California — Storm Recovery Resources: U.S. Senator Alex Padilla (D-Calif.) and California Insurance Commissioner Ricardo Lara hosted a virtual winter storm recovery forum to highlight state and federal resources available to Californians recovering from recent natural disasters. The conversation featured representatives from the Federal Emergency Management Agency (FEMA) and the Small Business Administration (SBA) to share the assistance that is currently available through the federal agencies.
“Californians have battled relentless rainstorms, flooding, and landslides that damaged infrastructure and property in communities throughout the state, and most tragically, cost 22 people their lives,” said Senator Padilla. “That’s why it’s important for Californians to know that after this winter’s storms, assistance is available to help them recover. This week, I will introduce two bills to give the federal government more flexibility to pick up the tab for federal disaster aid. I will continue to fight for more support to help our communities combat future extreme weather and natural disasters.”
“Communities across our state are still picking up the pieces, reclaiming the sense of safety they lost in the storms – and the reality is that recovering from a natural disaster is a marathon, not a sprint,” said California Insurance Commissioner Ricardo Lara. “My Department of Insurance fights for consumers, and we can help you make the most of your benefits so you can recover more quickly.”
Californians looking for more information on resources available to help during the recovery process can visit Senator Padilla’s Disaster Resources page for more information — http://bit.ly/3HL0lkY
Visit the California Department of Insurance winter storm recovery page for insurance help — https://bit.ly/3HL0lkY
Oregon — Recently Adopted Rulemaking: ORP payment parameters for 2023: The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:
ID 1-2023: Amending OAR 836-150-0040 to add ORP payment parameters for 2023
Amend Rules: 836-150-0040
Rules summary: Amended to define payment parameters for plan year 2023. Filed: January 24, 2023 Effective: January 31, 2023
Oregon — State releases reports on health insurance company compliance with Oregon Reproductive Health Equity Act (RHEA): All 12 health insurance companies in the individual, small group, and large group markets in Oregon failed to comply fully with the Reproductive Health Equity Act (RHEA) at varying levels, according to reports released today by the Oregon Department of Consumer and Business Services’ (DCBS) Division of Financial Regulation (DFR). The agency found that most noncompliance involved improperly charging copays, coinsurance, and deductibles or failing to cover mandated benefits.
The division examined Aetna Life Insurance Company, BridgeSpan Health Company, Cigna Health and Life Insurance Company, HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, UnitedHealthcare Insurance Company, and UnitedHealthcare of Oregon.
The examinations found that each of the 12 insurers failed to pay all eligible claims according to RHEA requirements. They applied copays, coinsurance, and deductibles, which are prohibited under RHEA for reproductive health and preventive care services. In some cases, insurers improperly denied claims for RHEA covered services.
In addition, the reports found that three insurers – Aetna, BridgeSpan, and Regence – failed to cover certain types of contraceptives or applied improper limitations on the amount or timing of when a member could refill a prescription.
Finally, examiners found that Cigna, HealthNet, Kaiser, and Samaritan each failed to properly resolve all consumer complaints and maintain adequate records demonstrating that they timely and adequately resolved member complaints, appeals, and grievances.
“RHEA is a critically important tool in the state’s effort to remove barriers to reproductive health care,” said Oregon Insurance Commissioner Andrew Stolfi, who is also the DCBS director. “As with every law, our insurers had an obligation to fully and timely implement each aspect of RHEA across all of their systems. It is disappointing to see that this did not happen. We will continue to monitor each insurer until they fully comply with RHEA and make whole any consumer harmed by these failures.”
Throughout the examination process, the division identified issues for each insurance company to immediately address to ensure members receive benefits mandated under the law, and progress towards full implementation of RHEA was observed and noted in several reports. Completion of these reports, which are similar to audits, is one of many steps the division takes in monitoring and addressing insurer compliance with the law.
Next steps include implementation of corrective action plans and ongoing data reporting and compliance monitoring with each insurer, as well as issuing regulatory guidance to clarify expectations. The DFR enforcement team will also now review the reports to determine appropriate penalties, restitution, and other action for each company. Finally, the division plans to continue working with community partners to raise awareness of benefits available under RHEA and other reproductive health laws. Consumers who believe they have not received the services or benefits they are owed under the law are encouraged to contact their insurer or the division’s consumer advocacy team at 888-877-4894 (toll-free) or go to the DFR help page.
The Oregon Legislature passed House Bill 3391 (RHEA) in 2017. Starting in 2019, health insurance companies were required to provide, with no cost share, a specified list of reproductive health, sexual health, preventive care, and other health care services, including contraception and abortion.
For more information on available benefits and to find a list of health insurance plans subject to RHEA, visit DFR’s reproductive health benefits webpage.
For more information on the RHEA examination process, findings, and recommendations, visit the division’s RHEA webpage.
Oregon — Recently Adopted Rulemaking: Oregon Employee Counting Methodology: The Oregon Division of Financial Regulation recently announced the following permanent rulemaking:
ID 2-2023: Revisions to Oregon Employee Counting Methodology
Amend Rules: 836-053-0015
Rules summary: Revises methodology for determining whether an employer is a small or large employer for purposes of purchasing a group health benefit plan under the Oregon Insurance Code. Adopts Exhibit B titled “Second Revised Counting Methodology for Determining Small or Large Group” and makes the counting guidance provided under Exhibit B mandatory for plan years beginning on or after January 1, 2024.
Filed: January 26, 2023 Effective: January 1, 2024
Washington — Kreidler issues $11,000 in fines for violations in January: Insurance Commissioner Mike Kreidler issued fines in January totaling $11,000 against insurance companies, producers, brokers, and individuals who violated state insurance laws and regulations.
Unauthorized Insurers
DNProtect, Epik Holdings Inc., Epik Inc., and Rob Monster, Bellevue, Wash.; fined $10,000 (order 22-0671).
Epik Inc., which registers internet domain names, solicited and advertised “domain name insurance” or “domain ownership coverage” — offered by DNProtect — without authorization to sell insurance in the state of Washington.
Producers & brokers
Petronilla Sefo McKenzie, Mission Hills, Calif.; fined $250 (order 23-0009).
Benefit Group Inc., Bloomfield Hills, Mich.; fined $250 (order 23-0006).
Evergreen Financial Group Inc., Camas, Wash.; fined $250 (order 22-0712).
Coastal Community Bank, Everett, Wash.; fined $250 (order 23-0706).
Washington — Request for information: BBPA dispute resolution mechanism: We released a request for information (RFI) for the Balance Billing Protection Act (BBPA) dispute resolution mechanism. OIC is soliciting comments as to whether Washington state should transition to the federal IDR system on July 1, 2023 or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers. For more information on this RFI or the BBPA, please visit our webpage on arbitration. Comments on the RFI are due February 15, 2023; please send them to policy@oic.wa.gov.
