling in Medicare

• Enrollment periods for Medigap, Medicare Advantage and Prescription Drug Plans

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

 To register for the workshops, please contact the SHIBA office at 1-800-247-4422.

Nevada

Highway Fatalities: the Department of Public Safety is worried. Nevada’s highway fatalities rose to a 10-year high. The department said 331 people died 2018 in 301 crashes.

Department spokesman Andrew Bennett said most of them were in Clark County. “In 2008 we were at 324, then we dropped to the mid 200s from about 2009 to 2013 and we then we saw a steady climb into the 300s in 2014,” he said. “So, 331 is on the high end in the last decade, but we have seen a 4 percent population growth over the past two years in the state as well.”

Pedestrian deaths in Nevada dropped from 98 in 2017 o 80 last year. Bennett said it is the first decrease in nine years.

Source link: Insurance Journal

Washington

The Commissioner’s 2019 legislative priorities: Surprise billing (HB 1065 and SB 5031 "Protecting consumers from charges for out-of-network health care services")

This legislation will stop patients from getting an additional bill, after the patient’s health plan has paid the normal rate and the patient has paid their portion (such as a co-pay) when they receive medical care for an emergency at an out-of-network emergency room and when they have an approved surgery at an in-network hospital or surgery center but receive services, such as anesthesiology, radiology or lab services, from a provider who is out-of-network.

The prime sponsor of HB 1065 is Rep. Cody. The prime sponsor of SB 5031 is Sen. Rolfes.

HB complete bill language (leg.wa.gov) (PDF, 181.46 KB)

   HB bill history (leg.wa.gov)

   HB Status: Public Hearing, January 23, 2019, 1:30pm

   SB complete bill language (leg.wa.gov) (PDF, 176.78 KB)

   SB bill history (leg.wa.gov)

   SB Status: Referred to Health & Long Term Care Committee

Disaster resilience working group (HB 1040 and SB 5106 "Concerning the creation of a work group to study and make recommendations on natural disaster mitigation and resiliency activities")

This legislation will create a work group composed of legislators, state agencies, insurance companies and other key stakeholders to review and make recommendations on how to best coordinate and improve disaster resiliency work in Washington State, including possibly creating a central place for coordination and planning.

The prime sponsor of HB 1040 is Rep. Reeves. The prime sponsor of SB 5106 is Sen. Das.

  HB complete bill language (PDF, 68.24 KB)

   HB bill history (leg.wa.gov)

   HB Status: Public Hearing, January 16, 2019, 8:00am/Executive Session, January 22, 2019, 10:00am/Executive Session, January 23, 2019, 8:00am

   SB complete bill language (leg.wa.gov)

   SB bill history (leg.wa.gov)

   SB Status: Public Hearing, January 15, 2019, 8:00am/Executive Action, January 17, 2019, 8:30am

Medicare access and CHIP Reauthorization Act of 2015 (MACRA) (SB 5032 "Concerning Medicare supplemental insurance policies")

This legislation will align Washington law with recent changes in the Medicare and Children’s Health Insurance Program (CHIP) statutes, which seek to prevent overutilization of services. Washington must have these changes in place by January 1, 2020. The two key changes are:

As of January 1, 2020, new enrollees will no longer be able to purchase a Medicare Supplement Plan which provides coverage for the Part B deductible. This does not impact existing enrollees.

Allow but not require companies to offer a new Plan G with a High Deductible option. Currently, only Plan F has an additional High Deductible option.

The prime sponsor of SB 5032 is Sen. Cleveland.

   SB complete bill language (leg.wa.gov) (PDF, 86.39 KB)

   SB bill history (leg.wa.gov)

   SB Status: Public Hearing, January 18, 2019, 8:00am

Criminal Investigations Unit (CIU) Separate Funding (HB 1069 "Concerning the creation of the insurance fraud surcharge account")

This legislation will create a dedicated funding stream for the Office of the Insurance Commissioner’s (OIC) Criminal Investigation Unit (CIU), who are charged with investigating and preventing insurance fraud. The legislation will also increase that funding to allow CIU to keep up with the increasing amount of fraud referrals by adding five new staff. The funding will be provided by dedicating a portion of the premium surcharge already collected by the OIC for CIU’s exclusive use.

The prime sponsor of HB 1069 is Rep. Stanford

   HB complete bill language (leg.wa.gov) (PDF, 82.11 KB)

   HB bill history (leg.wa.gov)

   HB Status: Public Hearing, January 16, 2019, 1:30pm/Executive Session, January 18, 2019, 9:00am

Source link: Washington Department of Insurance

Kreidler and Innovators: Washington Insurance Commissioner Mike Kreidler is offering innovators in the insurance industry a new way to engage his office about potential products that may benefit consumers.

Kreidler announced an insurance innovation portal, Resources for insurance industry innovators.

Click here to access the portal that includes guidelines, a hotline and web form. This is designed to encourage companies, agents and insurance startups to contact his office early in the development of new products.

Kreidler noted that changing social and technological trends have created an opportunity for insurance entrepreneurs. 

“The insurance industry is constantly evolving and we want to make sure innovators understand the laws that guide insurance regulation in Washington,” Kreidler said. “We are eager to work with innovators as they prepare to bring products to market. We’re committed to fair and efficient regulation.”

The Office of the Insurance Commissioner regulates Washington’s $42 billion insurance industry. For more information, please visit www.insurance.wa.gov

Source link: Washington Department of Insurance

Tags:  Around the PIA Western Alliance States  insurance content  insurance industry 

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Around the PIA Western Alliance States

Posted By Staff Reporter, Tuesday, January 8, 2019

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California

Regulations on Gender Discrimination in Auto Insurance: California Insurance Commissioner Dave Jones has issued new regulations that prohibit the use of gender in private passenger automobile insurance rating in California. The Gender Non-Discrimination in Automobile Insurance Rating Regulation became effective on January 1, 2019.

“My priority as Insurance Commissioner is to protect all California consumers, and these regulations ensure that auto insurance rates are based on factors within a driver’s control, rather than personal characteristics over which drivers have no control,” said Insurance Commissioner Dave Jones.

This is not the first regulatory action Commissioner Jones has taken to prevent gender-based discrimination in California’s insurance industry. In 2012, the Commissioner promulgated regulations that prohibit and prevent the denial of coverage or denial of claims for medical services based upon an insured or prospective insured’s actual or perceived gender identity. Prior to his election as Insurance Commissioner, then Assemblymember Jones authored legislation (Assembly Bill 119, in 2009) to prohibit gender-based discrimination in the pricing of health insurance. Thanks to that law, California eliminated gender-based pricing in health insurance before that became the national standard under the Affordable Care Act.

The Commissioner’s Gender Non-Discrimination in Automobile Insurance Rating Regulation mandates that all automobile insurance companies operating in California file a revised class plan that eliminates the use of gender as a rating factor.

Source link: California Department of Insurance

 

New Regs on Average Medical Service Contract Rate: Under the leadership of Insurance Commissioner Dave Jones, the California Department of Insurance adopted new regulations to implement provisions of Assembly Bill 72 (Chapter 492, Statutes of 2016). These regulations relate to the average contracted rate that a non-contracted medical professional will be paid when an insured seeks medical services at an in-network medical facility and is treated by an out-of-network provider. These average contracted rate regulations were approved by the Office of Administrative Law (OAL) and go into effect on January 1, 2019.

AB 72 protects consumers from surprise medical bills when they go to an in-network health facility and receive care from an out-of-network provider without specifically consenting to out-of-network care. The law also establishes a payment amount of 125 percent of the Medicare rate or the average contracted rate in that geographic region for that out-of-network medical service, whichever of the two is greater. These new regulations issued by the department provide the methodology for determining the "average contacted rate" for the medical service that insurers must use to reimburse non-contracting medical professionals. This will reduce disputes between insurers and medical providers about reimbursement rates for non-contracted medical care by providing a clear methodology for rate calculation for commonly billed services at in-network medical facilities.

Under these new regulations, the average contracted rate will be the average of the contracted commercial rates paid by a health insurer for the same or similar health care services in the baseline year (2015) in the geographic region in which the service was provided, with the rate then adjusted for inflation based on the date the medical service was provided.

"These regulations were carefully crafted to provide a fair way of calculating the average contracted rate for medical services in a given geographic region in those circumstances in which a patient inadvertently receives care from an out-of-network provider. Insurers are required to maintain an adequate provider network to ensure timely access to care for their policyholders and when patients are forced to go out-of-network at an in-network facility, the patient should not have to pay more for their care and the providers should be reimbursed fairly," explained Commissioner Jones.

The consumer protection in AB 72 that prevents policyholders from surprise medical bills for non-emergency care went into effect on July 1, 2017, and ensures that when consumers seek medical care at a facility in their insurer's network, but receive care from an out-of-network medical provider, they only have to pay their in-network cost sharing. The law also called for the Insurance Commissioner to set up an Independent Dispute Resolution (IDR) system that providers can use if they do not believe they have been paid fairly under the law. The IDR program was developed by the department for use by medical providers and insurers starting in September 1, 2017.

Source link: California Department of Insurance

 

Supreme Court Decision Fair Claims

 After a decade of legal wrangling over the regulations that implement the Unfair Insurance Practices Act (UIPA), the California Supreme Court let stand the decision of California Court of Appeal, 4th Appellate District, upholding the Insurance Commissioner's Fair Claims Settlement Practices Regulations, which prescribe how insurance companies must process insurance claims. The regulations are the foundation in determining the number of violations committed when assessing fines against insurers that have committed unfair claims practices.

Department of Insurance examinations of PacifiCare's claims-handling uncovered evidence of numerous unfair claims practices-which included wrongful denials for life-saving treatment for people battling serious illness and claim payment denials for providers and hospitals-all because the insurer was focused on maximizing profits through what it called "efficiencies" after the 2015 botched $9 billion acquisition of PacifiCare by UnitedHealthcare. The Department examinations also uncovered evidence the company was well aware of the egregious issues.

Under the Insurance Code, these unfair acts or practices include misrepresenting what medications or treatments an insurance policy covers, failing to promptly pay claims where liability is reasonably clear, and forcing claimants to file lawsuits to get full payment, and other acts. The Insurance Code allows the commissioner to impose fines of up to $5,000 each time an insurer commits an unfair act or practice on a consumer, or up to $10,000 each time if the insurer did so willfully.

"UnitedHealthcare purchased PacifiCare and imposed cost-cutting measures that destroyed PacifiCare's claims-handling processes and its arguments in litigation that insurance companies should be allowed to willfully harm consumers as long as they don't do it too often, reflect a gross disregard of the lives and well-being of the consumers who paid for the promise of coverage," Commissioner Jones said. "Customers have no choice but to rely on the integrity of their health insurance companies. PacifiCare breached that trust. By any measure, 908,000 violations reflect a general business practice of violating consumer protection laws. I am delighted the Supreme Court has rejected further challenges to the insurance commissioner's authority to punish insurance companies for knowingly harming even one consumer."

Based on departmental examination results and following an administrative hearing that took three years, Insurance Commissioner Dave Jones found PacifiCare committed 908,547 separate violations of the UIPA, and he imposed fines aggregating $173,603,750 in penalties. On behalf of PacifiCare, UnitedHealthcare sued the commissioner, arguing that none of its harmful conduct violated the Insurance Code.

PacifiCare argued that insurers are immune from fines for committing these unfair acts, even if the insurer did so intentionally, unless the commissioner is also able to show that the insurer knew it had committed the acts frequently enough to constitute a "general business practice." The court of appeal rejected the argument, stating: "PacifiCare's interpretation of section 790.03(h) is not only internally problematic, it stands in contrast to virtually every other statute the Legislature has enacted in connection with (1) enforcement of the Insurance Code against insurers generally; (2) enforcement of the UIPA in particular; and (3) the imposition of administrative penalties against insurers in other contexts."

The court also rejected PacifiCare's argument that the commissioner must prove an insurer had "actual knowledge" of its illegal conduct and held that it was within the commissioner's authority to hold the insurer responsible if its agents or employees were aware of facts that would cause a reasonable person to know of the violations. The court also found the commissioner's reasoning was sensible in that restricting the definition of "knowingly" to one particular individual's actual knowledge would fail to take into account that many people handle a claim, and an unfair practice can be committed by cumulative acts, not simply the intentional act of one person."

Further, the court of appeal also upheld the commissioner's interpretation that an insurer's "willful" violation of the act may be established by showing a purpose or willingness to commit the act and agreed that penalties for willful violations do not need to require a showing that the insurer intended to violate the law or injure someone. The court held, "As the Commissioner points out, he engaged in an extensive, formal rulemaking process in the course of promulgating these regulations. That careful consideration, combined with the Commissioner's expertise in the area, weighs in favor of according significant deference to the Commissioner's interpretation of the terms, and we do so."

Source link: California Department of Insurance

 

Wells Fargo Settlement

 Wells Fargo has agreed to pay a $10 million penalty as part of a settlement agreement with the California Department of Insurance. This settlement resolves the department’s accusation alleging improper insurance sales practices related to Wells Fargo’s online insurance referral program. The improper practices resulted in consumers being signed up and charged for insurance products without their consent.

“The Department of Insurance’s investigation found that Wells Fargo was signing up and charging customers for insurance without their consent,” said Insurance Commissioner Dave Jones. “Banks and other financial institutions should never be allowed to prey on their customers’ trust without being held accountable.”

Wells Fargo has agreed to not transact any new business during the remaining term of its two insurance licenses, which expire in July and September 2020, respectively. The company also agreed to not apply for a license for at least two years following the expiration of their current licenses. Wells Fargo has provided restitution to all California consumers who were charged premiums, bank fees and other direct monetary losses connected to the unauthorized insurance policies.

$5 million of the penalty is due immediately. If the company ever seeks to return to the California insurance marketplace, it will then pay the remaining $5 million penalty. The Department may also decline to issue a new license.

In November 2017, the department served on Wells Fargo an accusation seeking revocation of Wells Fargo’s insurance license for improper insurance sales practices. The accusation was the result of an investigation opened at the direction of Insurance Commissioner Dave Jones, which found that from 2008 to 2016, Wells Fargo customers were issued approximately 1,500 insurance policies without their knowledge or permission. In some cases, employees told consumers to enter their personal information on a policy application merely to receive a quote, but Wells Fargo employees later submitted the application to the insurer to purchase the policy without the consumer’s permission.

Source link: California Department of Insurance

 

Idaho

Drunk Driver Interlock Law

Starting this year ignition interlock devices are required for the vehicles of all drivers getting a first-time drunken driving conviction. The device will be connected to the vehicle for one-year.

In the past, the blow-into-a-mouthpiece device was only required for repeat offenders.

 

Source link: Insurance Journal

 

Nevada

Marijuana Sales: The Nevada Department of Taxation says marijuana sales in the state are quite brisk. October’s figures were released late last year and sales hit $42 million. That means $8.24 million in tax revenue for the state.

Sales from July through October of 2018 were almost half of the projected sales for the entire year.

Revenues are expected to go even higher since the state issued 61 more dispensary licenses in December bringing the total to 65.

Source link: Insurance Journal

 

Oregon

Off Duty Pot Use for State Workers

The Oregon Legislature is considering a bill that will make it illegal to fire an employee who fails a marijuana drug test if they used marijuana while off the clock.

The rationale is that it is unfair to penalize an employee for using a substance that is legal to use in the state.

Senate Bill 301 will not allow employees to use marijuana if their collective bargaining agreement says they cannot do that even while not working. So exemptions are in the bill for labor agreements, workers who are under the influence while working or from federal jobs that require employees to have a drug free workplace in order to receive federal dollars.

Source link: Insurance Journal

 

From the Department of Insurance: The Oregon Division of Financial Regulation recently adopted the following rule: ID 39-2018: Establishes reimbursement rates for out-of-network services provided at in-network health care facilities

 

Rules affected: OAR 836-150-0010, 836-150-0020, 836-150-0030, 836-150-0040, 836-150-0050, 836-150-0060

 

Rule Summary: Clarifies the purpose, statutory authority, and applicability for OAR 836-053-1600 to 836-053-1615. Adopt definitions of: anesthesia conversion factor; base units; base rate; CMS; CPT; CPI adjustment; director; geographic rating area; modifier adjustment; out-of-network reimbursement; physical status units; Q modifier adjustment; and time units. Adopt formula for out-of-network reimbursement for non-anesthesia-related claims. Adopt formula for out-of-network reimbursement for anesthesia-related claims.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id39-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id39-2018_ho-rec.pdf

Appendix A: Non-anesthesia reimbursement base rate — https://dfr.oregon.gov/laws-rules/Documents/OAR/div53-1605_exA.pdf

 

The Oregon Division of Financial Regulation recently adopted the following rule: ID 38-2018: Implementing the Oregon Reinsurance Program

 

Rules affected: OAR 836-150-0010, 836-150-0020, 836-150-0030, 836-150-0040, 836-150-0050, 836-150-0060

 

Rule Summary: Explains the purpose of the Oregon Reinsurance Program. Defines benefit year, department, reinsurance eligible claim, reinsurance eligible issuer and reinsurance payment. Lists the reporting requirements and payment processes to receive reinsurance payments. Establishes the attachment point, reinsurance cap and coinsurance rate for the benefit years 2018 and 2019. Describes how and when reinsurance payments are to be made. Describes the duties of the Oregon Reinsurance Program administrator.

 

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id38-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id38-2018_ho-rec.pdf

 

The Oregon Division of Financial Regulation recently adopted the following rule: ID 37-2018: Update to adoption of the Valuation Manual for principle-based reserving

Rules affected: OAR 836-031-0605

Rule Summary: Designates the version of the Valuation Manual insurers must use in establishing principle-based reserves beginning January 1, 2019, and confirms that the operative date of the Valuation Manual is January 1, 2017 under section 16(2) of Oregon Laws 2015 chapter 547.

Filed: December 19, 2018

Effective: January 1, 2019

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id37-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id37-2018_ho-rec.pdf

 

The Oregon Division of Financial Regulation recently adopted the following rule: ID 36-2018: Adoption of 2018 annual and 2019 quarterly statement blanks and instructions for insurers

Rules affected: OAR 836-011-0000

Rule Summary: Amended annually to prescribe the statement blanks and applicable instructions then in effect.

Filed: December 19, 2018

Effective: January 1, 2019

 

Documents:

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id36-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id36-2018_ho-rec.pdf

 

The Oregon Division of Financial Regulation recently adopted the following rule: ID 35-2018: Update to morbidity standards for valuation of individual and group health insurance policies

Rules affected: OAR 836-031-0270

Rule Summary: The rule sets forth the minimum standards to be used by insurers for the valuation of specified benefits, and the computation of contract reserves and claim reserves, for individual and group health insurance policies.

Filed: December 19, 2018

Effective: December 19, 2018

Documents:

 

Permanent Administrative Order — https://dfr.oregon.gov/laws-rules/Documents/id35-2018_rule-order.pdf

Summary of Testimony and Hearing Officer's Report — https://dfr.oregon.gov/laws-rules/Documents/id35-2018_ho-rec.pdf

 

Establishment of Oregon Prescription Drug Price Transparency Program, reporting requirements, fees, civil penalties

Rules affected: OAR OAR 836-053-0473, 836-200-0500, 836-200-0505, 836-200-0510, 836-200-0515, 836-200-0520, 836-200-0525, 836-200-0530, 836-200-0535, 836-200-0540, 836-200-0545, 836-200-0550, 836-200-0555, 836-200-0560

Need for Rules:

The Prescription Drug Price Transparency Act (2018 Oregon House Bill 4005, enrolled at 2018 Oregon Laws, Chapter 7) directs the Department of Consumer and Business Services (DCBS) to establish a reporting program for prescription drug manufacturers and health insurance carriers to increase the transparency of prescription drug pricing in Oregon. This program will be known as the Oregon Prescription Drug Price Transparency program. The law directs DCBS to engage in rulemaking to define key terms and timelines, and empowers DCBS to establish fees, adopt a schedule of civil penalties for violations and adopt any other rules necessary for carrying out the provisions of Section 2 of the law.

The proposed rule establishes:

  Definitions for key terms including “new prescription drug,” “net annual increase,” “one month supply” and “course of treatment” that clarify the circumstances when a report is required;

  Form, manner and content requirements for reports from drug manufacturers;

  DCBS’s supervisory expectations of participating drug manufacturers, including good faith standards;

  Timelines for DCBS to request additional information relating to drug manufacturer reports, and for manufacturers’ responses;

  DCBS’s process for adjudicating trade secret claims from drug manufacturers;

  Timelines for DCBS to make drug manufacturer reports publicly available, subject to applicable trade secret exemptions;

  DCBS’s process for receiving notices from consumers about prescription drug price increases;

  Establishing an annual $400 fee for drug manufacturers, as well as an additional surcharge fee for manufacturers that file reports with DCBS;

  Adopting a schedule of civil penalties for drug manufacturer violations; and

  Requirements for information on drug pricing to be provided by health insurance carriers in rate filings.

The proposed rules are necessary to ensure that the program is administered in a fair and equal manner for all participating drug manufacturers and health insurance carriers, to minimize the administrative burden and cost of the program for the state and the industry, and to achieve the program’s purpose of providing notice and disclosure of information relating to the cost and pricing of prescription drugs in order to provide accountability for prescription drug pricing.

Filed: December 28, 2018

Public hearing: January 22, 2019, 10:00 a.m.

Last day for public comment: February 1, 2019, 5 p.m.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

 

For more information on this proposed rule and others, please visit the Division's website:

dfr.oregon.gov/laws-rules/Pages/proposed-rules.aspx

 

Washington

The Department of Insurance Issues Fines: Insurance Commissioner Mike Kreidler disciplined and issued fines in November 2018 totaling $700,500 against insurance companies, agents, brokers and others who violated state insurance regulations.

Insurance companies

Dental Health Services, Seattle; fined $500,000, order 18-0437

Kreidler fined the dental insurer for:

  Failing to identify and process 23 policyholders’ appeals.

  Failing to identify and process 342 grievances from policyholders.

  Erroneously canceling polices.

  Double-charging 492 policyholders a total of $56,351. The company refunded the money with an additional $5,635 in interest.

  Failing to deliver enrollment materials to 76 policyholders.

In addition to the fine, Kreidler will prohibit the company from selling new policies for at least 12 months. After the probationary period, the company can ask Kreidler to allow it to sell policies if it completes compliance and corrective action plans to the commissioner’s satisfaction. Kreidler is suspending $400,000 of the fine and will impose additional penalties if the company fails to comply with the terms of the order.

Kreidler previously took action against Dental Health Services in 2017 and 2018. Kreidler fined the company $400,000 for mishandling consumer complaints and other issues.

 

American Pet Insurance Co., New York City; fined $10,000, order 16-0127

Kreidler imposed $10,000 of a suspended fine against the pet insurance company for failing to follow the compliance plan it agreed to in July 2016. The plan includes a self-audit, which revealed that one policyholder was charged the incorrect premium and eight policyholders did not receive the required 30-day notice for a rate change. Kreidler previously suspended $100,000 of the $250,000 to ensure compliance with the terms of the order. This is the first portion of the suspended fine that Kreidler has imposed on the company.

 

Kreidler disciplined the following companies for violating state insurance regulations:

  Country Mutual Insurance Co., Bloomington, Ill.; fined $50,000, order 18-0409

  Nationwide Agribusiness Insurance Co., Des Moines, Iowa; fined $25,000, order 18-0425

  Amica Mutual Insurance Co., Lincoln, R.I.; fined $20,000, order 18-0424

  Zurich American Insurance Co., New York City; fined $20,000, order 16-0107

  Horace Mann Insurance Co., Springfield, Ill.; fined $10,000, order 18-0408

  Garrison Property & Casualty Insurance Co., San Antonio, Texas; fined $10,000, order 18-0433

  Stillwater Insurance Co., Santa Barbara, Calif.; fined $10,000, order 18-0474

  Allied World Specialty Insurance Co., Wilmington, Del.; fined $3,500, order 18-0458

  Amica Mutual Insurance Co., Lincoln, R.I.; fined $3,000, order 18-0444

 

Agents and brokers

Kreidler disciplined the following insurance producers for violating state insurance regulations:

  Michelle F. Boyer, Parker, Colo.; fined $2,500, order 18-0390

  Rashun Mann, Mansfield, Texas; fined $500, order 18-0380

  Reed Jeff Insurance Agency and Jeffrey Reed, Silverdale, Wash.; fined $250, order 18-0363

  Steele Group Insurance Agency, Inc., and Kelly S. Steele, Eugene, Ore.; fined $250, order 18-0416

  Gentry Partners Ltd.; Greenwich, Conn.; fined $250, order 18-0440

  Bruce Gilchrist, San Carlos, Calif.; fined $250, order 18-0396

  Larry P. Chinn, Memphis, Tenn.; license revoked, order 18-0398

  Kathy Ann Graham, Fort Pierce, Fla.; license revoked, order 18-0427

  Andrea Godoy, Clovis, Calif.; license revoked, order 18-0428

  Tiana Tam, Everett, Wash.; probationary license issued, order 18-0438

  Kiara Munguia, Las Vegas; license revoked, order 18-0445

  Juan Alberto Porras, Phoenix; license revoked, order 18-0430

  Glenn Chavious, Hull, Mass.; license revoked, order 18-0431

  Bijan Richards, Omaha; license revoked, order 18-0432

  April Holmes, Mesa, Ariz.; license revoked, order 18-0435

 

Other organizations

  Credit Acceptance Corp., Southfield, Mich.; fined $30,000, order 18-0426

  Kreidler fined the company for selling nearly 10,000 guaranteed asset protection waivers to Washington consumers via car dealerships without being registered.

  Device Doctorz of Clermont LLC, dba Insure Apple, Oviedo, Fla.; ordered to cease and desist, order 18-0462; fined $5,000, order 18-0463

A Washington state consumer complained to Kreidler’s office when Insure Apple denied his claim for the loss of his iPhone. Upon review, the commissioner found the company sold insurance without a license in Washington state. Altogether, it illegally sold 37 policies for $4,436 in premiums.

 

Source link: Washington Department of Insurance

 

Workers’ Compensation Price Drop

The Washington Department of Insurance said the price for workers’ compensation is going to fall for most businesses in 2019.

Department L&I Director Joel Sacks said the drop will average about 5% and will be the largest drop in over 10-years. “We’re seeing fewer injuries on the job and we’ve made improvements in helping injured workers heal and return to work. That’s good news for workers and employers, and it’s helping us significantly lower workers’ compensation costs,” Sacks said.

Employers will pay about $58 less per employee. The drop for workers will average about $6 year. Estimated total premium savings for businesses in the state will be about $136 million in 2019.

Of course all of this changes from industry to industry. Some will pay more. Others less.

  Building and construction workers’ premiums will decrease by 9%

  Agricultural workers’ and food processors’ premiums will drop by 2%

  Healthcare workers’ premiums will fall by 4%

  Forest products workers’ premiums will go down 6%

  Government workers’ and school employees’ premiums will see a 3% drop

  Restaurant and hotel workers’ premiums will fall an estimated 6%

Not all areas will see a drop:

  City and county law enforcement officers’ premiums will rise by 8%

  City and county firefighters’ will see a 6% hike

Source link: Chinook Observer

 


Tags:  Around the PIA Western Alliance States  insurance content 

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