Tuesday, December 31, 2013

New car? Call your insurance agent

If you take advantage of a good end-of-the-year deal on a new vehicle, be sure to report it to your insurance company right away, and don’t forget to ask them for a quote for Debt Payoff Coverage. This coverage will pay off the outstanding loan balance if your vehicle is destroyed in a covered claim and its current market value is less than your outstanding loan. Your agent and insurer can answer your questions and provide more detail on how the coverage works.


Learn more about auto insurance in Washington state.

Friday, December 27, 2013

Did a furry new family member join you this holiday season?

If Santa brought you or someone in your household a puppy or kitten, you may be thinking about purchasing pet insurance.

Pet insurance is relatively new in the insurance world. It helps pay veterinary bills for preventive care or if your pet is ill or gets hurt. Most plans limit coverage to dogs and cats, so you can stop reading now if you got a new bearded dragon or bunny. Most also require a health screening to make sure your dog or cat is healthy; if you have an older pet, it likely won’t qualify for coverage.

Be a smart shopper – make sure the insurer is licensed in Washington, compare plans’ coverage, deductibles, copayments, coverage limits and exclusions.

Read more of our tips on pet insurance.

Thursday, December 26, 2013

OIC hiring program analysts to work with insurers, consumers

The Office of the Insurance Commissioner is hiring two Functional Program Analyst 3 positions, one in Rates and Forms and the other in Consumer Protection.

OIC’s Rates and Forms Division regulates insurance companies that do business in Washington. The person in that position is responsible for reviewing insurance policy forms to ensure they comply with state and federal laws and rules and working with insurance companies. It requires customer service experience, good communication skills and ability to work timely and accurately. This position is open until filled. Read more about the position and salary.

Our Consumer Protection Division helps consumers who have complaints about insurance companies. The person in this position will staff our consumer hotline and enter calls into our consumer protection database. They also research and resolve consumer complaints, including analyzing whether insurance companies’ solutions to consumer complaints comply with insurance rules. This position closes Jan. 12. Read more about the responsibilities and salary.

Did you miss the deadline for health insurance coverage in January? You still have time to get covered by February.

The deadline for applying for medical insurance under the Affordable Care Act for coverage that starts in January was Dec. 23. If you did start your application, you have until Jan. 15 to select a plan and pay your premium for coverage that back-dates to Jan. 1.

If you were unable to do that, open enrollment closes March 31. You can still obtain coverage starting in February or March, depending on when you sign up. For February coverage, the deadline to enroll is Jan. 23.

If you qualify for a subsidy or Medicaid, you should obtain medical insurance through the Washington Healthplanfinder, our state’s health benefit exchange. If you do not qualify for a subsidy, you can buy a health plan directly from an insurance company. Here’s a list of the plans that are available in Washington.

Friday, December 20, 2013

Before you rent a car or loan out yours, consider a few things


Will you need to rent a car during your holiday travels? Does your brother want to borrow your car while he’s home from college? Here are a few things to consider.

What should I know about rental car insurance?

If you are renting a car while you travel, you will likely be offered insurance by the rental car company. Before you decide, check with your agent to find out if your personal auto insurance policy covers damage to cars you rent. Many policies do not cover costs that aren’t directly related to damage, such as the daily fee charged by the rental agency for each day the car is out of service being repaired. In that case, you may want to consider buying coverage from the rental agency.

Read more about rental car insurance.

If I loan my car to someone and they cause a wreck, can my auto insurance increase even if I wasn’t driving?

It’s likely, since your insurer will have to pay a claim under your policy. We recommend you contact your agent to find out for sure. Unless you have a restricted policy that only covers you as a listed driver, a standard auto policy will typically cover people whom you allow to drive your vehicle. If the wreck involves a crime—fleeing the scene, driving under the influence or using the car to commit a crime – then your coverage would not extend to their use.

In general, unless you have a restricted policy or you didn’t authorize the use of your car, when you loan your car, you loan your insurance.

Read more about what most auto insurance policies cover.

Thursday, December 19, 2013

Finishing up your holiday shopping? Here are a few things to consider.

What should I do if gifts are stolen from my car?

Tired after a long day of shopping and you don’t unload your car? Or did you load your car with packages that you need to mail? If you find yourself the victim of a car break-in when you have a car full of gifts, your homeowner or renter insurance will cover the contents. If you do file a claim, make sure you have receipts for what was stolen, and you should be prepared to turn in a copy of the police report, if one exists. Damage to your car would be covered by your auto insurance.

Read more about understanding your auto insurance.

Is warranty worth buying for gifts or high-ticket items?

We encourage consumers to carefully read the terms of the warranty before making a decision. We also encourage consumers to find out if a warranty company is registered to do business in Washington state.

Complaints we get from consumers generally focus on warranty claims that the companies say aren’t covered, or consumers requesting a refund when they change their mind about the warranty. The warranty contract will tell consumers how they can request a refund; state law requires a 10-business-day window to request a refund of a warranty.

If you are unhappy with the service you receive with a warranty you purchase, you can file a complaint with us.

Read more about warranties and service contracts.

Wednesday, December 18, 2013

Should I buy travel insurance?

If you are getting ready to travel for the holidays, here are some things to consider about travel insurance before you decide if it's worth it.

Many travel companies—airlines, cruise lines, resorts—offer travel insurance that will refund most or all of the cost of the trip in certain circumstances. Policies typically cover things like trip cancelations due to illness, civil unrest, job loss, or the carrier going out of business. They’ll also pay for fees incurred by missed connections and delays; baggage damage or loss; medical expenses incurred by an injury or illness while traveling; emergency evacuation; car rental damage; and accidental death.

Before you decide whether to purchase travel insurance, you should consider:
  • What your medical insurance covers when you travel.
  • What your homeowner or renter insurance covers in the event of lost or stolen belongings.
  • What your life insurance policy covers in the event of accidental death while traveling.
  • What the cancelation policy is for the travel insurance.
  • Read the policy's fine print. Some don't cover certain activities such as hang-gliding, bungee jumping or other physical contact sports. Some also exclude certain pre-existing conditions from the medical coverage they offer.
  • .
  • You should also make sure the travel insurance company is licensed to sell insurance in Washington.

Read more about travel insurance on our website.

Tuesday, December 17, 2013

OIC web-based applications will be down tonight

Starting at 5 p.m. tonight, OIC’s website applications will be unavailable while the state Department of Consolidated Technology Services—the state’s IT agency—moves our applications to new servers. We expect the applications will be available early tomorrow morning. Our website, www.insurance.wa.gov, will remain live.

The outage will primarily affect insurance companies, insurance agents and brokers, consumers who have complaints and State Health Insurance Benefits Advisors (SHIBA) volunteers.

Most of our online services will be unavailable, including:

  • Agent and broker online licensing
  • Online consumer complaints
  • Agent and company lookup
  • Online filing search
  • SHIBA online

We appreciate your patience.

Monday, December 16, 2013

Washington receives $192,293 from multistate insurance settlement

Washington state is receiving $192,293 as part of a multistate settlement against Lincoln National Life Insurance Co. and two of its affiliated companies.

Lincoln National Life Insurance Co., Lincoln Life and Annuity Co. of New York, and First Penn Pacific Life Insurance Company—part of the Lincoln Group Companies—agreed to a $12.6 million settlement regarding its policies and procedures for identifying and paying customers and their beneficiaries for life insurance policies, retained asset accounts and annuity contracts.

Six states’ insurance commissioners led the case--California, Florida, Illinois, Indiana, New Hampshire, North Dakota and Pennsylvania. The settlement terms require Lincoln to reform some business practices and regulatory oversight for several years, culminating in a final review in five years.

In Washington, fines paid by insurance companies are deposited in the state's general fund to pay for state government operations and public K-12 education. Life insurance pays a predetermined amount of money to beneficiaries upon the death of the policyholder. Read more about life insurance on OIC’s website.

Friday, December 13, 2013

People in federal high-risk insurance pool get extra month of coverage

President Obama’s administration announced yesterday that people who participate in the federal Pre-Existing Condition Insurance Plan will be covered through Jan. 31, 2014. The extension affects about 443 Washington residents and about 135,000 nationwide. The pool covers people who were previously ineligible for health insurance because of chronic pre-existing health conditions including cancer, heart disease and other serious illnesses. The extension allows people in the pool more time to find coverage under the Affordable Care Act (ACA).

Approximately 3,675 Washington residents are covered under the Washington State Health Insurance Pool (WSHIP), which is the state’s insurance plan for people with chronic health conditions. People in that plan will keep their coverage through the end of 2017. Both the federal and state high-risk insurance pools are closed to enrolling new members.

WashingtonHealthplanfinder, Washington’s health benefit exchange, has been unavailable for many people this month. Yesterday, Washington Insurance Commissioner Mike Kreidler advised people who are not eligible for a subsidy and are still tyring to find insurance before Jan. 1 to find health insurance from a private broker or agent. Washington residents with incomes of up to $45,960 for an individual and up to $94,200 for a family of 4 are eligible for subsidized insurance plans through the Washington health benefit exchange. Read the news release.

Wednesday, December 11, 2013

Are all of the contents of my home covered by my insurance policy?

Maybe, maybe not. Some policies offer limited coverage for items such as jewelry, art, coins, stamp collections, furs, guns or business-related property. If you own these types of items, talk to your agent to determine if you need to buy increased coverage or a separate policy to cover the value of those items.

You will be expected to prove your ownership of the items with receipts or with photos of the damaged or missing items. Don’t wait until you have a loss to find out what your policy covers and requires.

Read more about understanding your homeowners insurance.

Friday, December 6, 2013

Witness smokes out insurance fraud by business owner

A Renton business owner has been sentenced after being found guilty of insurance fraud and first-degree theft, both felonies.

Cassk Thomas, Jr., owner of Sams Pitt II Mobile BBQ, filed a claim in August 2011 with American Family Insurance that the barbecue smoker and trailer he used to operate his mobile barbecue business were stolen. He sought reimbursement for $24,668 in lost business and $32,243 that he said he paid for the smoker and trailer. American Family Insurance paid him a total of nearly $56,000 – $30,474 for the smoker and trailer and the full amount he claimed for lost business. A witness later provided proof that the smoker and trailer were purchased by a former business partner for $9,740.

Mr. Thomas was sentenced to 30 days in jail, 120 hours of community service, and faces restitution to American Family Insurance. The full restitution amount will be determined by May 2014.

The Office of the Insurance Commissioner’s Special Investigations Unit investigates insurance fraud. You can report suspected insurance fraud on our website.

Thursday, December 5, 2013

Pipes freeze and break, tree hits your roof – does insurance cover these?


Winter conditions are setting in around the state, so now is a good time to prepare for cold, snow and ice and familiarize yourself with what your homeowner’s or renter’s insurance covers in the event of weather-related damage.
We have a page of frequently asked questions about winter weather and insurance coverage on our website.
You can read more about winter weather preparedness and holiday safety on the Washington Emergency Management Division’s website.

Tuesday, December 3, 2013

Commissioner Kreidler to testify before U.S. House of Representatives


Washington Insurance Commissioner Mike Kreidler will testify before the U.S. House of Representatives Ways and Means Subcommittee on Health on Dec. 4  about the Affordable Care Act and how it’s working in Washington state.
The Affordable Care Act is the first major step toward making changes that will improve the lives of millions of Americans. For the first time, people have access to affordable, comprehensive medical insurance that doesn’t penalize them for their gender or for having existing medical conditions. Americans will not be subject to limits on their lifetime or annual medical benefits, which unfairly targets people with chronic medical conditions. 

Commissioner Kreidler, a board member of Washington’s Health Benefit Exchange, will touch on our state’s experience in enrolling more than 100,000 citizens through Washington Healthplanfinder.
The hearing starts at 7 a.m. Pacific time and will stream live online.  

 

Tuesday, November 26, 2013

We're looking for a Deputy Commissioner of Operations

We're currently recruiting for a Deputy Commissioner of Operations. This in an executive level exempt position that manages 35 employees in the following areas: Human resources, budget and fiscal, facilities and telecommunications, information technology and public records.

The successful candidate will be an active member of the Executive Management Team (EMT), setting the strategic direction of the agency, developing legislative priorities, ensuring fiscal responsibility and creating an inclusive, performance-based work environment.

Here's the full job announcement. Please share with anyone you think could be interested.

The job is open until Dec. 9, 2014.

Friday, November 15, 2013

Why the commissioner decided against allowing canceled policies back into Washington

President Obama’s announcement this week that previously canceled individual health-insurance policies for 2014 could be reinstated – at the discretion of insurance commissioners – drew a lot of attention.

Washington state Insurance Commissioner Mike Kreidler acted quickly, deciding against allowing the previously discontinued policies to be put back into effect. The reasons are straightforward: The proposal does not make sense for Washington because of the overall negative effect on the stability of the health-insurance market.

To learn more about Commissioner Kreidler’s decision, please check his statement.

You can also see what is really happening with those canceled policies and how many consumers can qualify for more comprehensive coverage at less cost.

Tuesday, November 5, 2013

Canceled health plans? What's really happening.

There's been a lot of news lately about insurers cancelling some health plans and changing others. Consumers have been getting the word through  'discontinuation' notices.

So what's really going on? This is happening in the individual market - where people who don't get coverage from their employer - buy their own health plans.   Most likely, the existing plans being canceled or changed, failed to meet new federal standards for benefits.  The reality about most of these previous plans is that they provided extremely limited benefits - no maternity care or coverage for prescription drugs, for example.

Beginning Jan. 1, 2014, plans must provide everyone basic essential benefits, such as maternity care, prescription drug coverage and mental health services.  And no longer can insurance companies ask you about previous illnesses you may have had. They must accept everyone.

Premiums will change for some plans. But if you received a notice from your insurance company, it does not mean you have to stay with whatever they offer. You can shop around for plans, either in the new Exchange - www.wahealthplanfinder.org or from insurers selling outside of the Exchange.

Here's a map of all individual plans available by county.

For more details about insurers cancelling policies, check out this piece by Kaiser Health News.

Monday, November 4, 2013

"Where do I get a detailed review of my auto and homeowners premiums?"

We recommend that you get a policy-specific premium breakdown directly from your agent (or insurer, if you buy direct). Specifically, you might want to ask for a rate worksheet comparison between your last year's premium and your current annual premium. That's a good way to get an apples-to-apples comparison of what your rates are doing.

While you're at it, it's a good idea to make sure that the type and level of coverage is what you want. If you're driving a new car, you'll likely want comprehensive and collision coverage as well as liability (the latter is required by law.) If you're driving a $1,000 car, on the other hand, maybe liability coverage is enough. These are good things to discuss with your agent or company, particularly if you have changes in your life (new car, change in household members, moving, etc.)

Friday, November 1, 2013

Our home was damaged by a windstorm. We're worried. What's next?


We get this question a lot. It's very important that you try to safeguard your home from further damage. Depending on the type of damage, you may be able to safely do this yourself or you may need to hire someone - especially if you need to get a tarp on the roof if you're dealing with utilities or damaged and unstable structures.
 
You'll also want to contact your insurance agent or your insurer directly to let them know what’s going on, and to get any necessary instructions from them. They can also tell you how your coverage will apply. Most importantly, stay safe!
 

 

Monday, October 28, 2013

"The insurance company came out and looked at my car. Doesn't that commit them to paying the claim?"

No. Insurers are required to investigate claims, but the fact that they start an investigation doesn't obligate them to pay a claim that they wouldn't otherwise pay. Once the facts are gathered and reviewed, the insurer can then make a coverage decision.

That said, if you feel your claim has been wrongly denied, is delayed, isn't fair, etc., our consumer advocacy staff may be able to help you. (We're the state agency that regulates insurance in Washington state.) Email us at AskMike@oic.wa.gov or call us at 1-800-562-6900.

Not in Washington state? Here's a handy map to help you contact your own state's insurance regulator.

Tuesday, October 22, 2013

Why does my insurer ask such tough questions about my claim?


We get this question a lot. The insurance industry experiences millions of dollars of claims regularly, year after year. Many of the claims are legitimate, but unfortunately, many involve fraud.
 
Whether or not a claim is legitimate or fraudulent, it is important that insurance companies perform complete investigations and gather all supportive documentation to be able to evaluate a claim.
 
Of course, the claim process is not a fun thing to experience, but it is necessary that you cooperate with the insurer to help facilitate your claim. Expect them to want supporting documentation and to ask questions - it may take a bit of time. But, after you've answered their questions and provided the necessary information, you should expect a timely decision and a clear explanation of their decision. If you don't that you've been treated fairly, call us at 1-800-562-6900 or file a complaint. Maybe we can help!

Monday, October 21, 2013

Having trouble reaching the Exchange's call center?

We know Washington's Exchange, www.wahealthplanfinder.org is still experiencing high call volumes at most times of the day. If you need help getting started, consider calling a navigator or an insurance broker. You can find both in your area by entering your zip code. Here's the info. for finding a navigator and the broker information.

"I've invented a new medical treatment. How can I get insurers to cover this?"

Our consumer hotline gets this question periodically. Someone will have come up with a new way of treating some ailment, only to find that insurance companies don't want to cover it.

Insurance companies are far more likely to cover a treatment is it's "evidence-based. Typically, a treatment is deemed evidence-based after extensive clinical trials, for which the inventor (or inventor's company, actually) usually pays. In the scientific community, evidence-based treatments are considered more reliable, and therefor a better value for insurance companies' money -- and more likely to lead to success for the patient.

That said, insurance companies can pay for any treatment, so there's nothing stopping them from covering a treatment that's not evidence-based. However, with many health conditions, there are already numerous treatments available.

If you're a patient, and your insurer is refusing to pay for a particular treatment that you think would be effective, see our "How to appeal a health insurance denial" guide. You can win an appeal, but it takes some work.

Also, here in Washington state, the health plans we regulate -- which are about 37 percent of them -- must, by law, must include access to every type of licensed medical provider. Meaning that if you want to see a naturopathic physician, chiropractor, physician, acupuncturist, etc. for treatment, the choice is yours, so long as the treatment is within the scope of their practice. The law doesn't change what health conditions are covered by your plan, but it gives you more choice in who -- i.e. which kind of provider -- will treat you.

Thursday, October 17, 2013

Medicare open enrollment started this week and ends Dec. 7

Medicare's open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 - Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage.

If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state.

Remember, if you want to enroll in  new plan, you must contact Medicare. You cannot sign up through the state's new health benefit exchange, www.wahealthplanfinder.org.

If you have limited income and need help paying prescription drugs, check out Medicare's "Extra Help" program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov.

For more help, contact a local SHIBA office in your area.

Wednesday, October 16, 2013

Job seekers - We're looking for a legislative liaison and a policy/rules manager

Two jobs at the Insurance Commissioner's office just posted this week - a Legislative Liaison and a Policy and Rules Manager. Both positions are exempt, open until filled and salary depends on experience.

The Legislative Liaison is responsible for developing and managing our legislative and policy strategy, including developing our legislative agenda, legislative testimony, bill analysis, and stakeholder management. They're also the principal policy advisor to the executive management team on legislative and budget proposals impacting the agency.

The Policy and Rules Manager supervises staff in our Policy and Legislative Affairs division, prepares position briefs, decision memos, reports, coordinates rule-making for the agency, and drafts and adopts rules on behalf of the agency.

If you're interested or know someone who might be, encourage them to apply soon!


 

See most recent earthquakes in our area - are you ready for the big one?

 
We're getting ready for tomorrow's Great ShakeOut Earthquake Drill by cleaning out all the stuff under our desk - how about you? It's been a long time since the Nisqually Quake, but if you lived in Washington state then, you probably remember where you were and what it felt like. 
 
Some of us here in Olympia - only miles from the epicenter - heard what sounded like a freight train. Others saw the ground move like water. Are you ready for the next one? 
 
Check out the earthquake tracker on KIRO's mynorthwest.com. It'll show you the most recent quake, how big it was and where it occurred.  


And don't forget about earthquake insurance - here's what you need to know.

Monday, October 14, 2013

How to report insurance fraud in Washington state

Our agency -- Washington state's insurance regulator -- handles a wide variety of complaints about insurance fraud by individuals and by businesses.

To report insurance fraud or scams, please see our online reporting form.

We also offer tips to avoid insurance scams, starting with the old-but-true advice that if it sounds too good to be true, it probably is.

We also have some tips on how to identify and report Medicare fraud and abuse, such as being billed for services you didn't receive.

Wednesday, October 9, 2013

I know the new health subsidies are based on your household income, but how do they define 'household'?

“Household” only includes you, your spouse, and anyone you can legally claim as a dependent on your tax return.

 It generally wouldn’t include a non-marital relationship (such as a boyfriend or girlfriend), except under very limited circumstances.

To get more details, see page 16 of the IRS instructions for filling out Form 1040 or call the IRS (after the government shutdown ends) at 1-800-829-1040.

Tuesday, October 8, 2013

When your insurance renews, remember to look at the statement

When you get a new insurance policy or your current policy renews, be sure to review the statement. You need to be sure that you're getting the type and level of coverage you asked for. 

Most people simply file away the information -- or toss it. But take a few minutes to look it over first. You really don't want to find out after the fact that a) you were paying for coverage you didn't want or need, or b) worse, that you didn't have coverage for something important.

If you see something that doesn't look correct, contact your agent or insurer immediately, before a loss occurs. If you wait until afterward, you'll likely be stuck with whatever coverage was in force at the time of the loss.

It's also a good idea to periodically review your coverage with your agent or insurer. You may want to add or eliminate coverage as changes occur in your life situation.

Friday, October 4, 2013

Hole-in-one insurer pleads guilty to three felonies

Kevin Kolenda, a Connecticut businessman who insurers golf tournament hole-in-one prizes but has a history of not paying, pleaded guilty today in King County Superior Court to two counts of selling insurance without a license and one count of first-degree theft.

Kolenda started Golf Marketing in 1995 and sold hole-in-one insurance coverage to charity golf tournaments across the country including in Washington state. He repeatedly failed to pay winning golfers, leaving charities to come up with the prize money. To skirt prosecution, he also changed the name of his business several times.

Other states where Kolenda sold bogus insurance including: Montana, Ohio, Georgia, California, New York, Hawaii, Alabama, Massachusetts, Florida, Connecticut and North Carolina.

Kolenda paid $10,000 in restitution today. He will pay another $5,000 in four months, when he returns to Seattle for sentencing.

Thursday, October 3, 2013

What to do if your Medicare Advantage plan is going away

Medicare open enrollment starts Oct. 15. Some people may have already received a notice saying their Medicare Advantage plan is going away. If you or someone you know has received a notice, here's some steps to take:

  • Check with your medical providers and find out what Medicare Advantage plans they accept in 2014.
  • Read about your rights
  • Avoid a gap in coverage by selecting a new plan before Dec. 31
  • If you can't decide between a Medicare Advantage plan or returning to Original Medicare, see page 59 of the Medicare and You 2014 booklet for help

Need more help? Contact our free Statewide Health Insurance Benefits Advisors (SHIBA), They can  help your evaluate and compare plans. 

Wednesday, October 2, 2013

WAhealthplanfinder will be down tonight for system improvements

Washington's Exchange - the Wahealthplanfinder.org - is up and running, but some people are still experiencing slow loading times and difficulty submitting their applications. The Exchange is taking the website down tonight starting at 10 p.m. until 6 a.m. tomorrow morning to work on system improvements. Want an update on their progress? Check www.wahbexchange.org often.


I hear new health plans must meet 'actuarial value' standards - what's that mean?

All individual and small employer health plans sold inside and outside the new Health Benefit Exchange - Wahealthplanfinder.org - must have an actuarial value of at least 60 percent.

This means the plan must pay for least 60 percent of your medical costs for essential health benefits. Sixty percent is the standard for the new 'bronze level' plans. You also can choose from a silver level or gold metal level plan. Silver plans pay for 70 percent of your costs and gold pay for 80 percent.

Here's answers to additional questions about how the new 'actuarial value' works:

If my plan has an actuarial value of 70 percent  does that mean I will not have to pay more than 30 percent of my entire insurance costs?
No, the actuarial value is only based on the level of coverage the plan provides for essential health benefits.  If your plan has an actuarial value of 60 percent, for example, that means that the plan will pay 60 percent of your covered expenses for essential health benefits and you pay 40 percent of the covered expenses for essential health benefits. 
Although the actuarial value of your covered expenses for essential health benefits will be covered, you may have other costs such as deductibles, copays and coinsurance, as well as costs for services that are excluded or are not covered benefits.

Make sure you read your policy to see what services are excluded services.  Benefits that are not covered would be subject to the terms of your insurance policy, so it is important to read your policy before getting the service or treatment. 
What are essential health benefits? As of Jan. 1, 2014, all individual and small employer health plans must cover these 10 benefits:

  1. ambulatory patient services
  2. emergency services
  3. hospitalization
  4. maternity and newborn car
  5. mental health and substance use disorder services including behavioral health treatment
  6. prescription drugs
  7. rehabilitative and habilitative services and devices
  8. laboratory services
  9. preventive and wellness services, chronic disease management
  10. pediatric services ‐ including oral and vision care

 

Tuesday, October 1, 2013

Washington's Healthplanfinder now up and running

After a few hours of technical difficulties earlier today, Wahealthplanfinder.org is now up and running. There may be a few more glitches as additional issues are fixed, so if you're filling out an application, be sure to save your information. Also, the website will be down temporarily tonight at 8 p.m.

Eight health insurers have been approved to sell 46 different plans inside the Exchange. Remember, the Exchange is the only place you can go to receive federal tax subsidies to help lower your monthly premium - and there's only one official Exchange for our state - www.wahealthplanfinder.org.

If you earn more than the cut-off for a subsidy (about $46,000 for an individual and $94,200 for a family of four), you also can shop for insurance outside the Exchange. To see all of the plans available in your county - both inside and outside the new Exchange - check out this map.

Monday, September 30, 2013

Five things you should know about flood insurance

1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.

2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."

3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")

4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.

5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.

Wednesday, September 25, 2013

We're looking for a communications and social media manager

Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.

This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.

Here's the full job announcement. Please share with anyone you think might be interested.

We're taking applications through Oct.8.

How to contact Washington's Health Benefits Exchange


Earlier this month, the Washington Healthplanfinder (our state's health insurance exchange) opened its toll-free hotline to start answering questions about health coverage options, how to access financial help and what you need to know about the Exchange's enrollment process. The phone number is 1-855-923-4633 or TTY/TDD 1-855-627-9604. They're available from 7:30 a.m. to 8 p.m., Monday through Friday.

The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.

Friday, September 20, 2013

"I'm on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy"

Don't do it.

That's worth saying again: Do Not Do This.

Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.

Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.

And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)

Wednesday, September 18, 2013

"I just got a letter from my insurer saying that I have to switch health plans because of Obamacare. What can I do?"

Tens of thousands of Washingtonians are -- or will be soon -- getting letters from their health insurers telling them that their plans are going away and that they'll need to pick a new one.
"In order to comply with the new health care law, your current health plan will be discontinued on Dec. 31, 2013," reads one of the letters, which are being sent out by about half a dozen insurers. "But don't worry. You have lots of options."
What's going on? Under health care reform, each health plan has to cover 10 essential benefits. Some of those benefits -- such as prescription drug coverage -- aren't included in many health individual health plans today. The new plans also have to include numerous preventive services, and meet standards for what they'll cover.

In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.

So what can you do?

1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).

In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.

2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.

What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.

3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.

"I was turned down for life insurance due to my health. Does this mean I can't get life insurance at all?"

Not necessarily. Different life insurers have different underwriting standards, so another company might insure someone with your health condition.

So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.

Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.

Tuesday, September 17, 2013

Pierce County man charged with insurance fraud and attempted theft

A University Place man, Leandre Garner, has been charged by the attorney general's office with felony insurance fraud and second-degree attempted theft for filing a bogus claim with State Farm.

On Nov. 8, 2012, Garner got coverage online with the company for his 2007 Chrysler 300. Prior to that date, the vehicle was uninsured.

On Nov. 9, 2012, Garner said, he returned home from an appointment and discovered that his car had been hit by an unknown vehicle. The damage was estimated at $4,339. Garner filed a claim.

The problem: half a dozen people subsequently told investigators from State Farm and our Special Investigations Unit that Garner's car was damaged well before November. His ex-girlfriend said it happened around September, not November. A nearby tenant, an apartment office worker and an apartment groundskeeper also said the accident happened well before Nov. 8. So did the body shop that did the estimate.

Asked if he'd taken photos of the damage, Garner showed a State Farm investigator cell phone images he'd taken. He was surprised when the investigator pointed out that the metadata embedded in the images showed that they'd been taken Sept. 19, 2012.

When asked about this, Garner said that the must be a problem with the phone.

Arraignment is scheduled for Pierce County Superior Court on Sept. 24, 2013.

Monday, September 16, 2013

"I heard I can keep my adult child on my health insurance until age 26. But do I have to?"

Q: I heard I can keep my adult children on my health insurance until they turn 26. But what if I don't want to?

A: Then don't. Health care reform permits -- but doesn't require -- parents to keep their adult children on the parent's health plan up to age 26, unless the children have coverage through their own employer.

That said, you may want to provide coverage if you can afford it. No one is immune from bad luck, and rates for medical care when a person has no insurance can be very high indeed.

Also: if your child doesn't have a job or has a job that doesn't offer health coverage, you may be able to extend your coverage to him/her more cheaply than they could buy an individual policy on their own.

Wednesday, September 11, 2013

Woman who pretended to be employer in lost-wage claim pleads guilty to insurance fraud

A woman who pretended to be an employer to help her son allegedly file a fake lost-wages insurance claim has pleaded guilty to insurance fraud.

Sherryl Rose Brongil pleaded guilty on Monday in King County Superior Court to one count of insurance fraud.

According to an investigation by State Farm and our Special Investigations Unit, Brongil's son, Larry Kwant, was accelerating out of a parking lot in her Cadillac when he lost control of the car and caused $26,000 in damage to it. He filed a claim, including 23 days of lost wages at $25 an hour. The form was signed by a "Linda Lee."

Linda Lee turned out to be Sherryl Brongil. Not only did she sign the form, purportedly showing that her son had worked at a company where he'd never worked. She'd also pretended to be administrative assistant "Linda Lee" when contacted by a claims adjuster.

She was sentenced to three months in jail.

As for Kwant, he's been charged with insurance fraud and identity theft.

Tuesday, September 10, 2013

Common questions about Medicare and health care exchanges


We've been getting a lot of questions about whether the new health care exchanges affect people on Medicare.

The short answer is no. If you have health coverage through Medicare, you don't need to do anything. It will not affect your coverage.

Among the other questions we're hearing frequently:

Do I need to re-enroll in my Medicare plan through the new health insurance Exchange?

Nope. Medicare's open enrollment is not part of the Exchange. If you are on Medicare, do not sign up for a plan in the Exchange.

Will I lose my Medicare coverage due to health reform and the Exchange?

No. Health care reform and the Exchange do not affect your Medicare coverage. You still have the same benefits and security you have now with Medicare.

Will people on Medicare be fined for not buying a health insurance Exchange plan?

No. In fact, it's against the law for someone who knows you have Medicare to sell you an Exchange plan.

Can I go to the Exchange and get a subsidy to help pay for my Medicare coverage?

Sorry, but no. If you're on Medicare, you're not eligible for the subsidies, which are for people buying coverage through the Exchanges.

For more questions -- including how the Exchange and Medicare work for recent immigrants, for those about to turn 65, etc. -- please see our new "popular questions about Medicare and the Exchange" web page.

Changes mean quicker responses to your insurance complaints

We've launched a new complaint response system that's speeding up the time between consumer insurance complaints and resolutions.

As Washington state's insurance regulatory agency and an advocate for consumers, we help with thousands of consumer complaints each year. Typical complaints involve wrongly denied claims, delayed payments and cancelled coverage.

The new online system, which is a secure link between our office and insurance companies we regulate, allows us to quickly get those complaints (along with our questions or concerns) to insurers. They'll look into the case and often reconsider their initial decision.

For years, largely in the interest of protecting complainants' private information, this process was handled by mail. Insurance companies were allowed 30 calendar days to respond to a complaint. 

The new online system is also secure -- and it's dramatically faster. Now insurers must respond electronically within 15 business days.

In other words, we've cut the time to process consumer complaints against insurers by more than 25 percent.

Got a complaint about your insurer? You can file a complaint online or call our Consumer Hotline 1-800-562-6900.

Friday, September 6, 2013

Insurance questions: Does my homeowners policy cover lightning?

In most cases, yes. Lightning is a covered peril in standard homeowners policies. Typically, both direct physical damage -- like burns, shattered windows, melted wiring -- would be covered. And if the lightning sets your home on fire, your fire coverage would also kick in.

How about lightning-caused damage to your electronics, like a TV or computer? Also typically covered.

And what about your car? If that gets hit by lightning, is the damage covered? Again, in most cases yes -- IF you have comprehensive coverage. (A man riding his motorcycle near Chehalis yesterday was struck by lightning, but is apparently doing well, other than a partly melted helmet. Really.)


Wednesday, September 4, 2013

Health care reform questions: Where can I get help?

Q: Will there be health care advocates for people who are not able to understand the complexities of the health care process? I have a family member who cannot work and is in dire medical need and struggling with doctor and drug costs. What help will they get from the health care reform?

A: Yes, there definitely will be advocates to help people navigate the complexities of finding the right health coverage. Health care reform includes a network of navigators and other people to help, and many insurance agents and brokers can help as well. Here's a list of the organizations that have received grants to provide in-person assistance here in Washington state.

Here in Washington state, you can sign up with the Washington HealthPlanFinder to be contacted by assistance staff within the first two weeks of October. They can answer your questions and help with enrollment in the exchange, if that's the best option for you. The coverage would start in January 2014.

In this particular situation, with your relative struggling today to pay for medical care and prescription drugs, feel free to give our consumer advocacy staff a call. They can walk you through the options, including free or low-cost medical, vision and dental clinics, help paying for drugs, and how to appeal when a health insurer won't pay for a treatment or prescription.

The hotline number is 1-800-562-6900. (Don't live in Washington state? Here's how to find your own state's insurance regulator.) You can also email us at AskMike@oic.wa.gov.


WA: Two more Exchange health plans approved for King, Pierce, Spokane counties

From a press release we put out this morning:

FOR IMMEDIATE RELEASE – Sept. 4, 2013
Media contact: Public Affairs (360) 725-7055

Kreidler settles with another health insurer – approves two more Exchange plans for King, Pierce, Spokane counties

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler has reached a settlement with Molina Healthcare of Washington, Inc. (Molina) and approved its two plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

Consumers in Washington will now have 43 choices in the Exchange when open enrollment begins Oct. 1. Molina’s two plans will be available in three counties: King, Pierce and Spokane.

Previously, Molina only participated in the Medicaid market. Its approval to sell inside the new Washington Healthplanfinder guarantees Medicaid enrollees continuity of care and creates even more competition in the marketplace.

Molina was one of five companies Kreidler disapproved for sale in Washington’s new Exchange. Molina, Coordinated Care Corp., Kaiser, and Community Health Plan of Washington (CHPW) all appealed Kreidler’s decision. Molina later dropped its appeal, but reactivated it Aug. 29.

The reactivated appeal allowed a settlement. Specifically, Molina corrected information in its provider contracts to gain approval.

Kreidler began discussions with only those companies he believed could make the necessary fixes in time before the federal deadline of Sept. 5. Ten plans from Kaiser and Community Health Plan of Washington were approved Aug. 30.

The Executive Board of the Health Benefit Exchange is schedule to certify the final list of approved plans today at 1 p.m. It is scheduled to submit its final list to the federal government Sept. 5.

“I made the tough decision to disapprove some plans on July 31 because I didn’t believe they were good for consumers,” said Kreidler. “I’m pleased that we’ve reached a settlement with some of these companies to bring more quality plans to the Exchange and that consumers will be protected.”

####



Friday, August 30, 2013

Kreidler achieves settlement with health insurers - approves 10 more Exchange plans


Insurance Commissioner Mike Kreidler has reached settlements with Community Health Plan of Washington and Kaiser Foundation Health Plan of the Northwest and approved their 10 plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

 Consumers in Washington will now have 41 choices in the Exchange when open enrollment begins Oct. 1. Community Health Plan of Washington (CHPW) will have three plans available in 26 counties.

 Kaiser will offer an additional seven plans in Clark and Cowlitz counties.

 Kreidler said the additional 10 plans meet the same high standards held for the other approved companies. They also ensure continuity of care for Medicaid enrollees and create more competition in the marketplace.

 The Exchange set an initial July 31 deadline for the Insurance Commissioner’s review and approval of plans for inclusion in the Exchange, where subsidies for health coverage will be offered as part of the federal Affordable Care Act.

“We had 31 health plans approved by the Exchange’s deadline. Washington consumers now have an additional 10 quality plans to choose from,” Kreidler said.  “We took the initial deadline seriously, but we also followed our own legal process and it worked. The Exchange cannot delay any further. It must take action and approve these plans by Sept. 5.”

Friday, August 23, 2013

New online tool shows you what individual health insurance costs next year in WA


We've built a new online tool to help you find out what health care plans will cost next year. Simply click on the map -- premiums vary by where you live -- and it will tell you which insurance carriers are offering coverage in your area. You can click on each company to see its rates, which vary based on your age.



A couple of caveats: These rates are mainly for the individual market, meaning people who have to buy insurance for themselves, and don't get it through an employer, Medicare, etc.

Also, the rates do factor in the subsidies that will be available to some people. Those subsidies will reduce the cost of coverage substantially for many people. You can estimate how much you'll pay, with subsidies taken into account, by using this online calculator from the Washington HealthPlanFinder.

Lastly, the list of health plans is likely to grow over the next couple of months. We are still reviewing plans, for example, for multiple insurance carriers that have filed to sell coverage outside the state exchange. And some plans that were rejected for the Exchange have filed appeals. So stay tuned.

Thursday, August 22, 2013

An open letter from Mike Kreidler about insurance plans filed for Washington's exchange

An open letter from Insurance Commissioner Mike Kreidler

In January, the biggest changes under health care reform – or “Obamacare” – will take effect. Many health plans, which now have to comply with federal standards, will be significantly better. And hundreds of thousands of low- and middle-income Washingtonians will qualify for subsidies to help pay for coverage.

This fall, Washington’s new Health Benefit Exchange will open for business, giving consumers an easy way to compare health plans, sign up, and see if they qualify for the subsidies.

Many kinds of insurance policies, before they can be sold, must be reviewed and approved by my office. This is a very important consumer protection, designed to ensure that prices are fair and that insurers can deliver on their promises.

I’m pleased to report that based on state and federal law, we were able to approve 31 health insurance plans, from four carriers, for the Exchange. People shopping on the Exchange will have broad choice and significantly better coverage, starting Jan. 1, 2014.

Unfortunately, we had to reject applications from five other insurance carriers. These were not decisions I made lightly. I am a strong supporter of competition and consumer choice, and a longtime supporter of health care reform.

As the state’s insurance regulator, however, I have a duty to protect consumers and to hold all insurers to the same standards. There were substantial problems in the plans we rejected.

Health insurers must have adequate networks of doctors and other health care providers. And there were major problems with the networks of most of the rejected plans. One didn’t offer any pediatric hospital.

Another had no approved retail pharmacy. Certain plans didn’t have adequate access to transplant surgeons, or to HIV/AIDS specialists.

One network would have required people to drive more than 45 miles to see a cardiologist, and more than 120 miles to see a gastroenterologist. That would be like living in Tacoma but having to see a doctor in Bellingham.

These were not minor technicalities. They were major problems.

Some people have pointed out that three of the carriers whose plans were rejected are currently serving people on Medicaid. They worry that people whose incomes rise, making them ineligible for Medicaid, will have difficulty moving to a regular commercial plan, or would lose important continuity of care offered by the community clinics. Many of these community clinics offer important services, such as language assistance or transportation.

Rest assured: The plans I approved for the Exchange include a substantial number of community clinics throughout the state. In many cases, Medicaid patients who want to remain with the same clinic will be able to.

The Affordable Care Act requires all carriers participating in the Exchange to contract with an adequate number of “Essential Community Providers,” or ECPs. These are defined as health care providers that serve high-risk, special needs and underserved individuals. Many Sea Mar clinics, for example, have contracts with the commercial carriers who were approved for the Exchange.

My staff and I worked very hard to try to get all carriers and all plans across the finish line in time. We had dozens of meetings, and 14 webinars to try to walk them through the process. I called one CEO after another, laying out the key issues and timelines. On the final night, July 31, we had staff waiting at their desks until midnight, in order to give the companies every possible minute to succeed.

But some carriers – particularly those new to the commercial insurance market -- simply couldn’t meet the standards this time.

We knew this first big year of health reform implementation would be a bumpy ride, and it has been. But I remain optimistic about the future. We will continue to work with all carriers to help them get ready for the next year, when I fully expect more insurers to succeed.

In the meantime, consumers have a broad number of choices. The insurance is meaningful, the networks robust, the subsidies significant. Again, the process has been bumpy. But it’s a very promising start.

Mike Kreidler
Insurance Commissioner

Wednesday, August 7, 2013

Auto insurance and pizza delivery

We get a lot of calls from parents -- and usually those calls are after the fact, unfortunately -- about whether their child delivering pizzas needs additional auto coverage.

Sorry, but the answer's usually yes. Most personal auto insurance policies won't cover you if you're getting paid to use your own car to transport people or property for business purposes.

In general, you'll need to buy a business or commercial auto insurance policy if you are a health care worker who occasionally uses your own car to take clients to appointments. The same is true if you use your own car to deliver flowers, newspapers, pizzas, etc.

If you have questions about your coverage -- and policies do differ -- contact your agent or insurance company directly.

Tuesday, August 6, 2013

Health insurance questions: Preventive colonoscopies and polyps

Until fairly recently, when consumers had routine preventive colonoscopies, they often faced a substantial bill for surgery if a polyp was discovered and removed during the procedure. But current guidelines from the U.S. Department of Labor, under the Affordable Care Act, protect consumers from these extra charges for polyp removal.
Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy? 
No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.
In addition, the federal guidelines help people with a family history that put them in a high risk group for certain diseases. They will now be able to get more frequent preventive care without additional costs.
Q7: Some USPSTF recommendations apply to certain populations identified as high-risk. Some individuals, for example, are at increased risk for certain diseases because they have a family or personal history of the disease. It is not clear, however, how a plan or issuer would identify individuals who belong to a high-risk population. How can a plan or issuer determine when a service should or should not be covered without cost-sharing? 
Identification of "high-risk" individuals is determined by clinical expertise. Decisions regarding whether an individual is part of a high-risk population, and should therefore receive a specific preventive item or service identified for those at high-risk, should be made by the attending provider. Therefore, if the attending provider determines that a patient belongs to a high-risk population and a USPSTF recommendation applies to that high-risk population, that service is required to be covered in accordance with the requirements of the interim final regulations (that is, without cost-sharing, subject to reasonable medical management).
If you're having problems with your health insurer over these sorts of issues and you live in Washington state, feel free to contact our consumer hotline at 1-800-562-6900 or email us

Thursday, August 1, 2013

WA Supreme Court: Insurer can be held liable for agent's actions

In a case that’s been closely watched by the insurance industry, Washington’s State Supreme Court on Thursday affirmed that insurers are liable for the illegal actions of their agents.

“The ruling is a big win for consumers,” said Insurance Commissioner Mike Kreidler, whose decision the case was challenging. “If you allow someone to do business on your behalf, it only stands to reason that you can be held responsible for what they do.”

The case involved violations of the state’s insurance laws in 2006 and 2007 by an insurance agency appointed by Chicago Title Insurance Company. That agency, Land Title Co. of Kitsap County, Inc. repeatedly offered illegal inducements to get business. The violations included illegally “wining and dining” real estate agents, builders and mortgage lenders with free meals, donations for a golf tournament, monthly advertising, and Seattle Seahawks playoff game tickets.

Although Land Title was Chicago Title’s exclusive agent in the Washington counties at issue in the case, Chicago Title argued that it was not responsible for its agent’s actions. In a consent order signed in 2009, the company agreed to pay a $48,334 fine if it did not prevail in court.

“Chicago Title’s arguments were contrary to a century of insurance law,” said Kreidler. “In order to effectively regulate insurers and protect consumers, it’s important to hold insurers responsible for the actions of their agents.”

Title insurance practices have long been a concern to Kreidler, whose office in 2005 scrutinized 18 months of employee expense reports and ledgers for the largest title companies in King, Pierce and Snohomish counties. The examination found many cases in which the companies were providing gifts, golf tournament sponsorships, parties, ski trips, sports tickets, meals and other inducements to get business.

“Few people shop for title insurance, although they certainly can,” said Kreidler. “It tends to be included in the large stack of documents that homeowners are handed to sign. So title companies and others in the industry are positioned to steer business to particular insurers.”


New rules took effect in March 2009, clearly outlining what can be given. There are limits on advertising, donations to trade associations, meals, training, leasing workspace and gifts.

Tuesday, July 30, 2013

Agent charged with theft and forgery; collected commissions for fictitious customers

A former Vancouver insurance agent has been charged with theft and forgery for allegedly collecting about $15,000 in commissions by creating fictitious applicants for insurance policies.
Julie Anne Goss, 43, an independent agent for AFLAC, was arraigned last week in Clark County Superior Court.
The scam came to light after the owner of a restaurant in Battle Ground, Wash. told AFLAC that she’d received premium bills for two “employees” that had never worked there. 
AFLAC investigated, and it turned out that Goss wrote dozens of policies for 15 people that either weren’t employees at the named businesses or apparently didn’t exist. In other cases, she wrote policies for real employees, but they said they hadn't applied for the coverage.
In each case, Goss stood to get a commission for the policy. All told, the investigator found, between August 2010 and January 2011, Goss wrote 91 fraudulent insurance policies and collected more than $15,000 in commissions for them.
The company canceled its contract with Goss in March 2011 and reported the matter to our Special Investigations Unit. After investigating further, we revoked Goss’ insurance license in January 2012. The charges against her were filed in late June.
If you suspect insurance fraud and you live in Washington state, please report it.

Thursday, July 25, 2013

How to find an old life insurance policy (and other unclaimed property)

We get a lot of queries from people looking for old life insurance policies that they think might have named them as a beneficiary.

Here are some quick tips. For more specifics and links, please see our brand-new "how to find an old life insurance policy" web page.
  • Try to track down as much information as possible. You'll presumably know the name of the policyholder (any name changes?), and it also helps to know the state or states that the person lived in.

  • Ideally, you'll be able to locate a copy of the policy itself, which will have a number on it. But sometimes there's a wrinkle: the insurance company or its name may have changed, especially for older policies. That can be a challenge, but your state's insurance department can probably help you track down the current company information. If you live in Washington state -- we're the state insurance regulator there -- feel free to call us at 1-800-562-6900 and talk to our consumer advocacy staff.

  • If you can't find the policy, try going through the person's financial records, looking for payments made to an insurer. Also, look through old mail: the company may have sent periodic statements or billing reminders. It's also worth checking with the person's auto- or homeowners insurers, since people sometimes buy life insurance from the same company.

  • You could opt to pay a search company to run a check for the person's name through industry databases or send queries to a large number of insurers.

  • If a policy goes unclaimed for a long time, insurers are supposed to turn the money over to state-run unclaimed property programs. They hold the money, often forever, in case someone files a claim. You can easily run the person's name through these free, state-run online search sites. Washington state's is at http://ucp.dor.wa.gov, and you can easily find other state's unclaimed property programs at www.unclaimed.org.

Tuesday, July 23, 2013

COBRA and Medicare: How to avoid a common (and costly) mistake

If you're continuing your employer health coverage through COBRA and you become eligible for Medicare, it's important for you to sign up for Medicare during your Medicare eligibility period.

Here's why: Health insurers generally include language in their policies that says they can refuse to pay bills if they find out that you stayed on COBRA coverage after you were eligible for Medicare.

A lot of consumers get caught in this trap. Many people who are on COBRA don't know that they should sign up for Medicare when they become eligible. Instead, they assume that COBRA will continue to pay their medical bills, so they delaying signing up for Medicare until their COBRA coverage ends.

Then, months after becoming eligible for Medicare, they find out that their COBRA plan is refusing to pay for medical care that the consumer already received. They can't backdate their Medicare enrollment, so they're stuck with those medical bills. Yikes.

Don't get caught in this trap. If you're on COBRA and become eligible for Medicare, sign up.

Friday, July 19, 2013

"My doctor says I need a treatment, but my insurer won't cover it. What can I do?"

Q: "My doctor says that I need a particular medical treatment, but my health insurance company won't cover the cost. Is there anything I can do?"

A: Yes, there definitely is. Contact your health insurer, tell them you want to file an appeal, and ask what you need to do to start the process.

Then collect materials to support your argument, such as letters from your doctors describing why this is the best treatment for you, any medical journal articles or studies showing the treatment's effectiveness, etc.

You may also want to point out the health problems that will or can arise if the company doesn't pay for the treatment. Be sure to provide and estimate of the costs of treating those problems, especially if those costs would be significantly higher than paying for the treatment.

After you send in your appeal to your insurer, don't give up. Most people don't win the first round, but the odds of winning increase as you reach higher levels of appeals. The change of winning is highest when your appeal reaches the final level, called an "independent review organization."

For more tips on appeals, including templates, sample letters and detailed pointers, please see the appeals section of our website or call our consumer advocates at 1-800-562-6900. (If you live in a state other than Washington, please contact your own state's insurance department.)

Wednesday, July 17, 2013

Statement on U.S. House vote re: delaying the individual mandate

Note: The U.S. House of Representatives is scheduled to vote today on a bill that would delay for a year the individual mandate requiring most Americans to have health coverage starting in 2014. The penalty for not having coverage next year would be $95 or 1 percent of income, whichever is greater.

Statement from Washington Insurance Commissioner Mike Kreidler:

“Delaying the mandate would be unwise. This is an issue of personal responsibility. It’s unfair for people who can afford coverage to not have it, and to expect the rest of us to cover the cost of their care if they become seriously sick or injured. ”
“A critical part of the Affordable Care Act was the provision requiring that insurers take all applicants. No more screening out people because they have pre-existing medical conditions. But to make that work, you have to have as many people as possible in the insurance pool.
“Without an individual mandate to have coverage, people would likely just buy insurance when they knew they needed it. That’s like letting people get homeowners insurance only when their house catches fire.”