Around the PIA Western Alliance States – Week of May 5, 2025

California — Work Comp Premiums: The Workers’ Compensation Insurance Rating Bureau of California has submitted a September 1, 2025 pure premium rate filing. It’s seeking rates an average of 11.2% above the rates approved in September of last year.

The bureau is looking for $1.56 per $100 of payroll. Last year’s average was $1.40.

 proposing advisory pure premium rates on average 11.2% above the average approved September 1, 2024 advisory pure premium rates.

The average of the September 1, 2025, advisory pure premium rates proposed by the WCIRB in its filing to the California Department of Insurance is $1.56 per $100 of payroll, while the average of the approved September 1, 2024 advisory pure premium rates was $1.40.

Source link: Insurance Journal — https://bit.ly/4jHZwLz

California — Safe Homes Act: State and community leaders supported a bold new initiative to confront California’s worsening wildfire and insurance crises: the California Safe Homes Act (Assembly Bill 888). Driven by years of extensive community outreach and unprecedented stakeholder engagement, the Act represents a transformative step toward wildfire resilience and insurance affordability. The California Safe Homes Act passed the Assembly Insurance Committee on a 16 - 0 vote.

“Investing in mitigation is crucial to overcoming this insurance crisis. We are not powerless in this fight. We need to equip consumers with the resources to undertake necessary work,” stated Insurance Commissioner Ricardo Lara, the sponsor of the California Safe Homes Act. “We have traveled across every region of the state, listened to thousands of Californians, collaborated with local communities and firefighters, and consulted with insurance leaders from other states and countries. One thing is clear: wildfire safety works—and we must scale it like never before.”

“Investing in proven safety measures to make California safer from wildfires is essential to protecting lives, homes, and access to insurance,” said Assemblymember Lisa Calderon, author of the California Safe Homes Act. “AB 888 is a step in the right direction to assist California residents and create more resilient communities throughout our state.”

The California Safe Homes Act is designed to make homes safer from wildfires while increasing access to insurance. The Act will fund critical mitigation efforts, including:

Fire-safe roofing

Defensible space within the first five feet of a home, also known as “zone 0”

Community-level wildfire protection strategies

These are some of the most impactful and costly measures, and homeowners have consistently told the Department of Insurance they want to do this work but simply cannot afford it. California Safe Homes puts money back in people’s hands to pay for these essential projects.

The initiative builds on Safer from Wildfires—developed by the Department of Insurance—which lays out 10 proven, achievable wildfire safety actions. It is the first plan of its kind in the nation, created proactively to reduce wildfire risk before disaster strikes.

“Protecting homes before a hurricane ever happens has helped bring affordable insurance back to Alabama. Natural disasters like windstorms, earthquakes, or wildfires will come no matter what we do. That means you must find ways to build stronger before the event so you will have less damage after the event,” said Alabama Insurance Commissioner Mark Fowler, who told the committee about the success of the Strengthen Alabama Homes grant program. “It’s actually a pretty simple concept. AB 888 will help you pave that way.”

“I have sought clear, workable examples from beyond our borders,” said Commissioner Lara. “Through my leadership in the National Association of Insurance Commissioners and visits to other states, I have observed successful strategies in action. Disaster mitigation programs are the cornerstone of our National Climate Resilience Strategy, effectively protecting homes against perils, stabilizing markets, and providing consumers with more options. I’m honored to welcome Commissioner Mark Fowler, a leader and visionary in this field.”

Leaders from across sectors are supporting the bill — including nonprofits like United Policyholders and community officials.

“Through our work with our own defensible space grant program, we have witnessed homeowners who invest in these safety improvements not only better protect their homes but also gain access to more affordable insurance options — a lifeline in communities where coverage is increasingly difficult to secure,” said Jen Goodlin, Executive Director of the Rebuild Paradise Foundation which has worked directly with hundreds of homeowners rebuilding in wildfire-prone areas. “Families who participated in our program and created a non-combustible zone 0 — the critical first five feet of defensible space around their homes — have received the reward of insurability and peace of mind. This bill would greatly benefit not just Paradise, but our Upper Ridge community of Magalia — this area has limited resources and significant wildfire fuel — by providing the support needed to make critical safety improvements. AB 888 offers hope for communities like ours, helping ensure a safer, more resilient future.”

“Creating defensible space and hardening our homes against wildfire is a shared responsibility, but for many homeowners, the cost is simply too high,” said Tanya Harlow, Fire Safe Coordinator, El Dorado County Office of Wildfire Preparedness and Resilience. “California Safe Homes will provide much-needed support to help make our communities more resilient to wildfire.”

“We have worked with thousands of people in California and across the country to be prepared before a disaster ever happens. Home hardening and defensible space are proven ways to reduce wildfire risk and keep homes insured, and homeowners need help making these improvements,” said Amy Bach, Executive Director of United Policyholders, whose Wildfire Risk Reduction and Asset Protection program (WRAP) is a national model for community education. “The California Safe Homes Act puts money in people’s hands to do to their part and rewards those taking action to protect themselves and their neighbors.”

"As we speak, the City of Berkeley is in the process of adopting new Zone Zero requirements for more than 1,800 residents who live in the Very High Fire Hazard Severity Zone. We don't want cost to be a barrier that prevents homeowners from making these critical improvements,” said Berkeley City Councilmember Brent Blackaby. “The Calfornia Safe Homes Act will help finance this defensible space and home-hardening work at scale, which will make each homeowner safer, make their neighborhood safer, and make all of Berkeley safer."

The California Safe Homes Act will be heard next in the Assembly Appropriations Committee.

California — Defending State Health Insurance Laws: To protect Californians’ health insurance coverage in the face of continued attacks by the federal Administration on the rights and access to health care for historically disadvantaged and vulnerable populations, California Insurance Commissioner Ricardo Lara issued a formal Notice to all health insurers in the state. His consumer protection action reaffirms the California Department of Insurance’s unwavering commitment to enforcing all state laws that protect consumers’ rights to equitable, accessible, culturally competent health care.

“Californians deserve health care that is inclusive, does not discriminate, and is protected by state law,” said Commissioner Lara. “My Department is committed to upholding every legal safeguard in place to ensure that all communities, especially those historically left behind, continue to receive the coverage and care they are entitled to under California law.”

The Notice reminds insurers that all state consumer protection laws remain in effect, including coverage and antidiscrimination requirements for women, students, youth, immigrants, people of color, and members of the LGBTQIA+ community.

Commissioner Lara emphasized that California’s robust consumer protections remain firmly in place and are fully enforceable. Health insurers are required to comply in full.

“The Trump administration’s attacks on healthcare access are not just reckless—they’re dangerous, discriminatory, and morally indefensible,” said Equality California Executive Director Tony Hoang. “These policies are designed to intimidate and exclude—targeting women, immigrants, LGBTQ+ people, and people living with HIV. In moments like these, California must lead — and we are deeply grateful to Insurance Commissioner Ricardo Lara for standing firm in the face of dangerous federal overreach. His unwavering commitment to enforcing our state’s strong nondiscrimination protections ensures that all Californians can continue to access the care they need and deserve.”

Key laws that Commissioner Lara and the Department are ensuring compliance by health insurers, include, but are not limited to:

SB 923 (Wiener, Chapter 822, Statutes of 2022): The Transgender, Gender Diverse or Intersex Inclusive Care Act guidance requires trans-inclusive cultural competency training for insurer staff that are in direct contact with insureds.

SB 523 (Leyva, Chapter 60, Statutes of 2022): The Contraceptive Equality Act mandates, in part, that all health insurers must provide point-of-sale-coverage for all over-the-contraceptives without a prescription, patient cost sharing, or medical management restrictions and requires that they cover any clinical services associated with the provision or use of contraceptives.

AB 904 (Calderon, Chapter 349, Statutes of 2023): The Maternal and Infant Health Equality Program requires health insurers to develop a maternal and infant health equality program to address racial health disparities in maternal and infant health.

AB 1823 (Bryan, Chapter 688, Statutes of 2022): AB 1823 ensures that the health insurance coverage students enroll in through institutions of higher education comply with most of the same rules that apply to the individual health insurance market, including all essential health benefits, basic health care services, preventive care services, antidiscrimination requirements, and other consumer protection rules.

SB 855 (Wiener, Chapter 151, Statutes of 2020): The Mental Health Parity Act expands coverage requirements, and imposes utilization management parameters for all health insurance policies.

“California has led the way in passing laws to protect health care consumers and it’s vital that we continue to strongly enforce implementation of these laws so Californians get their full benefits,” said Amanda McAllister-Wallner, executive director of Health Access California, the statewide health care consumer advocacy coalition. “While our health care is at risk from federal attacks, we appreciate that Insurance Commissioner Ricardo Lara is committed to safeguarding our vital consumer protections. California health insurers are on notice to keep abiding by state law so all California communities have access to culturally competent health care, reproductive care, and mental health services.”

In addition, Commissioner Lara and the Department remind health insurers of existing California laws protecting reproductive freedom and access to life-saving medications namely:

Coverage for Abortion and Abortion-Related Health Care Services: Reminds health insurers following the Dobbs v. Jackson decision about California insurance laws protecting reproductive freedom.

HIV Preexposure Prophylaxis (PrEP): Reminds health insurers following the Braidwood decision of their obligation to provide continued access to medically necessary and essential preventive health services, such as PrEP, as required by state law, and outpatient prescription antiretroviral drugs for preventing HIV without prior authorization or step therapy requirements.

Idaho — Third annual post-award public forum for Section 1332 Waiver: The Idaho Department of Insurance (DOI) will hold a public forum and accept public comments regarding Idaho’s Section 1332 State Innovation Waiver on May 30, 2025, from 10:30 AM to 11:30 AM MST.

Background

On May 6, 2022, The State of Idaho applied for and received a State Innovation Waiver under Section 1332 of the federal Patient Protection and Affordable Care Act (ACA) to facilitate the operation of Idaho’s state reinsurance program as authorized by 41-5504(5), Idaho Code. The waiver’s effective date was January 1, 2023. Pursuant to the Standard Terms and Conditions (STCs) applicable to the 1332 Waiver, 31 CFR §33.120(c), and 45 CFR §155.1320(c), an annual post-award forum regarding the Section 1332 Waiver must be held, with the first such annual meeting being held within six months of the waiver’s effective date.

Public Forum

The purpose of the annual post-award forum is to allow the public an opportunity to provide meaningful comments on the progress of the waiver. Notice of the public forum was posted on Idaho’s public website, Townhall Idaho, on April 29, 2025. Public comments will be accepted at the public forum and will also be accepted through May 30, 2025, by email to DOI.Reform@doi.idaho.gov.

The May 30th public forum will be held at 10:30 AM MST at 700 W. State St, JRW East Conference Room. The forum will also be accessible via Microsoft Teams as shown below:

Microsoft Teams

Meeting ID: 298 210 471 822 5

Passcode: y6LJ95Cw

More detailed information regarding the Section 1332 Waiver may be viewed at the DOI website at https://doi.idaho.gov/information/public/reinsurance-waiver/.

Idaho — BULLETIN NO. 25-03: All Entities Offering Health Benefit Plans Subject to Idaho Code § 39-2301. From: Dean L. Cameron, Director

Subject: Compliance Guidance Regarding House Bill 134 (2025) – Coverage for Breast Cancer Screening, Idaho Code Title 39, Chapter 23

Purpose

This Bulletin provides guidance regarding House Bill 134 (2025), which creates Idaho Code Title 39, Chapter 23, “Breast Cancer Screening.” This new chapter establishes mandatory coverage requirements within health benefit plans for breast cancer screenings, specifically defining and requiring coverage for “supplemental breast screening” under certain conditions. These new statutory requirements are effective January 1, 2026.

This guidance highlights key statutory requirements and outlines necessary compliance actions, including form and notice filings. Insurers are responsible for reviewing the full text of the law (Idaho Code Title 39, Chapter 23) and ensuring their products and practices fully comply with all provisions by the effective date.

Applicability

Pursuant to Idaho Code § 39-2301(2) and Section 2 of House Bill 134 (2025), the requirements of Idaho Code Title 39, Chapter 23 apply to all applicable health benefit plans, as defined in § 39-2301(2), that are in effect on or after January 1, 2026.

The chapter applies to policies and contracts originally effectuated before January 1, 2026, that remain active on that date, as well as policies and contracts effectuated on or after January 1, 2026.

Summary of New Coverage Requirements Effective January 1, 2026

Idaho Code Title 39, Chapter 23 requires applicable health benefit plans to provide coverage for, at a minimum:

Annual Supplemental Breast Screening: Coverage for “all costs associated with one (1) supplemental breast screening every year” for covered individuals identified as having an increased risk of breast cancer.

“Supplemental breast screening” is defined in Idaho Code § 39-2301(1).

The specific criteria defining “increased risk” are enumerated in Idaho Code § 39-2301(3)(a) through (g).

Cost-Sharing: Pursuant to Idaho Code § 39-2301(3), the annual supplemental breast screening must be covered with no patient cost-sharing (deductible, copayment, or coinsurance). This applies to services received from in-network providers. Idaho Code § 39-2301(4) clarifies that cost-sharing provisions contained in the policy or plan may be applied to other breast imaging services that are in excess of this minimum required coverage (e.g., diagnostic imaging, supplemental screenings performed more frequently than annually). Similarly, additional costs may be applied to services from out-of-network providers.

Required Insurer Actions and Form Filings

To comply with Idaho Code Title 39, Chapter 23, affected entities must take the following actions:

Revisions to Plan Documents

Update plan contracts, Summaries of Benefits and Coverage (SBCs), Outlines of Coverage (if applicable), and any relevant marketing materials to accurately reflect the added benefit and its coverage without cost-sharing.

Submit all necessary form filings to the Department via the System for Electronic Rate and Form Filing (SERFF) prior to January 1, 2026.

Filings must include riders, endorsements, or amended forms necessary to bring all applicable policies, contracts, certificates, and evidences of coverage that will be in effect on or after January 1, 2026, into compliance with the statutory requirements.

Consumer Notification

Develop a clear notice for insureds/enrollees/members explaining the changes in coverage statutorily required by this law, effective January 1, 2026.

Submit a template of this consumer notice to the Department via SERFF as a Supporting Document included with the related form filing for review.

Distribute the approved notice to all affected insureds/enrollees/members no later than thirty (30) days prior to the date the coverage change takes effect (i.e., no later than December 2, 2025, as the change is effective January 1, 2026 for all applicable plans).

The notice must, at a minimum, include:

A clear explanation of the newly added supplemental breast screening benefit effective January 1, 2026.

The specific circumstances under which an individual is considered at increased risk, referencing or listing the criteria from Idaho Code § 39-2301(3)(a) through (g).

That the annual supplemental breast screening benefit is covered without patient cost-sharing (deductible, copayment, or coinsurance) when criteria in § 39-2301(3) are met. The notice should also clarify that cost-sharing may apply to other breast imaging services as outlined in the plan documents and permitted by § 39-2301(4).

Conclusion

The Department expects timely action by affected entities to ensure full compliance with Idaho Code Title 39, Chapter 23, including coverage of the annual supplemental breast screening without patient cost-sharing, for all applicable plans in effect on or after January 1, 2026.

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. Requests for additional information or other inquiries regarding this Bulletin can be directed to Market Oversight Bureau Chief Shannon Hohl at 208-334-4315 or shannon.hohl@doi.idaho.gov.

Idaho — Breast Cancer Screening Guidelines: The Idaho Department of Insurance has published Bulletin 25-03 to provide guidance on House Bill 134, which requires health insurance plans to provide additional preventive breast cancer screenings at no cost to members for in-network services.

House Bill 134 was signed by Governor Brad Little on March 24, 2025. The new statutory requirements are effective January 1, 2026.

Idaho Code Title 39, Chapter 23 requires applicable health benefit plans to provide coverage for, at a minimum:

Annual Supplemental Breast Screening: Coverage for “all costs associated with one supplemental breast screening every year” for covered individuals identified as having an increased risk of breast cancer.

Cost-Sharing: Pursuant to Idaho Code § 39-2301(3), the annual supplemental breast screening must be covered with no patient cost-sharing (deductible, copayment, or coinsurance). This applies to services received from in-network providers. Idaho Code § 39-2301(4) clarifies that cost-sharing provisions contained in the policy or plan may be applied to other breast imaging services that are in excess of this minimum required coverage (e.g., diagnostic imaging, supplemental screenings performed more frequently than annually). Similarly, additional costs may be applied to services from out-of-network providers.

Prior to January 1, 2025, insurers are required to update and file plan documents and notify members about the new benefits. More details can be found in the bulletin.

“House Bill 134 will help Idahoans access the critical preventive services they need,” said Idaho Department of Insurance Director Dean L. Cameron. “We would like to thank the legislature for passing this piece of legislation, and Rep. Brooke Green, Rep. Dori Healey and Rep. Ilana Rubel for sponsoring this important bill.”

“Early detection saves lives, and I’m thrilled to have helped pass this impactful legislation that will make life-saving care more affordable and accessible for so many Idaho women at high risk for breast cancer,” said Rep. Brooke Green (18).

“Consumers should contact their insurer with any questions, or contact our department if they experience coverage issues,” added Shannon Hohl, DOI Market Oversight Bureau Chief. “Our consumer affairs team is available to help with insurance questions and concerns.”

Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: NCCI Statistical Plan changes related to the Experience Rating Plan Manual for Workers’ Compensation

Rules Proposed: 836-042-0025

Rules Summary: This rule does not allow for scheduled rating plans, which is in conflict with ORS 656.508(3). Therefore, part (b) of this rule will be removed.

Rules Proposed: 836-042-0045

Rules Summary: Amended for revisions to become effective on or before July 1, 2025, is prescribed as the statistical plan for workers’ compensation and employers' liability insurance.

Filed: April 24, 2025

Hearing Date/Time: May 22, 2025, 9:00 AM, Pacific Time

This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.

Last day/time to offer comment: May 29, 2025, 5:00 PM 

For more information on recently proposed rulemaking, please visit the division's website:

https://bit.ly/3GCqENB

Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Amendment to 2026 standard silver health benefit plan

Rules Proposed: 836-053-0013

Rules Summary: Update standard silver plans

Filed: April 24, 2025

Hearing Date/Time: May 22, 2025, 11:00 AM, Pacific Time

This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.

Last day/time to offer comment: May 29, 2025, 5:00 PM 

For more information on recently proposed rulemaking, please visit the division's website:

https://bit.ly/44UPQbZ

Oregon — Oregon Division of Financial regulation returns over $2 million to Oregonians in first quarter of 2025: In the first quarter of 2025, the Oregon Division of Financial Regulation (DFR) recovered over $2 million through the work of its consumer advocate and compliance teams.

DFR’s consumer advocates have extensive knowledge across many areas of regulation, including helping those experiencing difficulties with insurance, mortgages, banking products, securities, student loans, and a variety of other financial services regulated by the division.

“This $2 million returned to Oregonians is a testament to what we can do when state government works diligently to protect consumers and hold financial institutions accountable,” Gov. Tina Kotek said. “I applaud the continued commitment to ensuring fairness and justice in our financial system.”

In the first quarter of 2025, consumer advocates received 1,431 total complaints, which is up over the last quarter of 2024 when advocates saw 1,248 total complaints. Complaints in the insurance realm continue to lead the way, with 868 complaints filed so far this year. Mortgage service complaints is the next highest in areas DFR regulates with 55.

Here are a few examples of work DFR advocates have done this year:

The consumer sold a vehicle and notified her agent’s office to remove that vehicle from the policy and add her new vehicle. The agent acknowledged receipt of the request and added the replacement vehicle but never completed removing the vehicle that was sold. The consumer noticed months later that the sold vehicle was never removed from the policy and requested a correction. The agent’s office was only able to backdate the vehicle’s removal 30 days, so a request was submitted to the corporate office for help. The insurer was unwilling to process the removal back to the requested date, saying that the information did not meet its guidelines for backdating. The consumer then filed a complaint with DFR. After reviewing the complaint, the insurer confirmed that the consumer’s request to remove the vehicle was in the agent’s notes and processed the backdated removal of the vehicle and refunded the consumer $3,354.89.

The consumer called his dental insurer to make a plan change due to his primary dentist not being in-network with his new plan. The customer service representative told the consumer they would be allowed to complete this application change, even though it was outside of open enrollment. The application was processed, but the consumer received a letter a week later saying to change plans he would have to submit a special enrollment period (SEP) validation, which he did not qualify for. The consumer filed a complaint with DFR, and the division requested that based on the information provided, the insurer allow the plan change outside of open enrollment. The insurer agreed to this, allowing the consumer to continue to see his dentist.

The consumer experienced a significant hail event and reported a claim for roof damage. The company hired an independent adjuster to inspect the roof, and the inspection revealed minimal damage to only roof vents and downspouts. A small payment of $94.89 was issued. The consumer contacted a roofer who completed an inspection, documented the damage, and provided an estimate for a roof replacement. The insurer did not agree with the roofer’s assessment, so the consumer filed a complaint. After receiving the complaint, the insurer conducted an additional review of the roofer’s photos, which documented roof damage. The insurer agreed to have the roof reinspected, which resulted in an approval to pay for a roof replacement.

“I continue to be impressed at the level of professionalism, customer service, and expertise our consumer advocates display on a daily basis,” said Andrew R. Stolfi, Oregon’s insurance commissioner and director of the Department of Consumer and Business Services. “They continue to work at a high level through extremely complex issues, which often leads to money back to Oregonians.”

In 2024, DFR recovered nearly $9 million for consumers and handled nearly 5,500 complaints.

“Our team continues to put its expertise to work for the benefit of Oregonians,” said DFR Administrator TK Keen. “Their work gets money back into the pockets of hard-working consumers, and gives them peace of mind knowing there are people who go to bat for them every day.”

Anyone who may need a consumer advocate can call 1-888-877-4894 (toll-free) or email dfr.insurancehelp@dcbs.oregon.gov for insurance related issues and dfr.finanicialserviceshelp@dcbs.oregon.gov for financial-related issues.

Washington — Podcast: Sens. Lovick & Slatter on wrapping up the 2025 legislative session: The podcast is back at the Capitol to meet with two lawmakers about their role in two pieces of action from the 2025 legislative session and how each one helps insurance consumers in Washington state.

Listen to the full episode here — https://bit.ly/42JL8fS

First, Sen. John Lovick (D-Mill Creek) from the 44th district chats with Commissioner Patty Kuderer about SB 5419, which changes how insurance companies report data from fire claims.

Then, Sen. Vandana Slatter (D-Bellevue) from the 48th district talks about the budget proviso to help fund the SHIBA program and how important it is to help people with their Medicare issues.