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Around the PIA Western Alliance

Posted By Staff reporter, Tuesday, May 21, 2019

Montana

Governor Signs Medicaid Expansion & Vetoes Drug Price Bill: Montana Governor Steve Bullock signed a bill to expand the state’s Medicaid program. He also signed a one that has a work requirement and increased premiums for those remaining on the state’s Medicaid program for over a year.

All together he signed nine bills that involve health. One of the bills requires the state to start a reinsurance program. The goal of that program is to cut premium costs for those using the Affordable Care Act’s marketplace and reimburse insurers for high-cost claims.

A bill to reduce prescription drug prices by regulating the contracts companies can sign with pharmaceutical benefit managers hired to negotiate prices for pharmacies and manufacturers was vetoed.

Bullock said the bill would cause administrative costs to rise.

Source link: Independent Record

 

 

Oregon

Filings: Oregon consumers can get a first look at requested rates for 2020 individual and small group health insurance plans.

In the individual market, seven companies submitted rate change requests ranging from an average 3.2 percent decrease to an average 13.5 percent increase, for an average of 3.3 percent. In the small group market, nine companies submitted rate change requests ranging from an average 0.3 percent decrease to an average 13.1 percent increase, for an average of 8.7 percent. See the attached chart for the full list of rate change requests.

“It’s early in the process, but we are encouraged to see carriers providing more options to Oregonians by expanding into both rural and coastal communities, and the market stabilizing in spite of uncertainty at the federal level,” said Insurance Commissioner Andrew Stolfi. “Now it is time to start our open and thorough review process that allows Oregonians to provide input on the filings that affect them.”

Moderate rate increase requests, recent health insurance company financial statements, and expansion into additional counties by multiple carriers reveal that the Oregon health insurance market is stabilizing in spite of continued uncertainty at the federal level. The Oregon Reinsurance Program continues to help stabilize the market as well. It consistently lowers rates by 6 percent each year.

Health insurance companies submitted rate requests to the Department of Consumer and Business Services, Division of Financial Regulation on May 13. Over the next two months, the division will analyze the requested rates to ensure they adequately cover Oregonians’ health care costs. The division must review and approve rates before they are charged to policyholders.

The requested rates are for plans that comply with the Affordable Care Act for small businesses and individuals who buy their own coverage rather than getting it through an employer.

Later this month, Oregonians will be able to compare their health plans and submit comments at  www.oregonhealthrates.org

Public hearing dates will also be posted to the site.

Oregonians are encouraged to comment on rate change requests during the public comment period, which opens later this month and runs through early July. The public can submit comments online and during the public rate hearings.

Preliminary decisions are expected to be announced late June, and final decisions will be made in late July.

 

 

Washington

Kriedler Disaster Plan: Insurance Commissioner Mike Kreidler’s proposal to prepare for and mitigate the effects of climate disasters was signed into law yesterday by Gov. Jay Inslee. Senate Bill 5106 passed the House on April 12 with a 95-0 vote and the state Senate on April 22 with a 48-0 vote. The law takes effect on July 28.

The bill creates a work group represented by 27 organizations including legislators, state agencies, insurance companies, Tribal leaders, municipal groups and other key parties. The group will review and make recommendations on how to best coordinate and improve disaster resilience work in Washington state.

“I thank Sen. Mona Das, (D-Kent), and Rep. Kristine Reeves, (D-Federal Way), for sponsoring this important legislation,” Kreidler said. “This is a crucial first step in being prepared to mitigate disasters that we face in Washington state, including earthquakes, wildfires and flooding.”

““Washington state is prone to natural disasters including earthquakes, floods, landslides, and wildfires,” Das said. We’ve seen an increase in these events because of climate change. We need to act now to ensure we’re fully prepared.”

The work group will hold its first meeting in September. The group’s final report on its recommendations on whether Washington should have an ongoing resilience program is due in December 2020.

Source link: Washington Department of Insurance

 

 

Kreidler & Long Term Care: Insurance Commissioner Mike Kreidler says signing House Bill 1087 into law is a good step toward helping Washington residents deal with the costs of long-term care. Gov. Jay Inslee signed the bill into law yesterday.

The legislation, better known as the Long Term Care Services and Support Trust Act (www.leg.wa.gov), would provide up to $36,500 in assistance toward long-term care costs. Washington residents will begin paying premiums through their workplace in January 2022.

Benefits will be available to qualified residents beginning January 2025.

Kreidler noted the new benefits can be combined with other options, such as long-term care insurance policies, to help pay for needed assistance.

“This program can help people avoid impoverishing themselves to get care in their older age,” Kreidler said. “Most people don’t even think of buying a long-term care policy until they are much older and the cost is prohibitive.

“This new program will have many more people paying in from a younger age. This will help keep costs down and provide many with greater options for long-term care in the latter part of their lives. This program offers some needed peace of mind.”

Source link: Washington Department of Insurance

 


Tags:  Around the PIA Western Alliance States  insurance content  insurance news 2019 

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Around the PIA Western Alliance States

Posted By Staff reporter, Tuesday, May 14, 2019

Around the Western Alliance States Weekly Insurance Industry News

California

Appeals Court Decision on Mercury: In 2015 the California Department of Insurance leveled a $27.5 million fine against Mercury Insurance for illegal fees. The fees — the department said — should have been premiums and disclosed as such.

 

The fees violated rules established by Proposition 103.

 

The appeals court said since the fees are premiums they ought to have been approved by the commissioner. But even when warned by the commissioner to stop the practice, Mercury’s agents — allowed to do so by the company — kept charging $50 to $150 in fees on top of the premium rates approved by the commissioner.

 

It did so by illegally by giving its agents the moniker broker. As a result unapproved fees were leveled in over 180,000 transactions from 1999 to 2004. Those transactions brought $27.5 million to Mercury’s coffers. Thus the size of the fine.

 

By the way, the $27.5 million is the largest fine ever imposed on an insurer by the California Department of Insurance.

 

“The decision is unequivocal: insurers cannot avoid the Department’s scrutiny by charging ‘fees’ on top of the rates already approved by the Commissioner,” Insurance Commissioner Ricardo Lara said. “Our efforts to maintain fair rates depend on insurers playing fair by disclosing the full cost of their insurance, which Mercury did not do.”

 

Source link: Insurance Journal

 

 

Oregon

From the Department of Insurance: Future Income Payments LLC fined $5.9 million for targeting pensions of veterans and retirees

 

Multnomah County Circuit Court Judge Katherine von Ter Stegge fined Future Income Payments LLC $5.9 million for executing a scheme on approximately 240 Oregon veterans and retirees. The Oregon Department of Consumer and Business Services’ Division of Financial Regulation and the Department of Justice sued Future Income, owned by Scott Kohn, for the scheme which provided illegal loans to low-income Oregonians with interest up to 200 percent.

 

The scheme required borrowers to authorize Future Income to make electronic withdrawals from their pension or retirement accounts to repay the loans. This provided Future Income the ability to remove money from victims’ accounts despite violating multiple Oregon and federal laws.

 

In addition to the judgment, the court declared all the loans void, saving victims more than $5 million in principal, interest, and fees. Since the judgement, a number of other states and the Consumer Financial Protection Bureau have taken similar action against Kohn and Future Income. The U.S. Attorney’s Office for the District of South Carolina indicted Kohn and Future Income last month for conspiracy to engage in mail and wire fraud.

 

“The collaboration with Attorney General Ellen Rosenblum and the Department of Justice was key in this case,” said Andrew Stolfi, division administrator. “Preying on the hard-earned pensions of our veterans and retirees is disgraceful, and all our teams work hard to protect Oregonians from being victims of illegal schemes like this.”

 

Oregonians are encouraged to know before you owe by making sure loan companies like Future Income are legally registered with the state before signing any agreement. For more resources to protect your finances visit dfr.oregon.gov/financial or contact our advocates at 888-877-4894 (toll free).

 

To learn more about protecting yourself from financial fraud visit, https://dfr.oregon.gov/financial/protect/Pages/senior-safe.aspx

 

 

Oregon Health Insurance Marketplace, a Statewide Partner Agent Program

The Department of Consumer and Business Services has released a request for grant proposals (RFGP) for the Marketplace’s Statewide Partner Agent Program. This program provides promotion, funding, and support for qualified, resident agents with the goal of helping educate and enroll Oregonians in health insurance through the Marketplace.

 

Proposals are due Friday, May 31, 2019 by 11:59 p.m. Pacific Time. The RFGP and supporting documents can be found on ORPIN and on our website under Agents resource center. Please contact Frances Wilkins, Procurement Specialist, at (503) 947-7008 or frances.j.wilkins@oregon.gov if you have any questions about this opportunity.

 

Oregon Health Insurance Marketplace

1-855-268-3767

agents.marketplace@oregon.gov

 

You are Invited to Our First Innovation Forum: THE FUTURE OF FINANCE, INSURANCE, COLLABORATION

 

June 7, 2019

8:30 a.m. - noon

Salem Convention Center

 

Learn how local financial and insurance companies are preparing for the future.

 

You’ll hear from:

 

  Oregon Division of Financial Regulation Administrator Andrew Stolfi

  Oregon State Treasurer Tobias Read

  Technology Association of Oregon

  maps credit union

  Umpqua Bank

  The Standard

  and more

 

This FREE event is for professionals from the financial

service, insurance, and technology industries.

 

Visit our website dfr.oregon.gov/innovation to register for this free event today, space is limited.

 

Learn more: https://www.eventbrite.com/e/oregon-division-of-financial-regulations-innovation-conference-tickets-60581985349

 

Updated Product Standards

 The Division has updated the following product standards:

 

440-4953 – We’re updating the Medical Binder Filings product standards for 2020 to comply with the maximum out of pocket (MOOP) listed in the 2020 Notice of Benefit and Payment Parameters. If the existing product standards have already been completed we are not requiring submission of these new standards. Just be aware of the updated MOOP of $8150 and published filing dates for the 2020 plan year.

440-4980 – Minor changes to coincide with 2020 plan year.

Tags:  around the pia western alliance states  industry content  Insurance Content 

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Around the PIA Western Alliance States

Posted By Staff writer, Tuesday, April 23, 2019

Around the PIA Western Alliance PIA Insurance

 

Arizona

Texting & Driving Ban

 Arizona Governor Doug Ducey says he will sign the bill making Arizona the 48th state to ban texting and driving. The law takes effect in 2021. It fines a first time offender somewhere between $75 and $149. Further violations could go up to $250 per incident.

Source link: Arizona Capital Times

 

Idaho

Job Opening

 The Idaho Department of Insurance has an open Consumer Affairs Officer position in Boise.  Below is the link to the job announcement and application:

This position is open for all qualified individuals to apply through April 28, 2019.  If interested, please apply through the application process via the Division of Human Resources website. There is an online exam associated with this position to ensure minimum qualifications are met. Feel free to pass this information along to any other individuals you think may be interested in this opportunity.

If you’re interested click here to apply.

 

Medicare Workshops

 A pair of free Medicare Workshops for individuals turning 65 and those approaching Medicare eligibility will be held in Lewiston the last full week of April. 

The first session is scheduled for Wednesday, April 24 from 6 p.m. to 7:30 p.m. at the St. Joseph Regional Medical Center, 415 6th St., Conference Room D. The second workshop will take place Thursday, April 25, from 10 a.m. to noon at the Community Action Partnership, 124 New 6th St.  Caregivers and all those interested in learning how Medicare works are encouraged to attend.

Another will be held in Preston on Tuesday, April 23 from 5:15 p.m. to 7:15 p.m. at Southeastern Idaho Public Health, 42 W. 1st South, Preston.

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 time frames for Medigap, Medicare Advantage, prescription drug plans, and how the different parts of Medicare work together.

Staff members 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 either session, please contact the SHIBA Helpline at 1-800-247-4422.

 

 

Montana

Firefighter Work Comp Law

 Montana Governor Steve Bullock has signed a bill into law that makes it easier for firefighters to get workers’ compensation insurance to cover cancer and other occupation-related diseases.

The bill ends a 20-year battle between legislators and firefighters over the issue.

Under the new law, an insurer can only deny a claim if it can prove the firefighter was not exposed to enough smoke or particles to cause an illness. Until the governor signed the bill into law, Montana was one of only a few states without a presumptive law.

The presumptive illnesses in the law include myocardial infarction, colorectal cancer, mesothelioma, non-Hodgkin's lymphoma and cancers of the esophagus, brain, lung and breast.

 

In signing the bill into law, Bullock said, “Today every firefighter should know Montana has your back and it's about damn time.”

The law goes into effect July 1st of this year.

Source links: Fire Engineering, The News & Observer

 

 

Oregon

State Innovation Hub

 If you have an innovative product, service, or idea for the financial service or insurance industry, don't miss this free event hosted by the Oregon Division of Financial Regulation.

Oregon's Innovation Hub is here to help financial services, insurance, and tech companies deliver innovative products and services to Oregon consumers.

Registration and more information available soon at dfr.oregon.gov/Innovation.

 

 

Washington

Kreidler Fines

 Insurance Commissioner Mike Kreidler issued fines in March totaling $158,000 against insurance companies, agents and brokers who violated state insurance regulations.

Insurance companies

  United States Fire Insurance Co., Wilmington, Del.; fined $25,000, order 16-0192

  United States Fire Insurance Co. sells pet insurance under the brand name ASPCA Pet Health Insurance. In July 2016, Kreidler fined the company $50,000 for several law violations, including charging customers the wrong rate, selling policies through unlicensed producers, issuing incorrect policy forms to customers and not disclosing the underwriter’s name to customers. At the time, Kreidler suspended $25,000 of the fine as long as the company followed a compliance plan to correct the violations.

Kreidler determined that the company has violated the compliance plan and is levying the remaining $25,000 fine. As recently as November 2018, the company continues to let unlicensed producers sell its pet insurance product and is selling pet insurance through an unappointed marketing website, www.policygenius.com.

Kreidler fined the following insurance companies for violating state insurance laws and rules:

  Lincoln National Life Insurance Co., Fort Wayne, Ind.; fined $100,000, order 19-0100

  IDS Property Casualty Insurance Co., De Pere, Wisc.; fined $7,500, order 19-0094

  USI Insurance Services National, Inc.; Seattle; ordered to pay premium taxes, order 17-0466

  Banner Life Insurance Co., Frederick, Md.; ordered to cease and desist, order 19-0048

Agents and brokers

  Paul Curtis Rhoton, Burien, Wash.; license revoked, order 19-0095

  Jack J. Barry, Vancouver, Wash.; license revoked, order 19-0092

  JetClosing, Inc., Seattle; fined $250, order 19-0018

  Noelia Clemons, Pickerington, OH; fined $250, order 19-0064

  Steven N. Farah, West Linn, Ore.; license revoked, order 19-0091

  Christopher Todd Price, Overland Park, Kan.; revocation rescinded, fined $500, order 19-0140

  Highland Health Direct and Daniel Strikowski, Deerfield Beach, Fla., and Ian McCauslin, Boca Raton, Fla..; fined $1,000, order 19-0097

  Stephanie F. Miller, Reading, Penn.; fined $250, order 19-0042

  Tabak Insurance Agency PLLC, Sugar Land, Texas; fined $250, order 19-0065

  Socius Insurance Services, Inc., San Francisco; fined $250, order 19-0068

  Hanna Perez, Phoenix; license revoked, order 19-0069

Other organizations

  International Hole in One Association dba Hole in One International, Reno, Nev.; ordered to cease and desist, fined $15,000 and ordered to pay premium tax, order 19-0113

  First Automotive Service Corp., Albuquerque, N.M.; fined $3,250, order 19-0067

  Apex Longevity, Avon, Ohio; fined $3,000, order 19-0070

  National Rural Letter Carriers Association, Alexandria, Va.; ordered to cease and desist, order 19-0098

  Landcar Agency, Inc., Sandy, Utah; ordered to cease and desist, order 19-0050

  BKL Holdings Inc. dba Insurance License Coach, Baton Rouge, La.; fined $1,500, order 19-013

Source link: Washington Department of Insurance

 

 

Tags:  Around the PIA Western Alliance States  insurance content  insurance news 2019 

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Commercial Rates — Looking Good!

Posted By Staff writer, Tuesday, April 16, 2019

The first quarter of 2019 is looking good for insurance rates. New data from MarketScout says both commercial lines and personal lines saw increases of 2% when compared to the first quarter of 2018.

MarketScout’s CEO Richard Kerr said, “Transportation risks were up by 4%. Auto continues to be assessed with the most aggressive rate increase by line of coverage at plus 7%. Also, energy exposures are now starting to see more rate increases. Otherwise, the commercial market is stable.”

Here are the statistics by line:

  Commercial property: +2.5%

  Business interruption: +2%

  BOP: +2%

  Inland marine: +2%

  General liability: +2%

  Umbrella/excess: +2%

  Commercial auto: +7%

  Workers’ compensation: -1%

  Professional liability: +2%

  D&O liability: +1%

  EPLI: +1%

  Fiduciary: +1%

  Crime: +1%

  Surety: Flat

By account size:

  Small — up to $25,000: +2.5%

  Medium — $25,001-$250,000: +2%

  Large — $250,001-$1 million: +1%

  Jumbo — over $1 million: +1%

By industry:

  Manufacturing: +2.5%

  Contracting: +2%

  Service: +2%

  Habitational: +3%

  Public entity: +2%

  Transportation: +4%

  Energy: +2.5%

Kerr said personal lines rates are in the positive as well. The composite rate only rose 2% but Kerr said the number isn’t exactly what it seems. The totals are a bit deceptive.

“The personal lines market is so large that the composite rate can sometimes be misunderstood. There is an incredible volume of business in benign areas, which helps stabilize rate increases in catastrophe-exposed areas such as Florida and California,” Kerr pointed out. “Some of the insurers of larger homes in Florida are increasing rates significantly or choosing to restrict their writings. In California, it’s a mess for wildfire- and mudslide-exposed properties. California homeowners are experiencing rate increases of 20% for homes in brush areas, and for the brush-exposed homes without adequate protection, rate increases are up over 40%.”

Here are the personal lines stats:

  Homeowners under $1 million value: +2%

  Homeowners over $1 million value: +2%

  Auto: +2.5%

  Personal articles: +1%

Source link: Insurance Business America

Tags:  2019 insurance rates  Around the PIA Western Alliance States  commercial lines  insurance content  insurance news 2019  personal lines 

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Around the PIA Western Alliance States

Posted By Staff writer, Tuesday, April 16, 2019

PIA is now an official appointed agency for SAIF program

 

Arizona

Distracted Driving: SB 1165 — sponsored by Republican Sen. Kate Brophy McGee — has passed the Senate and is now lounging in the Arizona House. It addresses the distracted driving of people texting or talking on their phones while driving.

The bill — if passed by the House and signed into law by the governor — would make that illegal unless they’re pulled over or at a stop sign or stop light.

AAA of Arizona says its survey says 85% of Arizonans are in favor of the ban. Spokeswoman Michelle Donati-Grayman said, “Voters from across the state agree that it is time that we take a statewide approach to this issue and ensure that everyone operates under the same rules. Legislators should rest assured that this is something their constituents overwhelmingly support.”

Source link: Your Valley

California

 

Work Comp Premiums Down: The California Workers’ Compensation Insurance Rating Bureau says California’s workers’ compensation rates continue to drop. They fell 4% in 2018 over 2017 and 6% below 2016.

Other findings in the WCIRB report:

  The average rate per $100 of payroll of $2.25 is 11% below 2017 and 24% below the peak in 2014

  The projected combined ratio is 91% and is six-points above 2017

  Indemnity claims were settled faster and the ratio of claims to closure is at a 19-year high

Source link: Insurance Journal

Insurance Diversity Bill: The California Senate Insurance Committee has approved Senate Bill 534, which encourages the $310 billion insurance industry to use its buying power to benefit diverse small businesses. SB 534 is authored by Sen. Steven Bradford (D-Gardena) and sponsored by Insurance Commissioner Ricardo Lara.

SB 534 extends innovative programs that bring increased transparency and opportunities for partnership between the nation’s largest insurance market and woman-, minority-, LGBT- and veteran-owned businesses.

"California’s nation-leading insurance industry can be an engine of prosperity for diverse businesses, benefiting our communities and the customers they serve,” said Insurance Commissioner Ricardo Lara. “SB 534 will continue to leverage the rapid growth of the insurance sector’s role in contributing to vibrant local economies.”

“California is a diverse state and becomes more diverse with each day,” said Senator Steven Bradford. “Ignoring that fact also ignores the proven value diverse businesses have and the importance of making our economy more inclusive. Insurance spending on diverse businesses increased 93% over the few years the supplier survey was administered. I think that difference speaks to the enormous impact this measure will have.”

Since 2011, the California Department of Insurance’s Insurance Diversity Initiative has aimed to increase supplier and governing board diversity in the insurance industry. Through surveys administered by the Department to insurers since 2012, critical data has revealed important findings on diversity in the industry.

The Department’s surveys have seen procurement between insurers and California’s diverse-owned businesses increase by 93% over a five-year period, from $930 million in 2012 to $1.8 billion in 2017.

SB 534 will reauthorize the Insurance Supplier Diversity Survey, which expired in January 2019, and expand it to include LGBT- and veteran-owned businesses. In addition SB 534 will continue the Department of Insurance’s governing board survey and extend the Insurance Diversity Task Force, comprised of up to 15 members representing insurance companies, experts in supplier and governing board diversity, and minority, women, disabled-veteran or veteran, and LGBT business enterprises.

Source link: California Department of Insurance

 

 

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 Thursday, April 18 from 2 p.m. to 4 p.m. at the Hospice of North Idaho Community Building, 2290 W. Prairie Ave., Coeur d’Alene.  Caregivers and all those interested in learning how Medicare works are 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 members 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 — Cease & Desist Order: A cease and desist order for soliciting health insurance clients without being properly licensed to do so in Idaho has been issued to Makina Health, the Department of Insurance announced.  

The order immediately prevents Makina Health or any entity with the word ‘Makina’ in its name from engaging in the business of transacting insurance in the state of Idaho.  The actions of Makina, which operates as a private purchasing cooperative based out of Texas, are in violation of Idaho Code § 41-213(1)(a). 

Acting on a tip from the public, the Department began investigating Makina this past December following an allegation the company was soliciting self-funded health care plans in the Gem State.  The company maintained a website touting health plans labeled “fantastic options for the value.” Idaho Code § 41-4003(3) provides that self-funded plans, including multiple employer welfare arrangements (MEWAs) that operate within Idaho must be registered with the Department.  Makina violated this code by acting as a MEWA in the state of Idaho.

“We have a responsibility to protect Idaho consumers by making sure the insurance producers with whom they do business are properly licensed under the Idaho Insurance Code,” said Director Dean Cameron.

Makina may file a request for a hearing in this matter.  A copy of the Makina Order is available on the Department website.

 

 

Montana

 

Asbestos Superfund Removal: Montana’s asbestos-filled vermiculite mine in Libby has been taken off of the Superfund list. It appears — at least to the federal government — that the 17-year project is finished.

Or at least close to finished.

It’s a processing plant owned by W.R. Grace. The mine polluted the Montana cities of Libby and Troy until it was closed down in 1990. Over 400 people are said to have died because of asbestos exposure and another 3,000 became sick. People in that area are still being diagnosed with asbestos poisoning today.

The cost of the cleanup has been estimated at $596 million. Two other sites in the area are still on the superfund list.

Source link: Insurance Journal

 

 

Oregon

 

From the Department of Insurance: The Oregon Division of Financial Regulation recently announced the following Proposed Rulemaking hearing:

Network Adequacy Compliance Requirements

Rules affected: OAR 836-053-0320, 836-053-0330

Need for Rules:

Oregon adopted its network adequacy requirements through House Bill 2468 in 2015 and adoption of related administrative rules in 2016. The Oregon process allows insurers to demonstrate its networks are adequate by submitting to the department evidence of compliance with a nationally-recognized standard.

Acceptable nationally-recognized standards were established in administrative rule and included federal network adequacy standards applicable to Medicare Advantage plans, adjusted to reflect the age demographics of the enrollees in the plan or federal network adequacy standards applicable to Qualified Health Benefit Plans as outlined in the Final United States Department of Health and Human Services Notice of Benefit and Payment Parameters and Letter to Issuers in the Federally-facilitated Marketplaces.

The Centers for Medicare and Medicaid Services (CMS) no longer conducts network adequacy compliance reviews for Qualified Health Plans (QHPs) and now defers to state processes to determine compliance. CMS relies on insurers’ accreditation with an HS-recognized accrediting entity for states without authority and means to conduct network adequacy reviews.

At the time Oregon’s current network adequacy rules were adopted, the rulemaking advisory committee considered whether accreditation with an HHS-recognized accrediting entity would be an acceptable nationally-recognized standard and determined the accreditation process would not provide sufficient evidence that networks are adequate.

The proposed amendments to the rules remove the federal network adequacy standards applicable to QHPs as an acceptable nationally-recognized standard to use in demonstrating network adequacy. The proposed rules also provide clarification requested by the external rulemaking advisory committee on:

  The applicability of the annual report required in OAR 836-053-0320 to networks associated with health benefit plans currently in force and to those health benefit plans currently being sold.

  The evidence of compliance with a nationally-recognized standard should be based on compliance as of December 31 of the calendar year immediately preceding the March 31 reporting date.

  How the Medicare Advantage network adequacy standards must be adjusted to reflect the age demographics of the enrollees in the plan.

Filed: April 5, 2019

Public hearing: May 23, 2019, 10:00 a.m.

Last day for public comment: May 31, 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

 

 

Washington

 

Surprise Medical Bill Passes: Insurance Commissioner Mike Kreidler’s proposal to end the harmful practice of surprise medical billing passed the Senate today on a vote of 47 to 0. It now goes back to the House of Representatives for a concurrence vote before heading to the governor’s desk.

Second Substitute House Bill 1065 (www.leg.wa.gov) prevents consumers from getting a surprise bill when they seek either emergency treatment at an out-of-network emergency room or medical services at an in-network hospital or facility but are treated by an out-of-network provider. 

“I’ve heard from hundreds of people  with health insurance who received a surprise medical bill on top of what they expected to pay,” said Kreidler. “We learned this year of two Washington families facing surprise medical bills of $100,000 and $227,000. Both feared bankruptcy and losing their homes. Something is clearly wrong with our system when you have health insurance, follow what’s required by your health plan, and you still face medical bankruptcy.”

Kreidler added, “Thankfully, everyone involved this year worked really hard on bill language that everyone can live with – and most importantly, that protects consumers from being caught in the middle. I’m grateful to Rep. Eileen Cody, D-West Seattle, and Sens. Christine Rolfes, D-Kitsap County, and Annette Cleveland, D-Vancouver, for their critical work on this legislation and to the other legislators who supported this important consumer protection."

In part, under the proposed legislation:

  A consumer who receives emergency care in an out-of-network emergency room or who has a non-emergency medical procedure in an in-network hospital or facility cannot be balanced billed.

  An insurer cannot balance bill a patient if they seek emergency care at an out-of-network facility in a state that borders Washington.

  Insurers must pay the out-of-network provider or facility directly for care their enrollee receives.

  If the insurer and provider or facility do not agree on a commercially reasonable payment for out-of-network services within 30 days, their dispute goes to binding arbitration.

  A disclosure template will be developed to describe when a consumer can and cannot be balanced billed.

  Insurers, providers, and facilities must include provider network information on their websites.

  Any provider who continues to illegally balance bill may be referred to the state Department of Health for enforcement.

“We are close to enacting one of the strongest surprise billing laws in the country,” said Kreidler. “It strikes a good balance and does what everyone agrees should happen – it takes the innocent consumer out of the middle of these billing disputes.”

Learn more about our efforts to end this practice, Watch one Clark County resident’s story about how she dealt with a surprise bill of over $100,000 and read about one Washougal couples’ struggle (www.time.com) with a $227,000 surprise bill and what it took to bring them relief.

Source link: Washington Department of Insurance

Tags:  Around the PIA Western Alliance States  insurance content 2019  insurance news April 16 2019 

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Social Media — A Love-Hate Relationship

Posted By Staff writer, Tuesday, April 9, 2019

We don’t like social media big shots like Twitter and Facebook. Or so says an NBC News/Wall Street Journal poll. It found a high percentage of us say these sites do nothing positive. In fact, they do more to divide us than they do to unite us. Respondents say the sites spread falsehoods that some try to pass off as legitimate news.

 

The poll also found six in 10 of us — or 60% — don’t trust Facebook to protect vital personal information.

 

Going a step farther, when it comes to the economy, the poll things technology has more positives and benefits than drawbacks. However, half of us want to see the largest technology companies — Apple, Google, Amazon and Facebook — broken up.

 

Micah Roberts is a spokesman for the Republican-leaning Public Opinion Strategies. He said, “Social media — and Facebook, in particular — have some serious issues in this poll.” And then he added, “If America was giving social media a Yelp review, a majority would give it zero stars.”

 

When asked if the federal government should break up the largest tech companies like Apple, Amazon, Facebook and Google:

 

  47% said yes

  50% said no

 

Here is how the poll says we view social media:

 

  82% — wastes our time

  15% — say they help us use our time well

  61% — spreads unfair attacks and rumors

  32% — say it holds public figures and corporations accountable

  57% — it divides us

  55% — spreads lies and falsehoods

  Just 35% say these sites do more to bring us together

  Younger respondents to the poll are less likely to say social media divides us than older respondents

 

Here’s how we perceive the technology giants in terms of trust and when it comes to our personal information:

 

  28% don’t trust Amazon

  37% don’t trust Google

  36% view Facebook positively

  33% see it as a negative

  Twitter is 24% positive, 27% negative

  35% don’t trust the federal government

 

When it comes to personal information, and the collecting of personal information, most of us say giving these companies our personal information to pass onto advertisers is not an adequate trade-off for free or for lower priced social media services:

 

  74% say it is not an acceptable trade off

  23% are good with the trade off

 

Jeff Horwitt of Hart Research Associates is a pollster for Democrats. He said “If these were political candidates, it would be one thing. But for companies, you’d think these ratings would be [more] on the positive side.”

 

Here’s more:

 

  69% use social media once a day or more often

  63% pay bills online

  In the last couple of years, 48% have made an effort to limit how often they use their smartphone

  42% have made an effort to limit or stop using social media in the last couple of years

  42% have applied for a job using an online job search site

  33% listen to podcasts to get news and information

  26% have blocked or unfriended someone on Facebook or another social media site because of their political opinions

  26% use a personal assistant device like Alexa or Google Home

  24% have used a ride-sharing app like Uber of Lyft in the last month

  18% have used an online dating app or website

  14% play an online multi-player video game

 

Last question — how old is a child under age of 18 old enough to have their own smartphone:

 

  42% said 15 or older

  40% said 12 to 14

  11% say 11 and younger

 

Source link: NBC News

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

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Around the PIA Western Alliance States

Posted By Administration, Tuesday, March 26, 2019

Arizona — Department Consolidation: Arizona Governor Doug Ducey wants Department of Insurance head Keith Schraad to lead the Arizona Department of Financial Institutions on a temporary basis.

Actually, it’s not all that temporary. The two agencies are being consolidated into one.

Bob Charlton — who has led that agency for 32 years — is retiring.

Source link: Insurance Journal

Idaho — Medicare Workshops: A pair of Medicare Workshops for individuals turning 65 and those approaching Medicare eligibility will take place in Coeur d’Alene the final week of March. The first session will be held Tuesday March 26 from 1 to 3 p.m., with a second session scheduled for Thursday, March 28 from 5:30 p.m. to 7 p.m.  Both workshops will be held at the Salvation Army Kroc Center, 1765 W. Golf Course Road.

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

The 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.

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

ID 04-2019: Amendment to 2020 standard bronze and silver health benefit plans (Temporary)

Rules affected: OAR 836-053-0013

Rule Summary:

Refiled to remove the word "Draft" on Exhibits.

Need for the Rule:

ORS 743B.130 requires the Department of Consumer and Business Services (DCBS) to prescribe by rule the form, level of coverage, and benefit design for bronze and silver health benefit plans that must be offered by insurance carriers. These plans must meet federal requirements issued by the Department of Health and Human Services (HHS). Each year, HHS updates the actuarial value (AV) calculator used for determining coverage levels. Changes may include costs, plan designs, populations, developments in the function and operation of the AV calculator and other actuarially relevant factors.

As a result of changes made to the federal AV calculator for 2020, the AV for the standard bronze and silver plans prescribed in OAR 836-053-0013 exceeded federal requirements. Failure to update the rule would result in DCBS requiring carriers to submit plans that are illegal with respect to federal law.

This year, HHS released the AV calculator later than in previous years. As a result, rulemaking would not be able to be completed in time for carriers to submit plans in May for review.

Filed: March 21, 2019

Effective: March 21, 2019 through September 13, 2019

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

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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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