Around the PIA Western Alliance States

California — Consumer Protection Board Appointees: Insurance Commissioner Ricardo Lara announced several new appointments to multiple statewide boards to advance the Commissioner’s and the Department of Insurance’s mission to protect California consumers.

These appointments include one new member to the California Long Term Care Insurance (LTCI) Task Force, one member to the California Earthquake Authority (CEA) Advisory Panel, three members to the California Insurance Guarantee Association (CIGA) Board of Governors, one member to the California Organized Investment Network (COIN) Advisory Board, five members to the Insurance Diversity Task Force, and one member to the Workers’ Compensation Insurance Rating Bureau (WCIRB) Governing Committee.

“Protecting consumers is our top priority. These statewide boards do critical work in guiding policies and processes to guard consumers’ health, recover from workplace injuries, and be resilient in the face of natural disasters,” said Commissioner Lara. “I am confident these appointees are ready to get to work and provide their advice and diverse perspectives to continuing building a healthy insurance industry in California that best serves consumers.”

Created by the Governor’s signing of AB 567 (Calderon, Chapter 746, Statutes of 2019), the LTCI Task Force, under Commissioner Lara’s leadership, is exploring how a statewide long-term care insurance program could be designed and implemented to expand the options for people who are interested in insuring themselves should they encounter functional or cognitive disability that requires long-term care, services, and supports.

The CEA provides earthquake insurance for California homeowners, condominium owners, mobile homeowners, and renters. The CEA Advisory Panel advises the Governing Board of the CEA on issues including basic insurance coverage issues, CEA’s insurance rates, long-term sustainability and survivability of the CEA, and availability and affordability of earthquake coverage.

The CIGA Board of Governors oversees the guarantee association’s general operations and management in order to protect policyholders in the event of an insurance company insolvency. Established in 1969 by the Governor and California State Legislature, CIGA comprises all insurance companies admitted to sell homeowners, workers’ compensation, automobile, and other specified property and casualty lines of insurance in California.

The California Organized Investment Network (COIN) was established in 1996 within the Department of Insurance to guide insurers on making financially sound investments that yield environmental benefits throughout California and social benefits within the State’s underserved communities. Commissioner Lara has prioritized COIN investments which drive affordable housing, support small businesses, especially during this pandemic, combat climate change, and encourage investors to utilize diverse investment managers more. The COIN Advisory Board provides guidance to the Commissioner and the COIN program to meet its mission and chief priorities.

The Insurance Diversity Task Force oversees the Department’s Insurance Diversity Initiative, which encourages insurers to increase procurement contracts with diverse business owners, such as a woman-owned, veteran-/disabled veteran-owned, historically disadvantaged community-owned, or LGBTQ+-owned businesses, as well as advance diversity of insurance company corporate boards. The Task Force makes recommendations to the Insurance Commissioner regarding innovative ways to increase diversity within the insurance industry.

The WCIRB Governing Committee sets policy, oversees management of the affairs of the WCIRB, and oversees all issues involving pure premium rates, classifications, rating plans, rating systems, manual rules and policy, and endorsement forms. The WCIRB is a private organization licensed by the Department of Insurance for the purpose of collecting, analyzing, and compiling rating data, with funding coming from assessments of its insurer members. All workers’ compensation insurance companies in California are required by law to be members of the WCIRB.

The next meetings will be held on:

Thursday, April 21, 2022 – LTCI Task Force

By mid-Summer 2022 – CEA Advisory Panel

Tuesday, May 3, 2022 – CIGA Board of Governors

Thursday, April 14, 2022 – COIN Advisory Board

Wednesday, June 8, 2022 – Insurance Diversity Task Force

Wednesday, April 20, 2022 – WCIRB Governing Committee

More details are available at: www.insurance.ca.gov/boards. These positions are uncompensated.

Oregon — SERFF Updates for Annual Reports: How to file Annual Required reports rev 3-22.pdf (under General Instructions for Oregon) Expanded options of what you can file.

New Life & Health items submitted thru SERFF Now

New reports are now available on SERFF for Health. These can be accessed by Entering TOI: Annual Required Reports and Filing type of Annual Reports, from there you choose which report you are trying to file.

Accident and Health Advertising Certificate of Compliance

Illustration Actuary Certification

Medicare Select Quarterly-Updated list of Network Providers

Multiple Medicare Supplement Report

Annual Network Adequacy

Health Recessions Reporting

Long Term Care – Claim Denials

Long Term Care – Lapses & Replacements

Long Term Care – Recessions

Long Term Care – Suitability

Patient Protection – Grievances and Appeal

Patient Protection – Network Adequacy

Patient Protection – Quality Assessment

Patient Protection – Utilization Review

Prompt Pay

Mental Health Parity – NEW

Medicare Supplement Refund Calculations – NEW

Oregon — Updated Product Standards: There have been some changes to our standards.

Current forms list shows in red edition dates which ones have changed.

440-3617 Boiler & Machinery – was taken down and replaced with previous version as it was not ready to be posted. 

You can view or update your subscriptions, password or e-mail address at any time on your User Profile Page. All you will need are your e-mail address and your password (if you selected one).

This service is provided to you at no charge by Oregon Department of Consumer and Business Services. Visit us on the web at http://www.oregon.gov/DCBS/.

OREGON

Updated Product Standards

There have been some changes to our standards so please pay attention to those changes.

Current forms list shows in red edition dates which ones have changed.

440-3146 Individual Health Major Medical

440-3604 Crop/Hail & Aircraft

440-3617 Boiler & Machinery

440-3627 Inland Marine, Burglary, & Theft

440-3136b Small Group Major Medical

Updated documents in SERFF:

2023 – FAQ – Plan Management General Instructions for HBP located under attachments at the bottom of the page.

Washington — Health Care Sharing Ministries (R 2021-17) Second Stakeholder Draft Posted: We have released a second stakeholder draft for Health Care Sharing Ministries (R 2021-17). The commissioner is considering adopting rules relating to the exemption for health care sharing ministries (HCSM) found in RCW 48.43.009 (leg.wa.gov) and the sale of HCSM plans by licensed producers. This will involve updating existing rules and adding new rules.

Comments on the second stakeholder draft are due April 8, 2022; please send them to rulescoordinator@oic.wa.gov.

For more information, including the second stakeholder draft, please visit the rule’s webpage.

Washington — Kreidler extends orders on coronavirus and surprise billing to April 28: Insurance Commissioner Mike Kreidler has extended two emergency orders. His order requiring health insurers to waive copays and deductibles for any consumer requiring testing for the coronavirus (COVID-19) and his order protecting consumers from receiving surprise bills for lab fees related to medically necessary diagnostic testing for COVID-19 are both extended until April 28.

Kreidler’s order waiving cost-sharing applies to all state-regulated health insurance plans and short-term, limited-duration medical plans. The order on surprise billing applies to both in-state and out-of-state laboratories when a provider orders diagnostic testing for COVID-19.

Also, insurers must continue:

    Allowing a one-time early refill for prescription drugs.

    Suspending any prior authorization requirement for treatment or testing of COVID-19.

In addition, if an insurer does not have enough medical providers in its network to provide testing or treatment for COVID-19, it must allow enrollees to be treated by another provider within a reasonable distance at no additional cost.

“Consumers are rightly concerned about prevention, testing and possible treatment,” Kreidler said. “My emergency order provides guidance to health insurers and should help reassure the public that we will take all necessary steps to protect them.”

Kreidler is using powers granted to him following the statewide emergency that Gov. Jay Inslee declared to protect Washington residents against the spread of the coronavirus.

When the governor issues an emergency proclamation, the commissioner can issue an emergency order related to health care coverage to ensure access to care. The order can be extended by the commissioner for 30 days at a time as long as the governor’s emergency proclamation remains in effect.

Washington — Draft E2SHB 1688 Consumer Notice: The Legislature has passed E2SHB 1688; it is awaiting the Governor’s signature.  Section 13 of the legislation directs OIC to, in consultation with health carriers, health care providers, health care facilities, and consumers develop standard template language for a notice of consumer rights notifying consumers of their rights under the state Balance Billing Protection Act and the federal No Surprises Act.  The legislation maintains current law at RCW 48.49.060 directing OIC to determine by rule when and in what format health carriers, health care providers, and health care facilities must provide consumers with the notice.

OIC has prepared a draft notice for review and comment.  Please submit any comments regarding the notice to policy@oic.wa.gov by April 6, 2022.