Around the PIA Western Alliance States – Week of October 7, 2024

California— Agent Convicted of Insurance Fraud: Former insurance broker Karen Marie Dondanville, 56, of Mission Viejo, pleaded guilty to 90 counts including grand theft, insurance fraud, financial elder abuse, and forgery for collecting premiums and failing to place insurance coverage for her customers resulting in $183,047 in stolen premium payments from 32 victims over the span of eight years.

Dondanville was ordered to pay $335,349 in restitution to the victims, which includes payments to victims who had uncovered losses as a result of Dondanville’s theft. Dondanville is sentenced with three years of formal probation and faces 33 years in prison if she violates her probation.

The Department of Insurance is the state’s leader in preventing and stopping insurance fraud by regulating licensed agents and companies and investigating complaints to ensure they are acting in the best interest of consumers. The Department of Insurance received multiple consumer complaints against Dondanville while she was doing business as Streamline Insurance Services and Broadstreet Insurance Services. Dondanville attempted to cover up the theft by providing her clients with fraudulent insurance documents as proof of insurance when no such coverage existed. She also transacted insurance without a license.

Dondanville’s fraudulent actions of overbilling, receiving excessive premium payments, and failing to remit the premiums to the insurance companies, resulted in many policies cancelling for nonpayment. Dondanville also submitted fraudulent documents to insurers to divert premium refunds to herself. This left her 32 victims with more than 10,000 collective days without insurance coverage, exposing them to the danger of substantial uninsured losses.

An investigation by the Department revealed in one instance, Dondanville created fraudulent insurance documents for her client indicating that a homeowner’s policy cost $2,800, when the true cost was less than $900. Dondanville collected the $2,800 premium payment, but remitted less than $400 to the insurance company, causing the consumer’s policy to be canceled for nonpayment, leaving them unknowingly uninsured.

The investigation further revealed one consumer filed a claim and discovered Dondanville gave them a fake insurance document and their property was not insured. The consumer experienced approximately $100,000 in uncovered losses as a result of Dondanville’s actions.

The Department issued two Cease and Desist orders against Dondanville after receiving complaints from consumers who purchased insurance from Dondanville through their mortgage company, even after the Department of Insurance revoked her license on November 6, 2019.

On January 11, 2021, the Department adopted an Administrative Law Judge’s proposed decision which affirmed the Department’s Cease and Desist Orders and ordered Dondanville to pay a penalty of $20,000 within 90 days for her unlawful insurance transactions and fraud.

This case was prosecuted by the Orange County District Attorney’s Office Major Fraud Unit.

The Department reminds consumers to verify they are working with a licensed agent at http://www.insurance.ca.gov/0200-industry/0008-check-license-status/. If a consumer suspects they have been a victim of Dondanville or another agent, they are encouraged to file a complaint with the Department.

California — Lara orders insurance protections for Lake County residents: Insurance Commissioner Ricardo Lara issued a mandatory one-year moratorium on insurance companies to preserve residential insurance coverage for more than 16,000 policyholders affected by the Boyles Fire located in Lake County. The Commissioner’s Bulletin shields those living within the perimeters or adjoining ZIP Codes of this fire from insurance non-renewal or cancellation for one year from the date of the Governor’s emergency declaration regardless of whether they suffered a loss.

“The Boyles Fire is contained, but the damage it has caused the survivors will take time to repair,” said Insurance Commissioner Ricardo Lara. “My moratorium will give these homeowners peace of mind that they will remain covered by insurance as they recover and rebuild. Protecting wildfire survivors from non-renewals is essential as we continue to address the impacts of climate change and make long-term reforms to get our state’s insurance marketplace back on track.”

Commissioner Lara’s ability to issue these moratoriums is a result of a California law that he authored in 2018 while serving as a state senator in order to provide temporary relief from insurance non-renewals and cancellations to residents living within or adjacent to a gubernatorial-declared wildfire disaster.

Thus far in 2024, approximately 984,000 policies are protected for one year. Today’s order protects over 16,000 policyholders for one year, effective September 29, 2024, for the Boyles Fire. Consumers who were non-renewed prior to the emergency declaration date and are unable to obtain insurance or are dissatisfied with their current coverage should contact the Department of Insurance for assistance in shopping for insurance.

Consumers can go to the Department of Insurance website to see if their ZIP Code is included in the moratorium. Consumers should contact the Department of Insurance at 800-927-4357 or via chat or email at insurance.ca.gov if they believe their insurance company is in violation of this law or have additional claims-related questions.

Since taking office in 2019, Commissioner Lara has done the following major wildfire-related actions:

Announced his Sustainable Insurance Strategy, the largest insurance reform in 30 years, which includes multiple executive actions aimed at improving insurance choices and protecting Californians from increasing climate threats while addressing the long-term sustainability of the nation’s largest insurance market.

Modernized and improved the California FAIR Plan, the insurer of last resort. Commissioner Lara’s plan offers homeowners and condo associations and business owners expanded coverage in a new “high-value” plan with limits up to $20 million per building, a sound financial formula to protect policyholders in extreme loss scenarios, and improved transparency by requiring increased public reporting on FAIR Plan activity and customer service metrics. Commissioner Lara previously raised residential and commercial coverage limits for the first time in 25 years to keep pace with increased costs.

Released his catastrophe modeling regulation that will help restore options for all Californians. His proposed regulation will have major benefits for Californians in the form of more reliable rates, greater availability of insurance, stronger oversight, and safer communities.

Announced “Safer from Wildfires,” a new insurance framework that incorporates wildfire safety measures to help save lives while making homes and businesses more resilient. Safer from Wildfires was created by a first-ever partnership between the Department of Insurance and the emergency and preparedness agencies in the Governor’s Administration, including CAL FIRE, the Governor’s Office of Emergency Services (CalOES), the Governor’s Office of Planning and Research, and the California Public Utilities Commission.

Finalized new regulations to incorporate Safer from Wildfires in insurance pricing, driving down costs for consumers who have taken actions to protect their communities while increasing transparency about their home’s or business’s “wildfire risk score.”

Sponsored new insurance protections signed into law by the Governor — despite opposition from insurance companies — that will mean larger payouts for some claims, less red tape from insurance companies, and more help for people under evacuation orders.

Following the Governor’s state of emergency declarations, the Department of Insurance partners with CAL FIRE and CalOES, pursuant to existing statute, to identify wildfire perimeters for mandatory moratorium areas. The Department of Insurance will continue to collaborate with CAL FIRE and CalOES to identify additional wildfire perimeters for any fires where the governor declares a state of emergency.

California — Governor Newsom signs six Department of Insurance sponsored bills: Insurance Commissioner Ricardo Lara thanked Governor Gavin Newsom today for protecting California consumers through the signing of six bills that he sponsored this legislative session. These new laws focus on improving protections for vulnerable individuals, including women and LGBTQ+ families, disaster survivors, immigrants, and seniors. The laws guarantee insurance coverage for fertility treatments, implement important emergency disaster planning for LGBTQ+ youth, and protect reproductive health care without out-of-pocket expenses for consumers, among others.

“Protecting consumers is my number one priority,” said Commissioner Lara. “I am using every tool available to protect Californians, especially families, seniors, and those most vulnerable to abuse or disaster. I am grateful to the many legislators and partners who worked with me to champion these important issues and thank Governor Newsom for signing these bills that ensure the health and safety of Californians.”

Expanding access and ensuring anti-discrimination in health and other insurance

Senate Bill 729, authored by Senator Caroline Menjivar, requires insurance coverage for fertility and infertility care under disability insurance policies and large group health plans. This protects Californians’ access to in-vitro fertilization (IVF), and updates the definition of infertility to be inclusive of LGBTQ+ family planning experiences, despite any federal action to limit this coverage. This applies to large and small group health care service plan contracts and disability insurance policies issued, amended, or renewed on or after July 1, 2025. For CalPERS, the mandate begins July 1, 2027. SB 729 was co-sponsored with the Alliance for Fertility Preservation, the American Society for Reproductive Medicine, Equality California, Our Family Coalition, and RESOLVE:

The National Infertility Association.

Assembly Bill 2258, authored by Assemblymember Rick Chavez Zbur, makes sure that all Californians have access to affordable and preventive health care without out-of-pocket costs. This includes mandatory coverage for critical reproductive health care including contraceptives such as intrauterine device (IUDs), HIV prevention medications like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and screenings for HIV and other sexually transmitted infections (STIs). AB 2258 was co-sponsored with APLA Health, Equality California, the Los Angeles LGBT Center, and the San Francisco AIDS Foundation.

Protecting vulnerable Californians

Senate Bill 990, authored by Senator Steve Padilla, updates the State Emergency Plan to include best practices for local government and non-governmental entities to equitably serve LGBTQ+ communities during an emergency or natural disaster. This responds to data showing that LGBTQ+ people are more likely to become homeless or face negative health impacts after a disaster. SB 990 was co-sponsored with Equality California and the California Legislative LGBTQ+ Caucus. This update is required to occur as soon as possible, but no later than January 1, 2029, and be updated every five years.

Senate Bill 263, authored by Senator Bill Dodd, protects Californians, especially vulnerable seniors, from potential abuse and exploitation by curtailing harmful sales of annuities that are not in the consumer’s best interest. Annuities are typically marketed to retirees to provide a guaranteed income stream. California will now adopt the updated NAIC Suitability in Annuity Transactions Model Regulation, creating additional consumer protections to ensure California’s insurance companies and licensed producers who sell annuities are following the highest standards of conduct.

 Assembly Bill 2780, authored by Assemblymember Tina McKinnor, protects the safety of newly arrived immigrants by requiring commercial passenger transportation, prior to transporting 10 or more vulnerable passengers, to notify local authorities and follow basic requirements. This important piece of legislation will ensure California has the proper tools and support to welcome migrants in a humane manner and with the dignity and respect that migrants deserve. AB 2780 was co-sponsored by the Coalition for Humane Immigrant Rights.

Updating important insurance laws

Senate Bill 577, authored by Senator Melissa Hurtado, helps clarify existing law, deletes obsolete and superseded code sections, and creates new laws agreed to between the Department and stakeholders.

“I am very proud of the work we have done with our legislative partners this year to secure crucial protections for California consumers,” added Commissioner Lara. “As we look ahead to next session, I aim to push solutions to help address more insurance-related problems while further expanding consumer protections in partnership with legislators and key stakeholders.”

All of these sponsored measures go into effect on January 1, 2025, unless otherwise noted.

Idaho — Health insurance rates for 2025 now available to the public: Final 2025 premium rates for individual and small group health insurance plans have been released by the Idaho Department of Insurance.

Plans will increase by an average of 5% percent in the individual market, and 9% percent in the small group market. Each carrier’s justification of the 2025 increase amount is published alongside the rate increases on the Department website at: https://doi.idaho.gov/consumer/RateReview/.

“While medical inflation continues to drive up premiums, Idaho’s overall average increase is lower compared to other states. We continue to have highly competitive health insurance markets, giving Idahoans more choices and lower premiums than in most states,” said Director Dean Cameron. Rates will remain mostly stable thanks to the 1332 State Innovation “Reinsurance Waiver.” Idaho’s waiver continues reducing the cost of individual market health insurance by offsetting the premium impact of high-cost health conditions.

Open enrollment for 2025 begins October 15th and ends December 16th. Those seeking coverage can visit the state’s health insurance marketplace, Your Health Idaho, at yourhealthidaho.org, where they can compare and choose from 149 medical and 24 dental plans to enroll in for 2025 coverage. At the same time, consumers can find out if they are eligible for a tax credit, which can pay for some or all of their monthly premiums, and other savings, which lowers out-of-pocket costs for things like co-pays and prescription medications. These savings are only available when purchasing through Your Health Idaho. Consumers can find licensed Your Health Idaho-certified insurance agents at https://www.yourhealthidaho.org/find-help/. For help navigating the application process or general questions, you can also call Your Health Idaho at 855-944-3246.

Idaho consumers will continue to have choices from 8 carriers when shopping for individual coverage. In 2025 Select Health, PacificSource Health Plans, Blue Cross of Idaho, Regence Blue Shield of Idaho, Mountain Health CO-OP, Molina Healthcare, Moda Health Plan, and St. Luke’s Health Plan will offer health plans. With the addition of a new dental carrier, 7 carriers will offer dental options in 2025.

Idaho — Medicare Enrollment: The Idaho Department of Insurance and Senior Health Insurance Benefits Advisors (SHIBA) encourage consumers eligible for Medicare to review their plan options and costs during this year’s open enrollment. From October 15 through December 7, Idahoans can make changes to existing Prescription Drug or Medicare Advantage plans or enroll in new plans.

“Medicare can be confusing, and plans and one’s circumstances can change. It’s important that Idaho seniors who have Medicare take the time to review their plans during open enrollment and choose the plan that best fit their medical needs,” said Director Dean Cameron. “I strongly encourage consumers to seek guidance from our SHIBA representatives and a licensed agent.”

Senior Health Insurance Benefits Advisors (SHIBA) from the Idaho Department of insurance are available to talk with Medicare beneficiaries and those eligible to join the federal health care program. SHIBA representatives can provide free Medicare information, including reviewing Medicare coverage options. 

Call toll free (800) 247-4422 to speak with a SHIBA counselor. SHIBA also offers monthly Medicare webinar workshops. To register for an upcoming Medicare webinar, please contact the SHIBA Helpline at 1-800-247-4422. 

The open enrollment period can also be a time when improper marketing can make things confusing for seniors and healthcare providers. Idahoans can learn more about how to protect themselves during 2024 Medicare Open Enrollment by visiting https://bit.ly/3XZe6ER

Idaho — Open enrollment is a good time to review Medicare plans; SHIBA to offer Medicare review workshop in Pinehurst: The Idaho Department of Insurance (DOI) and Senior Health Insurance Benefits Advisors (SHIBA) encourage consumers eligible for Medicare to review their plan options and costs during this year’s open enrollment. From October 15 through December 7, Idahoans can make changes to existing Prescription Drug or Medicare Advantage plans or enroll in new plans.

SHIBA representatives are available to talk with Medicare beneficiaries and provide free Medicare information, including reviewing Medicare coverage options. They are offering a Medicare Review Workshop on Wednesday, October 16, 2024, at 107 Main Street, Pinehurst, ID, from 1:30 pm to 3:00 pm.

“It is important to review your Medicare plan annually,” says DOI Director Dean Cameron. “Medicare Advantage and Prescription Drug plans can change each year, including premiums, provider networks, co-pays / co-insurance, pharmacy networks, covered drugs and extra benefits. The SHIBA Medicare Review Workshop is a free opportunity for consumers to ensure their plan is the best plan for their current health needs.”

Anyone interested in attending this free workshop please contact SHIBA at 1-800-247-4422 to register.

Oregon — SAVE THE DATE: The Oregon Division of Financial Regulation is pleased to extend an invitation to its Innovation Hub on Oct. 28 from 8:30 a.m. to noon at the Oregon Museum of Science and Industry (OMSI) in Portland. This year’s theme is “Can innovative technologies make green finance better?”

Oregon's Innovation Hub is here to help financial services, insurance, and tech companies deliver innovative products and services to Oregon consumers. The event will include two panel discussions: Artificial Intelligence and Green Finance, and Blockchain and Green Finance. After the two panel discussions, DFR Administrator TK Keen will host an executive chat with Washington State Department of Financial Institutions Director Charlie Clark. Their discussion will center on regulating the use of innovative technologies in green finance.

You can register for the event online. The event is free and refreshments available. Check-in begins at 8 a.m. on Oct. 28.

Washington — Ground Ambulance Services & the BBPA Consumer Webinar: The 2024 Legislature enacted Substitute Senate Bill 5986 (SSB 5986). Effective January 1, 2025, the new law includes ground ambulance transportation services in the Balance Billing Protection Act (BBPA). Per RCW 48.49.200, ground ambulance service organizations (GASO) cannot balance bill consumers for covered ground ambulance transports occurring in Washington State.

OIC is hosting a webinar for consumers on October 22, 2024, from 11:00 am to 12:00 pm. We will provide background on the BBPA and discuss the new protections for ground ambulance transports. There will also be a question-and-answer portion at the end of the presentation. Please register in advance to attend the webinar — https://bit.ly/3Y15T3b

The webinar will be recorded and posted to the OIC website. 

Washington — Producer and Adjuster Licensing Requirements (R2024-06): We adopted the Producer and Adjuster Licensing Requirements (R2024-06) on October 1, 2024. The rule takes effect on November 4, 2024.

This rule includes both substantive and technical changes to producer and adjuster licensing requirements under Chapter 284-17 WAC. It aims to ensure that insurance regulations are clear, relevant, and consistent with Title 48 of the Revised Code of Washington and the forthcoming National Insurance Producer Registry (NIPR) interface enhancement.

For more information, including the adopted rule (CR-103) and the concise explanatory statement, please visit the Producer and adjuster licensing requirements (R 2024-06) webpage.

Washington — Consolidated Health Care proposed rule posted: We have released the proposed rule language on (R 2024-05). The Insurance Commissioner is implementing consolidated health care rulemaking due to the recent passage of insurance-related legislation and other changes in law. Multiple provisions of health care and insurance regulations in the Washington Administrative Code (WAC) need to be updated by OIC to be consistent with the legislation passed and recent federal law changes. These rules will ensure that all affected health care and insurance entities understand their legal rights and obligations.

This rulemaking incudes clarifying prescription drug coverage for behavioral health treatment; updating the definition of “established relationship” as applied to audio-only telemedicine services; and clarifying coverage and cost sharing requirements for preventive services. The rulemaking impacts the following authorities: WAC 284-170-130, 284-43-0120, 284-43-0160, 284-43-5080, 284-43-5110, 284-43-5642, 284-43-5800, and 284-43-5980.)

We scheduled a public hearing on the rule:

When: November 7, 2024, at 9:00 a.m.

Where: Virtual, please register in advance.

Comments on the proposed rule language are due on November 8, 2024 at close of business. Please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the Consolidated health care (R 2024-05) webpage.