Friday, March 28, 2014

What’s the “individual mandate”?

Our consumer advocates have been getting a lot of questions about the individual mandate, which is the penalty for failing to obtain health insurance under the Affordable Care Act (ACA), which is a federal law. In Washington, the last day to enroll in a health plan is March 31, only four days away.

If you qualify for free or subsidized health care, enroll through Washington Healthplanfinder at  People qualify for help if their income is less than 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013). If your income exceeds that threshold, you may wish to contact an insurance broker or agent directly.

Those who qualify for Washington Apple Health (Medicaid) may continue to enroll throughout the year. There are also certain events that allow you to enroll or change your enrollment throughout the year. Read more about qualifying events.

With a few exceptions, people who do not purchase an ACA-compliant health insurance plan will pay a penalty when they file their 2014 federal income taxes. The penalty is 1 percent of your income or $95, whichever is greater. The penalty increases yearly through 2016, when the penalty will be the greater of 2.5 percent of your household income or $695 per adult and $347 per child. If you lacked coverage for part of the year, your penalty will be prorated.

There are exemptions to the penalty:
  • People who cannot afford coverage because the cost of premiums exceed 8 percent of their household income.
  • People whose household income is below the minimum threshold for filing a tax return.
  • People who are incarcerated.
  • Members of federally recognized tribes.
  • People who are eligible for care through the Indian Health Service.
  • People who live in the United States illegally.
  • People whose religious beliefs prohibit having health insurance and are recognized as such by the Social Security Administration.
  • People who belong to a health care sharing ministry.
  • People who experienced a health insurance coverage gap of fewer than three months.
  • U.S. citizens who live outside of the country for at least 330 days during a 12-month period. However, once they return to the U.S., they need to purchase health insurance within three months.
People must apply for an exemption to the individual mandate through the IRS. The IRS created a section on its website about the mandate, exemptions to it, and how to file.

Thursday, March 27, 2014

Balancing consumer protection, innovation is focus of new health insurance rules

Balancing consumer protection with innovation is the focus of the new rules under consideration for new health insurance plans that will be available in 2015.

The Insurance Commissioner’s office has been working on the health insurance network rules for more than four months. The process began soon after the emergence of what are called “narrow networks.” That’s the common reference now to health plans that don’t always include the doctors and hospitals that insurance companies typically contracted with in the past before the Patient Protection and Affordable Care Act took effect this year.

While still providing access to a full range of medical providers, health insurers have said they have not contracted with some traditional doctors and hospitals because of the higher rates they charge for some services. It’s a key way that insurers have said they can keep premiums lower for consumers and still maintain comparable quality care – especially considering the often wide discrepancies in what providers charge for the same service.

Insurance Commissioner Mike Kreidler saw early on that consumers and providers needed more guidance in developing health plans for 2015. The new rules under consideration are heavily focused on providing more transparency – answering the common question: “Is my doctor and hospital in the network of the health plan I might buy?”

“Consumers have a right to know,” Commissioner Kreidler told the members of the Health Benefit Exchange at its monthly public meeting March 27. “It’s my job to ensure that consumers can access the care they need and that insurers live up to their promises.”

That hasn’t been as clear as it should have been through plans offered this year. The new rules are designed to give consumers more information on which to make choices in 2015.
The commissioner has heard from a wide range of interested parties, including insurance companies, doctors, consumer advocates, Indian tribes and more.

A public hearing on the rules is scheduled for April 22 in Olympia. They are set to take effect May 1, about the same time that insurers will begin proposing new plans. Considerable flexibility is built into the new rules to make sure that health plans for 2015 are given time to comply. The fact is, health insurers have been involved in the process for months. And much of what’s being asked for in the rules is already required.

The new rules are simply providing a formal and clearer roadmap for all to follow on behalf of consumers.

Wednesday, March 26, 2014

If I have a child care business in my home, can my insurer cancel my homeowner policy?

An insurer cannot decline to issue a homeowner policy, cancel or fail to renew a homeowner policy for the sole reason that the customer operates a home-based child care, in accordance with state rules (WAC 284-30-700). However, insurers may exclude liability coverage for any liability that arises related to the child care business. People in Washington who operate home-based child care businesses should talk to an insurance agent or broker about seeking a separate business liability policy to insure themselves and their business in the event of a liability issue. Find a licensed agent or broker.

People who care for children in their homes typically require a license from the Department of Early Learning. Read more on DEL’s website.

People who run other home-based businesses should contact their insurance agent to find out what types of coverage they may need.

Read more about insurance and home-based businesses.

Tuesday, March 25, 2014

Join the Insurance Commissioner’s consumer protection team!

The Office of the Insurance Commissioner is recruiting to fill a Functional Program Analyst 3 position in the Consumer Protection Division at our Tumwater headquarters. This position supports our mission by advocating on behalf of consumers to ensure fair treatment by insurance companies and by educating the public on insurance matters.

The position researches and resolves consumer complaints involving health, life, annuity & disability (L&D) insurance and licensed carriers and responds to consumer inquiries regarding L&D insurance issues, including questions involving federal health care reform. This position staffs our consumer hotline four hours per day and spends the remaining time researching and resolving consumer complaints and then following up with consumers. Our consumer protection staff work with consumers and insurance professionals and also work heavily in our database, with some website content responsibilities.

In 2013, we received more than 5,000 consumer complaints and recovered more than $8 million related to insurance billings, refunds and various claim-handling issues.

Read more about this position or apply. This job closes on April 6.

Monday, March 24, 2014

Important information about landslide insurance

Gov. Jay Inslee has declared a state of emergency in Snohomish County after a large landslide hit the town of Oso on March 22. Tragically, at least eight lives were lost and several people were injured. Searches underway for more than 100 people who are still missing. The Office of the Insurance Commissioner’s thoughts are with the families, emergency responders and communities affected by the landslide.

In addition to the human toll, the slide destroyed at least 30 homes and 20 other structures, and caused a backup in the Stillaguamish River, sparking concerns about flooding. The landslide destroyed an area of at least one square mile, including Highway 230 and parts of neighboring Darrington. FEMA announced today it will assist with the landslide response.

People who lost or suffered damage to property as a result of the landslide can contact the Insurance Commissioner’s consumer advocates with questions about their options at 800-562-6900 or online.

In general, homeowner policies do not cover landslides or land movements caused by rain runoff. That type of coverage would be covered by a separate policy. If you think you purchased such a policy—or you would like to–contact your insurance agent or broker.

Read more information about homeowner insurance and landslides.

Gov. Inslee has a webpage with information about the landslide and the state Emergency Management Division has a page with updates and resources.

Thursday, March 20, 2014

Be on the lookout for Medicare red flags

The Insurance Commissioner’s SHIBA program has received reports that some Washington Medicare subscribers are receiving calls from a person claiming they’re selling Medicare Supplement (Medigap) insurance. Medigap plans are sold by insurance companies and fill the gaps that Medicare parts A and B don’t cover, like copayments, coinsurance and deductibles.

The reports are that a solicitor is cold-calling consumers and setting up an appointment to come to consumers’ homes to talk about Medigap coverage and costs. When the solicitor schedules the appointment, they ask for personal information, including Social Security numbers and consumers’ home addresses. A company representative shows up for the appointment without any identification or proof they represent the insurance company; during the meeting they ask consumers for money to buy additional coverage.

Whenever a salesperson calls you unsolicited, you should proceed with caution. Consumers should never give personal information over the phone, including Social Security numbers, bank account numbers, credit card numbers, or anything that could be used to defraud you or steal your identity.

It’s also a good idea for consumers to find out if an agent is licensed to sell insurance in our state before meeting with them or giving them money. Consumers can also call the Insurance Commissioner’s consumer advocates at 1-800-562-6900 to verify someone is licensed to sell insurance in Washington or to report suspected Medicare or insurance fraud.

Wednesday, March 19, 2014

Do you still need health insurance? Open enrollment ends March 31

Open enrollment for health insurance for this calendar year ends in less than two weeks. If you do not have a qualified health plan, you will be subject to a tax penalty when you file your 2014 taxes. The penalty for the first year is up to $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater.

  • To be covered starting April 1, you must apply, select and pay for a health plan by 5 p.m. on March 23.
  • To be covered starting May 1, you must apply, select and pay for a health plan by 11:59 p.m. on March 31.

Those who qualify for Washington Apple Health (Medicaid) may continue to enroll throughout the year. There are also certain events that allow you to enroll or change your enrollment throughout the year. Read more about qualifying events.

If you qualify for free or subsidized health care, enroll through Washington Healthplanfinder at  People qualify for help if their income is less than 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013). If your income exceeds that threshold, you may wish to contact an insurance broker or agent directly.

Open enrollment for 2015 starts Nov. 15, 2014 and ends Feb. 15, 2015.  


Tuesday, March 18, 2014

Special Investigations Unit hiring an Administrative Assistant

The Office of the Insurance Commissioner is hiring a full-time, permanent Administrative Assistant 4 in our Special Investigations Unit (SIU), located in Tumwater. SIU investigates insurance fraud in Washington state and has the authority to conduct criminal investigations, arrest suspects and submit fraud cases to prosecutors. The unit works with federal, state and local law enforcement; insurance companies' investigators; and regulatory agencies. Read more about SIU's work.

This position is the principle administrative support for the SIU Director and works closely with a staff of seven criminal analysts and detectives to support of the unit’s mission to combat criminal insurance fraud.

Duties include:

  • Providing administrative support to the Director and the Special Investigations Unit.
  • Scheduling meetings, preparing agendas and taking meeting minutes.
  • Transcribing interviews.
  • Preparing spreadsheets, charts and graphs.
  • Managing and directing incoming assignments; monitoring deadlines and projects.
  • Coordinating travel for division employees.
  • Correspondence with citizens, stakeholders and partners.
  • Records retention and gathering records requested under the Public Records Act. 
  • Providing administrative support to various stakeholder groups, including the SIU Advisory Board, and other internal and external groups.

Applicants must be able to pass a fingerprint-based background check and must maintain confidentiality about criminal investigations.

The job closes on March 31. View the full job posting and application instructions

View all of the jobs that are currently open at OIC.

Friday, March 14, 2014

Do some leg work before you purchase an auto warranty

We receive a number of complaints from consumers regarding auto warranties, warranty premium refund guarantees, and loan gap waivers sold by car dealerships. Unfortunately, we get the calls after consumers encounter a problem with the warranty they purchased.

Generally these types of products are offered at the time of the vehicle’s sale and consumers may feel pressured to buy these types of warranties without really understanding what they are getting. The cost of these types of warranties is often added to the loan amount, which increases the amount you borrow, your monthly payment and the warranty price because you interest on it over the life of the loan.

While we are not finance experts, we do recommend that consumers contact their insurance agent or our consumer advocates before deciding to buy these products. Consumers can call or email us to discuss the product; consumers can see whether or the warranties are properly registered to sell plans in Washington by searching our company or agent lookup.

Remember, you have 10 days under state law to revoke your purchase of any warranty and receive a full refund. After 30 days, the company may prorate your refund.

Many consumers don’t know that you can request your insurance agent add a debt waiver or loan balance payoff coverage to your insurance policy when you buy a new car. This type of insurance protects you if your car is “totaled” (called a “total loss” by your insurer) and you owe more than its current market value. If you are in the market for a vehicle, it’s always a good to discuss your insurance options with your agent before you buy anything.

Read more about auto insurance.

Read more about warranties and service contracts.

Wednesday, March 12, 2014

Truth is stranger than fiction -- these life insurance questions prove it

Life insurance can be confusing under the best circumstances. Our Consumer Advocates shared some questions they’ve received about life insurance benefits under unusual circumstances:

My ex-husband died and the life insurance company won’t give me the money, even though I’m still listed as the beneficiary on his life insurance policy. Can they do this?

Yes, they can. In fact, state law requires it. Under Washington probate law, divorce automatically cancels an ex-spouse’s standing as beneficiary on a life insurance policy. What if someone still wants their ex-spouse to be the beneficiary after the divorce? After the divorce is final, they should fill out and submit a new beneficiary form listing the ex-spouse (again) as beneficiary.

I’m in the midst of a divorce and I want to remove my soon-to-be ex-spouse as the beneficiary on my life insurance policy. Do I need to wait until the divorce is final?

The answer to this depends on a few things.

Does it look like the divorce decree will list this life insurance policy as one of the marital assets? If so, you should wait until the divorce is final, because the divorce decree might dictate what you can do with the policy. If you’re sure the divorce decree won’t list this life insurance policy as a marital asset, you could remove your wife as beneficiary for up to 50 percent of the policy.

While the marriage is still in effect, though, state community property laws make people list their spouse as beneficiary for 50 percent of the policy unless the spouse agrees in writing to do otherwise. The moment a divorce becomes final, state probate law automatically cancels the ex-spouse as beneficiary on the policy. As a result, even if you never remove your ex-spouse as the beneficiary, the insurance company won’t give your ex the life insurance money.

For obvious reasons, though, most people choose to fill out a new beneficiary form after a divorce is final.

I briefly dated someone and after we broke up, she told people that she bought a life insurance policy for me while we were still together. Is that even possible?

As odd as this may sound, we hear this question regularly. The answer: It’s unlikely that someone could buy a life insurance policy on your behalf without your knowledge and consent. Washington state law says that people need to have an “insurable interest” before they can buy a policy on someone’s life, and only a close relative such as a spouse or parent would meet this standard.

Also, before selling a life insurance policy, most insurance companies send a representative to meet you, check your identification and take a sample of your blood for testing.

If you are genuinely concerned in a situation like this and fear for your safety – something we’ve heard from many consumers – we advise you to contact your local police department.

Find more information about life insurance on our website.

Monday, March 10, 2014

OIC expands online services through NIPR

The OIC has expanded the types of applications we can accept online through our partnership with the National Insurance Producer Registry (NIPR) to new and renewing insurance licenses for: 

  • Washington resident insurance producers (full lines only) 
  • Washington surplus lines brokers 
  • Out-of-state surplus lines brokers

Through our partnership with NIPR, an applicant or licensee can submit multiple applications or renewals to more than one state simultaneously. In today’s marketplace, many insurance professionals hold licenses in multiple states. View a list of applications that may be submitted to OIC through NIPR.

Friday, March 7, 2014

Protect your identity to prevent Medicare fraud

During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Medicare is the national health care plan for all U.S. citizens age 65 and older. It also covers people younger than age 65 who receive Social Security Disability Income and people diagnosed with specific conditions.

Medicare is a $585 billion program with approximately 48 million enrollees. That number will grow as more baby boomers become eligible for Medicare. Medicare fraud can be hard to track, but some estimate that Medicare fraud accounts for up to 10 percent of its annual budget.

We all pay a price for Medicare fraud, waste and abuse, which contributes significantly to rising health care costs. Here are some red flags to watch for:

  • Check your monthly statement for services or equipment you didn’t receive or for prices that seem higher than you expect or were told.
  • Never give your Medicare number (which is your Social Security number) in exchange for “free” testing, screening, products or services. Never give your Medicare number to anyone who calls or solicits you. Medicare will never call you.
  • A medical provider should never charge you for billing Medicare on your behalf or for filling out forms.
  • Medical providers should never who waive your coinsurance or deductible.

View more Medicare fraud tips on our website.

If you suspect Medicare fraud or have questions about your bill, call OIC’s Statewide Health Benefits Insurance Advisors (SHIBA) at 1-800-562-6900 or contact a local SHIBA office.

SHIBA also holds Medicare fraud prevention workshops throughout the state

Thursday, March 6, 2014

Are you covered for flood damage? The answer may surprise you

This month has been the soggiest March on record in the Seattle area, according to the Associated Press, and some areas of the state are experiencing heavy rain that may cause flooding today and tomorrow. Here are some things that are good to know about floods and insurance:

  • Homeowner policies typically do not cover flood damage. Flood damage is not on standard homeowner policies and most commercial policies, although many people assume it is. That can be a costly assumption. Your mortgage lender may require you to have flood insurance if your home is located in a flood-prone area, also known as a "special flood hazard area." You can estimate your property's flood risk online.
  • Most people buy flood insurance through the government’s National Flood Insurance Program, which is run by the Federal Emergency Management Agency (FEMA). These policies are sold through local insurance agents and brokers, which you can locate online. As with most policies, there are limits to what is covered.
  • Flood insurance rates are in flux. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which changed the way the National Flood Insurance Program is run. Among those changes were premium rate increases to make the program more financially stable. However, a new bill is being heard in Congress that would slow the premium increases for certain policyholders. That bill, call Grimm-Waters, passed the U.S. House of Representatives on March 4.
  • If your vehicle is damaged in a flood, your auto policy’s comprehensive coverage typically will cover it. However, you should verify you have that type of coverage with your insurance agent or broker. Read more about auto insurance.

You can read more about flood insurance on OIC’s website. 

OIC’s SHIBA can help consumers find health benefits

During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.
The Office of the Insurance Commissioner oversees Washington’s Statewide Health Insurance Benefits Advisors (SHIBA). SHIBA offers free, unbiased and confidential assistance with Medicare and other health care choices.
SHIBA can help you:
  • Understand your health care coverage options and rights.
  • Determine your general eligibility for health care coverage programs.
  • Evaluate and compare health insurance plans.
In 2013, our 570 SHIBA volunteer advisors helped 54,000 people understand their health insurance. Advisors are available in communities throughout the state;.
For people who are about to turn or recently turned 65, we host Medicare events around the state. You can also find information about Medicare on our website.
Are you interested in becoming a SHIBA volunteer? Find out more.

Wednesday, March 5, 2014

Important tips for insurance consumers

Editor's note: During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Today, we are sharing tips with Washington insurance consumers based on questions and complaints we’ve received over the years. These tips are general and are intended to help you avoid common insurance pitfalls.

  • If you are having a problem with your insurance company or agent that you can’t get resolved, we recommend that you call us about it as soon as you are having the problem. We do get calls from people who wait years (yes, years) before they call us. By that time, it’s very hard to untangle the issues. We will try, but it’s significantly more difficult. Contact us at 1-800-562-6900 or on our website. The sooner you contact us, the sooner we can determine how we might be able to help.
  • Do an annual review of your policies and what possessions you are covering. A lot can happen in 12 months—did you remodel your home? Buy a car? Sell a car? Buy a boat? Have a birthday? Any of these things could affect your insurance premium. For homeowner or renter insurance policies, the National Association of Insurance Commissioners (NAIC) has a home inventory checklist available as a PDF or as an app.
  • Many people have their auto and home policies with the same insurer. However, many do not. If you change address or have any other issue that might involve both policies, be sure to contact both insurers to discuss your situation and make any needed changes to policies.

It’s important to be an informed consumer, and we are here to help. OIC’s website has a wealth of information about auto, home, health and life insurance for Washington consumers at Our consumer site is tablet- and mobile-friendly.

Tuesday, March 4, 2014

Consumers have rights to appeal claim denials

Editor's note: During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Sometimes, insurance companies deny claims for reasons that vary as widely as there are claims. Here is some information about insurance claim denials and your appeal rights.

Health insurance

Most health plans are required to comply with a very specific appeal process. However, this requirement doesn’t apply to some health plans, such as Medicare or Apple Health (Medicaid) plans.

Other types of insurance, such as long-term care or disability insurance, are required to provide an appeal process but can create their own process.

If you want to file an appeal with your health plan, contact them and ask: “What do I need to do to file an appeal?” After that, you’ll need to collect materials that support your appeal, such as:

  • The health problems that can or will arise if the company doesn’t pay for this treatment, plus an estimate of the cost of treating those problems.
  • Any medical journal articles or studies that show the treatment’s effectiveness.
  • Letters from your doctors describing why you need this treatment.

After you send your appeal materials to the health plan, be persistent. Most people don’t win at the first level of appeal, but the odds of winning increase as you reach higher levels of appeals. The chance of winning is highest when your health plan appeal reaches the final level, called an “Independent Review Organization.”

For more tips, please visit the appeals section of our website.

Property and casualty insurance

With property and casualty insurance—such as homeowner, renter and auto insurance—consumers generally can use the appraisal provision of their auto or home policy or the arbitration provision for personal injury protection (PIP) and under- or uninsured motorist (UIM) claims on auto policies. Appraisal provisions are used for disputes of claim value, and arbitration provisions are generally used when the application or availability of coverage is being questioned.

More information

Monday, March 3, 2014

March 2-8 is National Consumer Protection Week

You may have seen that this week is National Consumer Protection Week. The Washington state Insurance Commissioner has an entire unit devoted to helping consumers who experience trouble with their insurance policies or companies. In 2013, we responded to more than 5,000 inquiries from consumers and helped recover $8.4 million in insurance billings, refunds and other claims-related issues.

Our consumer advocates can help:

We also share information of interest to insurance consumers on this blog and through our social media channels. Many of our posts are generated by questions our consumer advocates receive from Washington citizens. Consumers can reach us by phone at 1-800-562-6900 and online via our web form. Read more about consumer advocacy at OIC.