Around the PIA Western Alliance States – Week of August 5, 2024

Idaho — DOI publishes preliminary health insurance rates for 2025: The Idaho Department of Insurance (DOI) has received preliminary premium rates from health insurance carriers for plans sold starting January 2025. The DOI is seeking public comments before final rates are published.

The DOI is reviewing premium rate submissions from health insurance carriers for 2025’s individual and small group plans. These proposed health insurance premium rates are published on the DOI website at https://doi.idaho.gov/consumers/health-insurance/idaho-rate-review/. The average proposed change in premium by location, by metal level, and the corresponding 2025 rates by plan, as well as the carriers’ explanations for the changes, are made publicly available for comment. Carriers filed individual market rate changes from between -3% to 11%, with an average market change of 6%. Rates for small group health insurance are proposed to increase an average of 9%. By law, the DOI only has the authority to determine the rates “unreasonable” if the requests are not adequately justified. Final rates will be publicly available October 1, 2024, at the same web address. In Idaho, the individual health insurance average market premium rates have remained below where they were five years ago, demonstrating the stability of Idaho’s market.

 Idaho is in year two of the 5-year Health Innovation 1332 waiver, which has provided a 16% reduction in individual market rates in 2024. The anticipated impact for the third year of the waiver in 2025 is that individual health insurance premiums will be 20% lower than they would have been without the waiver.

 “The waiver continues to benefit Idahoans purchasing individual health insurance more than originally anticipated and we are grateful for the support of Governor Brad Little and the Idaho Legislature,” Director Cameron added.

The 1332 waiver – combined with the High-Risk Reinsurance Pool – has helped keep Idaho’s individual health insurance market healthy. Idaho consumers can choose from 8 health carriers and 149 plans on the exchange.

Comments, questions, or ideas can be submitted via online form at https://doi.idaho.gov/contact-doi/?id=285 or mailed to the following:

2025 Rate Comments

Idaho Department of Insurance

PO Box 83720

Boise ID 83720-0043

The DOI encourages consumers to carefully review all their options with a licensed insurance agent once the final rates are published.

Idaho — Rate of Interest on Deferred Payment of Cash Surrendered Benefits, Effective July 1, 2024: Idaho Code Sections 41-1927(3) and 41-1927A(3)(b) permit an insurer to defer the payment of any cash surrender value under a life insurance policy or individual deferred annuity when payment of the surrender value is requested by the policyholder with surrender of the policy.  If payment of the surrender value is deferred, the same code sections require that the insurer pay interest to the policyholder.  Non-tender of payment of the surrender value within 30 days of a request therefore is considered an election by the insurer to defer payment. The thirty-day period begins on the date the request was received by the insurer or its authorized agent or representative.

Effective July 1, 2024, insurers must pay a minimum interest rate of 10.125% on deferred payment of cash surrender values, pursuant to Idaho Code Sections 41-1927(3) and 41-1927A(3)(b). The 10.125% interest rate is computed in accordance with Idaho Code § 28-22-104(2) and is effective from July 1, 2024, through June 30, 2025. The Idaho State Treasurer announces a new rate on or about July 1st of each succeeding year. The rate calculation can be reviewed at the State Treasurer’s website: https://sto.idaho.gov/Reports/Legal-Rate-of-Interest.

This Bulletin is not new law but is an agency interpretation of existing law, except as authorized by law or as incorporated into a contract. Any questions regarding this Bulletin can be directed to Deputy Director Wes Trexler at 208-334-4214 or weston.trexler@doi.idaho.gov.

Oregon — Permanent Rule Making ID 14-2024: Drug Manufacturers Annual Fee Assessment: Adopt Rule: 836-200-0553

Rule Summary: Adopted annual fees paid by drug manufacturers.

Amend Rule: 836-200-0555

Rule Summary: Amended assessments against prescription drug manufacturers for 2023 and prior.

Filed: July 31, 2024

Effective: August 1, 2024

Oregon — Oregon Division of Financial Regulation lowers health insurance rates; preliminary decision would reduce rates in individual and small group markets: Each year, the Oregon Division of Financial Regulation (DFR) conducts a transparent health insurance rate review process for health plans that comply with the Affordable Care Act for small businesses and people who buy their own coverage rather than getting it through an employer.

Conducting a yearly rate review ensures that premium rates charged to Oregonians adequately cover health care costs without being too high or too low. This transparent process includes public hearings and a public comment period. Once a year, insurance companies submit to the division their rate change requests for the next year. These requests are rigorously reviewed by division actuaries during a months-long public review process.

In May, six health insurance companies submitted health insurance rates in the individual market with a weighted average increase of 9.3 percent. Following an initial public hearing and public comment period, DFR has issued a preliminary decision lowering those rates to an average 8.1 percent increase. The lowered rates were driven by an actuarial review by the division that found several components of the company rate filings to be above division actuarial parameters. The department has the authority to review and revise rates to ensure they are “reasonable and not excessive, inadequate or unfairly discriminatory,” pursuant to ORS 743.018 (4).

“Our new health rate review guide helps to bring clarity and make the process more accessible. I’m glad we were able to find ways to save Oregonians money in a time when budgets are tight,” said Andrew R. Stolfi, Oregon insurance commissioner and director of the Department of Consumer and Business Services. “Our health insurance market is competitive, and we have five carriers offering plans in every Oregon county next year, which gives Oregonians more options to shop for plans to fit their budget.”

As part of this year’s health rate review filings, Moda became the fifth company to offer health insurance in every single county in Oregon after expanding into Benton, Linn, and Lincoln counties. Moda joins BridgeSpan, PacificSource, Providence, and Regence as health insurance companies who provide coverage in all parts of Oregon. It is the first time that five insurers have offered plans in every county. 

In the small group market, which serves small businesses with one to 50 employees, eight insurance companies submitted health insurance rates with a weighted average increase of 12.3 percent. DFR’s analysis resulted in lowering the requests of two companies. The average increase range is now 5.7 percent to 16.3 percent, for a weighted average increase of 12.2 percent. The increase was due in large part to medical costs and inflation.

DFR’s review also showed that the Oregon Reinsurance Program continues to help stabilize the health insurance market and keep rates lower. This program works to offset risk experienced by insurers, ultimately lowering premiums. Reinsurance lowered rates by at least 6 percent for the seventh straight year. In fact, this year it saved consumers 8.4 percent.

See the attached chart for the full list of rate change requests — https://dfr.oregon.gov/healthrates/Documents/2025-rate-and-county-coverage.pdf

The division has created a Consumer Guide to 2025 Health Insurance Rate Filings to explain how rates were arrived at and the adjustments made. This guide provides comprehensive detail as to the key components of the 2025 rates and an explanation to adjustments made by the division.

The division has also created a general Consumer Guide to Health Insurance Rate Review to help explain how rates are determined each year.

DFR will hold a virtual hearing Tuesday, Aug. 6, at 1 p.m. for final public comment on the preliminary rates. A link for the hearing and the consumer guides can be found at www.oregonhealthrates.org.

Final decisions will be made in August after the public hearing and comment period end.

Oregon — Drug Price Transparency Program seeks input on prescription increases: The Oregon Division of Financial Regulation’s (DFR) Drug Price Transparency Program is seeking the public’s input on high prescription drug prices. Consumers are encouraged to report prescription drug price increases on DFR’s website, dfr.oregon.gov/rxdrugprices.

If anyone needs help completing this form, or has questions, they can call the message line at 833-210-4560 (toll-free) and leave a message with the best time to call back. Individuals can also reach DFR by email at rx.prices@dcbs.oregon.gov.

Getting information directly from consumers will help DFR have more accurate information about how consumers are affected by high or increased costs of their prescription drugs. This will help the division inform the Oregon Legislature in DFR’s annual report, which is expected to come out in December. Consumers can also view the data on the DFR website and provide stories for the annual hearing and report.

“We recognize that prescription drug costs are increasing and the impact this has on Oregonians on a daily basis,” DFR Administrator TK Keen said. “Our hope is to get input from the public so we can inform policymakers and researchers alike on prescription drug costs.”

Oregon — Oregon Division of Financial Regulation warns people to be careful before signing assignment of benefits agreement after natural disaster: With wildfires raging across the state, the Oregon Division of Financial Regulation (DFR) wants to make sure people are taken care of in the event of a catastrophe and warned of those who may want to take advantage of a vulnerable situation.

One of those ways is through an assignment of benefits (AOB) agreement, which is a contract between a homeowner and a third party that transfers the insurance claim rights or benefits in an insurance policy to the third party. This allows the third party, which is typically a contractor, plumber, roofer, or other construction professional, to file the claim, make decisions about home repairs, and collect insurance payments without involving the homeowner.

DFR stresses that you are not required to enter an AOB with a third party to have repairs done – you can file a claim directly to your insurance company.

An AOB can be a useful tool for getting repairs done, as it allows the repair company to deal directly with an insurance company when negotiating repairs. It also allows the insurer to pay the repair company directly. However, an AOB is a legal contract, so policyholders need to understand the rights they are signing away and make sure the repair company is trustworthy. Here are some reminders:

With an AOB, the third party, like a roofing company or plumber, may file your claim, make repair decisions, and collect insurance payments without your involvement. They can also sue your insurer, and you can lose your right to mediation.

Once you have signed an AOB, your insurer only communicates with the third party.

It is possible the third party may demand a higher claim payment than the insurer offers and then sue the insurer when it denies the claim.

“It is important for homeowners to know their rights and understand what they are agreeing to with an assignment of benefits,” said Andrew R. Stolfi, Oregon insurance commissioner and director of the Department of Consumer and Business Services. “Importantly, you are signing away your right to control many decisions related to the repair of your home. While this arrangement can be a good thing with the right contractor, it can result in a headache if it ends up in the wrong hands.”

DFR reminds homeowners to be diligent and alert for fraud. Home repair fraud is common after a natural disaster, and some contractors may prey on victims in hopes of making a quick buck. It is usually a good idea to do business with local businesses or trusted companies. Check references and talk to your friends and family. You should also always confirm that a contractor is licensed in the state of Oregon. Your insurance company may also have recommendations, and you should get more than one bid for your repairs.

“It is also essential that homeowners protect their investment by only working with contractors that have been licensed with the Construction Contractors Board (CCB),” said Chris Huntington, Oregon CCB administrator. “Homeowners should always visit the CCB website to verify the license and review the history of the contractor they are considering for the job. The CCB provides a variety of resources to help homeowners avoid scams and successfully complete their repair work after any disaster.”

Anyone who has questions or feels they may have been taken advantage of can always contact one of our consumer advocates at 888-877-4894 (toll-free) or through email at dfr.insurancehelp@dcbs.oregon.gov. 

For more information about AOB agreements, the National Association of Insurance Commissioners offers additional resources and information. DFR also has resources on understanding homeowners insurance and other insurance tips, including a brochure designed to help homeowners avoid disaster scams.

Washington — Notice of updated sample nondiscrimination notice: The Department of Health and Human Services (HHS) released a new final rule on section 1557 of the ACA. The final rule relates to nondiscrimination in health programs and activities. § 92.10 of the new rule requires carriers to post a notice stating that they are compliant with federal non-discrimination laws.

OIC has provided a sample notice that aims to aid carrier compliance with both federal and Washington state nondiscrimination laws. Given the newly adopted federal rule, , the sample notice has been updated  for use by carriers.

Note to carriers: Obtaining a religious and/or conscience exemption from HHS, as described in the notice, does not excuse any carrier from full compliance with Washington state laws.

For more information, please visit the sample notice webpage — https://bit.ly/3LWgA1e

Washington — New report offers options for improving the affordability of health care in Washington state: The Office of the Insurance Commissioner (OIC) issued a new report today (PDF, 3.20MB) studying five potential policy options that could make health care more affordable in Washington state. The report, delivered to the state Legislature, uses pricing data to provide an economic and actuarial analysis of each policy option that estimates savings for consumers, organizations and the state’s economy.

“We’ve made great strides in getting people access to health coverage in Washington state, but it’s simply not enough,” said Insurance Commissioner Mike Kreidler. “Too many people have insurance they can’t afford to use, either because the deductibles are too high or medical costs are growing faster than inflation. This report looks carefully at several options we’ve talked about generally and provides the detailed analysis we’ve needed to help our policymakers find a path forward for consumers, employers and our health care system.”