Around the PIA Western Alliance States – Week of October 13

California — Insurance Commissioner Ricardo Lara and Senator Ben Allen Limit “the List” as Important Consumer Protection Measure is Signed by Governor: California wildfire survivors will now face one less burden on their road to recovery as Governor Gavin Newsom today signed Senate Bill 495, authored by Senator Ben Allen (D-Pacific Palisades) and sponsored by Insurance Commissioner Ricardo Lara.

Beginning January 2026, in the event of a declared emergency, insurance companies will be required to pay 60 percent of personal property (contents) coverage limits, with a cap of $350,000, to policyholders who experience a total loss without requiring policyholders to submit a detailed inventory for at least 100 days.

“The recent LA Fires exposed difficult inefficiencies in our insurance system that unnecessarily delay the urgently needed financial support survivors are justly due,” said Senator Allen. “I am grateful to have worked with Insurance Commissioner Lara over the past year to ensure fairer upfront payments are moving out the door quickly and without overburdening those who just lost everything. Thank you Governor Newsom for recognizing we can and must do more to support disaster victims on the difficult road of recovery.”

Under the current law, insurance companies are only required to pay 30 percent of primary structure (dwelling) coverage limits, and it is capped at $250,000. Not only is this formula confusing for policyholders given it is based on primary structure coverage, but it often results in insufficient payments for properties with higher limits - examples of which were common in the recent Los Angeles wildfires. Policyholders are also currently required to complete a content inventory and to submit proof of loss to insurers within 60 days of loss. This process is unduly burdensome for policyholders and unrealistic as many policyholders in the recent wildfires did not have access to their insured property for an extended period of time due to unsafe or hazardous conditions.

This bill also requires insurers to provide the Department of Insurance annual, point-in-time reinsurance and catastrophe model data for policies written in California for the previous year. A key element of Commissioner Lara’s Sustainable Insurance Strategy is to expand the writing of insurance policies for consumers in wildfire areas and protect the long-term strength of the California insurance market. Having clear, point-in-time data on reinsurance and catastrophe modeling associated with wildfire risk will help protect the strength of the California insurance market and work to address availability concerns. With this data, the Department will publicly aggregate results, evaluating short- and long-term market trends and scenarios.

“Senator Allen and I worked to enhance consumer protections based on the experiences of wildfire survivors. It is inhumane to require survivors to list destroyed items before receiving benefits," said Commissioner Lara. "By ensuring a fair upfront payment, we ease a significant burden for survivors, allowing them to focus on what truly matters after a catastrophe: finding shelter and starting the long journey to recovery with dignity, compassion, and meaningful financial support."

This bill will also give the Insurance Commissioner authority to either issue a bulletin or promulgate regulations that describe the parameters of any attestation forms that insurers may require policyholders to sign. This will make the process clearer, more supportive, and less burdensome for policyholders who are already navigating a traumatic experience.

California — Wildfire safety leads Commissioner Lara’s agenda as Governor Newsom signs sponsored bills: Insurance Commissioner Ricardo Lara announced new wildfire safety protections for California consumers as Governor Gavin Newsom signed three critical bills aimed at enhancing mitigation efforts, reducing risk, and attracting insurers back into our market. These laws seek to provide financial assistance for wildfire safety, enhance insurance discounts, and establish the nation’s first public wildfire model for community planning and education.

“Investing in mitigation is essential to tackling the insurance crisis. We are not powerless in this fight. With these new laws, we can equip consumers with the resources needed for necessary work while putting money in their pockets,” said Insurance Commissioner Ricardo Lara. “We have traveled across the state, listened to thousands of Californians, collaborated with local communities and firefighters, and consulted insurance leaders from other states and countries. Disaster mitigation programs are the cornerstone of our National Climate Resilience Strategy, effectively safeguarding homes against risks, stabilizing markets, and providing consumers with more options.”

These new protections build on the Safer from Wildfires initiative, a groundbreaking insurance discount regulation enacted by Commissioner Lara in 2021 that outlines proven and achievable wildfire safety actions. Safer from Wildfires is the first plan of its kind in the nation, proactively created to mitigate wildfire risk before disasters occur.

AB 888 (Assembly Member Lisa Calderon) The California Safe Homes Act: This act protects homes and access to insurance by establishing a grant program within the Department of Insurance to assist qualifying residents in obtaining new or replacement fire-safe roofs and implementing fire-safe mitigation measures within 5 feet of their homes—known as “Zone Zero.” This program will cover part or all the costs and will be included in communitywide safety initiatives.

These measures are among the most impactful yet costly, and homeowners have consistently communicated their desire to undertake this work but lack the financial means. The California Safe Homes Act provides financial assistance for these essential projects.

SB 429 (Senator Dave Cortese) The California Wildfire Public Catastrophe Model Act: This act enhances community safety and education by allowing the Department of Insurance to issue grants for establishing the nation’s first publicly available wildfire loss data source. The public model will facilitate assessments of wildfire risk, educate the public, and ensure greater transparency so communities can plan effectively. The bill builds on recommendations from the Cal Poly Humboldt-led Public Wildfire Model Strategy Group. Learn more.

AB 1 (Assembly Member Damon Connolly) The Insurance and Wildfire Safety Act: This act enhances insurance discounts by requiring the Department of Insurance to regularly review its groundbreaking Safer from Wildfires regulations, ensuring they reflect advancements in science, safety, and mitigation. The law will ensure that regulations meet the needs of consumers and the industry, providing maximum benefits to homeowners and essential support to communities most vulnerable to wildfires.

The California Safe Homes Act and the Insurance and Wildfire Safety Act have garnered support from over a dozen local governments and major consumer groups, including the California Association of Realtors and United Policyholders. The California Wildfire Public Catastrophe Model Act is backed by national climate and consumer advocacy groups, including United Policyholders, the Environmental Defense Fund, and the Natural Resources Defense Council.

“Homeowners shouldn’t be left in the dark about how decisions about their insurance are made. SB 429 will create the nation’s first wildfire public catastrophe model to help homeowners understand whether they’re getting a fair deal, and it will give communities, local governments, and first responders better tools to prepare for and respond to wildfires. When homeowners know their wildfire risk, they can take meaningful steps to reduce it, protecting their property and lowering their insurance costs.” – Senator Dave Cortese, author of SB 429

“Now that AB 1 has become law, California will be able to provide much needed relief to consumers on their insurance bills while also mitigating wildfire risk,” said Assemblymember Damon Connolly. “I am proud to have authored this important legislation in partnership with Insurance Commissioner Lara, to give homeowners the chance to be heard, and allow for more Californians to benefit from the Safer from Wildfires program.”

“One thing is clear: wildfire safety works—and we must scale it like never before,” said Commissioner Lara. “I am grateful to the many legislators and partners who worked with me to champion these important issues, and I thank Governor Newsom for signing these bills to enhance wildfire safety and preparedness for all Californians.”

Idaho — Idaho’s workers’ compensation rates to drop again in 2026: The Idaho Department of Insurance (DOI) has reviewed and accepted a National Council on Compensation Insurance (NCCI) filing that will reduce workers’ compensation rates by 2.5%, effective January 1, 2026. This marks the ninth straight year of reductions for Idaho employers and continues a long-term trend of lower rates.

NCCI’s recommendation reflects multiple factors, including claims volume and utilization, workforce and wage data, as well as recent rule and legislative changes. With DOI’s acceptance of the 2.5% reduction, workers’ compensation insurers can now either adopt the NCCI rates without modification or propose to the Department’s review an adjustment from NCCI’s rates.

“This is another significant decrease to workers’ compensation rates,” said Dean L. Cameron, Director of the Idaho Department of Insurance. “Workers’ compensation rates have declined in 10 of the past 11 years—nine consecutively. The 2026 rate reduction highlights our state’s ongoing improvements in projected claims costs and the continued drop in claims frequency.”

Workers’ compensation insurance provides critical protection for both employers and employees. It covers medical expenses and wage replacement for workers injured on the job, while protecting employers from costly litigation.

NCCI annually collects information about the workers’ compensation system and submits proposed rates to the Department of Insurance for review and approval. The Department continues working with the NCCI to keep rates low for Idaho businesses and Idahoans.

Nevada — Ned Gaines Named Nevada Insurance Commissioner: Department of Business and Industry Director Dr. Kristopher Sanchez has announced the appointment of Ned Gaines as Commissioner of the Nevada Division of Insurance effective October 6, 2025.  Gaines has served as Commissioner in an acting capacity since July 2.

Gaines has more than 25 years of experience in the insurance industry. Prior to joining the Nevada Division of Insurance as the Chief Deputy Commissioner in April 2025, he served 12 years with the Washington State Office of the Insurance Commissioner in a variety of leadership roles, most recently as the Deputy Commissioner of Rates, Forms and Provider Networks. Previously, he worked for several national property and casualty insurers as a compliance manager, claims manager, claims adjuster and agent.

"Ned's extensive experience in the insurance industry and as a regulator will be an asset to the State as we continue to navigate a complex and evolving insurance landscape. Through his leadership and engagement with all stakeholders, we must work together to find and implement solutions that work for all Nevadans," said Dr. Sanchez.

As Commissioner, Gaines is charged with protecting the rights of consumers and the public's interest in dealings with the insurance industry. Under his leadership, the Division will maintain its focus on helping Nevadans navigate insurance choices, reviewing rates and forms to ensure compliance with state law, and expanding public resources to help consumers understand coverage options and how to seek assistance through the Division's Consumer Services Section. Accessibility and responsiveness to consumers and industry stakeholders will remain top priorities for the Division.

"Serving Nevadans as Commissioner is an extraordinary honor," said Ned Gaines. "I am committed to ensuring Nevadans have access to a fair insurance market and to strengthening the Division's work on consumer education, market oversight, and industry engagement. I look forward to continuing our work with the Department of Business and Industry, insurance providers, and community partners to protect consumers and promote a stable insurance market for Nevada."

Oregon — Oregon Division of Financial Regulation warns of gold bar scams: The Oregon Division of Financial Regulation (DFR) is issuing a warning to Oregon residents about the “gold bar” scam that is rapidly spreading across the nation. This scam involves fraudsters impersonating government officials who convince victims to purchase gold bars to supposedly protect their nest eggs.

This scam involves contact from someone claiming to be a government official, often associated with the U.S. Department of Treasury, who convinces the victim to convert money held in financial accounts into gold bars. The fraudster claims the victim’s financial institution isn’t safe and that physical gold is the only way to protect the assets. Once the victim agrees to convert the funds to gold, the fraudster either appears at the victim’s front door or arranges for the victim to meet them at a nearby location to pick up the gold bars. DFR urges the public to stay alert, informed, and safe. Do not become the next victim of this scam.

More generally, the scam goes like this: Victims are contacted through text, email, or phone call and told their financial accounts are at risk of being compromised for various reasons. The reasons given may include that the accounts were subject to a cyberattack or are being used for illegal activity and must be closed. Victims are advised to empty the account, purchase the gold bars, and then deliver the bars over to the “government official.” For those unable or unwilling to purchase the gold themselves, the fraudster will offer and even insist on making the purchase for them. Sometimes this includes giving the “government official” remote access to the victim’s electronic devices. Victims are tricked into believing that converting their assets to gold and storing it with the government via the scammer, or “government official,” is necessary to protect their assets. This is positively – and always – a scam.

It has already caused millions of dollars in losses to Oregon investors and others across the country.

“It is troubling that these criminals are using fear and a false sense of urgency to pressure victims into making devastating financial decisions,” said TK Keen, DFR administrator. “Even more troubling is the reality that they are in our communities and facilitating these crimes in person.”

As an additional precaution, DFR emphasizes that government officials will never contact you and demand payment using gold bars. To stay safe:

·       Be cautious of someone contacting you and claiming to be a government official. The imposter scam was the most common scam reported to the Federal Trade Commission in 2024. Government officials will never threaten you or demand that you make a payment using cryptocurrency, gift cards, or gold. If you need to communicate with a government agency, look up the contact information yourself, verify that you have not been directed to a scam site, and – only then – contact the agency using the information provided on its official website. Never share your home address with strangers who contact you.

·       A government official will never give you a top-secret password. Some victims are given a supposedly top-secret password and instructed to give assets to a person who provides them with the password. This is always a scam.

·       Never click on suspicious links or respond to unsolicited messages. If you receive an email or text from an unknown sender (even if the details appear accurate), do not respond, and do not click on any links or attachments found in that email. You could unknowingly download malicious software.

·       Never give out your personal and financial information. Do not share personal and financial information with strangers. Steer clear of communication and calls from strangers.

Those seeking employment might be tempted to accept positions as a driver or courier from these scammers. This is part of the scam, to use outsiders – referred to as “money mules” – to help facilitate the crime. Be very skeptical about these employment offers. Research a company thoroughly before agreeing to become involved in any “employment” of unusual activity.

DFR cautions Oregonians to remain cautious and informed. Contact local law enforcement to report this scam. You can also contact DFR to report suspected fraud, inappropriate securities business practices, or to obtain consumer information. Free investor education and fraud prevention materials are available at dfr.oregon.gov or by calling one of DFR’s consumer advocates at 888-877-4894 (toll-free) or dfr.financialserviceshelp@dcbs.oregon.gov.

Oregon — Sarah Young hired to lead Prescription Drug Affordability Board

Salem: The Oregon Division of Financial Regulation (DFR) recently hired Sarah Young as the executive director of the Prescription Drug Affordability Board and the Drug Price Transparency Program.

Young was the director of the policy and research division in the Federal Office of Rural Health Policy (FORHP) in the Health Resources and Services Administration since 2023. As director, she managed a division of 17 people conducting FORHP’s policy analysis, data analysis, research, and rural residency development efforts. Young’s past work in FORHP has included managing Rural Health Clinic COVID-19 response programs, analyzing rural hospital and Critical Access Hospital (CAH) policy, tracking nationwide rural hospital closures, and coordinating the Medicare Rural Hospital Flexibility Program focused on improving CAH quality of care and operational efficiency.

“We were very fortunate to get someone with Sarah’s expertise and experience who wanted to come back to Oregon,” said TK Keen, DFR administrator and acting insurance commissioner. “Sarah is going to be a great leader for not just the board, but also our Drug Price Transparency Program.”

Young was born and raised in eastern Oregon and holds an master’s in public health from Portland State University. She has worked for the federal government since 2011 through the Presidential Management Fellows Program. Young started at DFR on Oct. 6.

In addition to a new executive director, the board welcomed a new member, Michele Yoder, to fill a vacancy. Yoder is currently the pharmacy director for the Multnomah County Health Department. She is a past pharmacist member of the Oregon Pain Management Commission (2013-2021) and the Oregon Health Resources Commission. The board also confirmed the reappointments of Dan Hartung, Chrstopher Laman, and Dan Kennedy.

Oregon — Oregon finalizes 2026 health insurance rates for individual and small group markets: The Oregon Division of Financial Regulation has finalized the 2026 health rates for the individual and small group plans following months of federal uncertainty that delayed the normal review timeline.

Five insurers – Moda, Bridgespan, PacificSource, Providence, and Regence – will continue to offer plans statewide. Kaiser Permanente will provide coverage in 11 counties, giving consumers six options to choose from in major portions of the state.

Average changes for 2026

 Individual market: In the individual market, six companies submitted rate change requests ranging from an average increase of 3.9 percent (PacificSource) to 12.9 percent (Kaiser), for a weighted average increase of 9.7 percent. That average increase is slightly higher than last year’s requested weighted average increase of 9.3 percent.

 Small group market: In the small group market, eight companies submitted rate change requests ranging from an average increase of 5.2 percent (PacificSource) to 21.5 percent (Providence), for a weighted average increase of 11.5 percent, which is lower than last year’s 12.3 percent requested average increase.

Federal policy shifts add pressure to 2026 rates

Consumers will see the costs of premiums rise next year due to the scheduled expiration of federal Affordable Care Act tax subsidies that helped offset costs for many Oregonians. Those expanded subsidies, known as Enhanced Premium Tax Credits, will expire on Dec. 31, 2025, unless Congress acts to reauthorize them.

Without reauthorization of the subsidies, people who buy their own health coverage through the federal marketplace will receive smaller tax credits to lower their monthly premiums. For some households, especially those in middle-income brackets or in rural parts of the state, this may translate into substantial increases in premiums and out-of-pocket costs.

Although this federal change is beyond the state’s control, the state anticipates most who buy plans from the marketplace (about 126,000 as of the end of the second quarter this year) will see increases, some as much as 300 percent to 400 percent.

Even with increased premiums, it is important for consumers to maintain health insurance coverage to protect their health and guard against unexpected financial losses. To assist in selecting a plan or to compare plan costs, the Oregon Health Insurance Marketplace has a calculator tool to help consumers make an informed decision on which plan is best for them.

Despite national cost pressures, Oregon’s reinsurance program continues to play a major role in holding down premiums. Since its creation eight years ago, the program has lowered individual-market premiums by at least 6.5 percent annually and by 9 percent this year alone, compared to what rates would have been without it.

The finalized rates and map are on DFR’s website — https://bit.ly/3Lbca9p

Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Prior Authorization Insurer Data Reporting Updates HB 3134 (2025)  

Rule Proposed: 836-053-1070

Rule Summary: Updates the rule to align with the prior authorization data reporting requirements in HB 3134 (2025), including:

•Amends the prior authorization aggregate data metrics to be reported to DCBS.

•Amends the prior authorization aggregate data reporting due date from “on or before June 30” to “on or before January 31”.

•Adds statutory definitions of standard and expedited prior authorization requests.

•Updates statutory citations.  

Filed: Sept 25, 2025

Hearing Date/Time: Oct 22, 2025, 1:30 PM

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: Oct 29, 2025, 5 PM 

Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: 2025 Behavioral Health Parity Rule 

Rule Proposed: 836-053-1430

Rule Summary: This rule governs annual data reporting requirements for health insurers related to behavioral health parity in Oregon. It implements changes required by SB 824 (2025), including:

•Restoring and making permanent the quantitative data reporting requirements for behavioral health parity.

•Adding confidentiality protections for carrier-submitted data.

•Updating statutory citations. 

Filed: Sept 26, 2025

Hearing Date/Time: Oct 22, 2025, 2:30 PM

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: Oct 29, 2025, 5 PM 

Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Revisions to NAIC accreditation standards and related model laws and regulations implementing SB 831 (2025) 

Rule Proposed: 836-027-0005, 836-027-0150, 836-027-0160

Rule Summary: The standards implemented in SB 831 (2025) add tools to enhance group solvency supervision, specifically the Group Capital Calculation and the Liquidity Stress Test and also add best practices regarding receivership. These standards must be adopted by January 1, 2026, to maintain accreditation. Some aspects of the new accreditation provisions require rulemaking to implement the law, particularly potential exemptions to the Group Capital Calculation. In SB 831 and Model Law #440, the Insurance Commissioner has the authority to exempt certain insurers from filing the Group Capital Calculation but the criteria for exemption must be detailed in rule. The Liquidity Stress Test framework itself must also be specified in rule. Additionally, NAIC Model Regulation #450 contains additional description of receivership provisions enacted in law that must be implemented in rule.

Filed: Sept 25, 2025

Hearing Date/Time: Oct 23, 2025, 11 AM

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

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

Washington — Fourteen health insurers approved to sell plans in Washington's 2026 individual health insurance market: Fourteen health insurers have been approved to sell health plans in Washington’s 2026 individual health insurance market. Wellpoint Washington is new to the individual health insurance market and will sell Exchange plans in Grays Harbor and King counties.

Insurers requested a 21.2% rate change, and 21% was found to be actuarially justified. Open enrollment for the individual market runs November 1 through January 15. Most people buy coverage through the Exchange, wahealthplanfinder.org, and most qualify for premium tax credits to help lower their monthly costs.

See the approved premiums for all 2026 individual health insurance plans. Your monthly payment could be lower if you purchase through the Exchange and qualify for a subsidy.

To see the list click the link below. 

Source link: Washington Department of Insurance — https://bit.ly/3KSAuNe

Washington — Service contract and protection product guarantee rule prepublication draft posted: We released a prepublication draft for the service contracts and protection product guarantee rule (R 2025-09). The rule implements House Bill 1006 and clarifies what a motor vehicle service contract is and which forms must be filed with the Commissioner in accordance with RCW 48.110.073.

The comment period for the prepublication draft began on October 8, 2025 and ends on October 22, 2025. Please send comments to rulescoordinator@oic.wa.gov.

For more information, including the text of the prepublication draft, please visit the rule's webpage.

Washington — Kuderer asks insurers to give federal workers a premium grace period: Washington State Insurance Commissioner Patty Kuderer today called on insurance companies selling auto, homeowners and renters insurance in Washington to support federal workers affected by the ongoing federal government shutdown.

Kuderer urged insurers (PDF 214.39KB) to allow a grace period of at least 30 days for federal employees who are unable to make timely premium payments due to the shutdown. She emphasized that families should not lose their insurance coverage or face penalties because of circumstances beyond their control.

Washington — Ground ambulance treat no transport report & recommendations: As directed by the Legislature in Section 13 of Substitute Senate Bill (SSB) 5986 (2024), on October 1, 2025, OIC submitted a report and recommendation to the Washington state legislature regarding the cost, potential cost savings, and total net costs or savings of covering services provided by ground ambulance services organizations when a ground ambulance is dispatched to the scene of an emergency and the person is treated but is not transported to a hospital or behavioral health emergency services provider. 

The report and cover letter can be found on the OIC webpage — https://bit.ly/4q9vQdV