Monday, December 28, 2015

There’s still time to get a health plan for 2016


Consumers have until Jan. 31 to sign up for a health plan for 2016 coverage. People who do not have a health plan for 2016 face a penalty on their taxes of 2.5 percent of their income or $695 per person, whichever is higher. Read more about the tax penalty.

If you are still looking for a health plan, you check our state’s health insurance exchange, Washington Healthplanfinder to find out if you qualify for financial help, including tax credits that may lower the cost of coverage. 

If you do not qualify for help with your health insurance, you can contact an insurance agent or broker directly to find out what your plan options are. You can look at the 2016 individual plans and rates on our website.

Read some tips from us about things you should consider when shopping for a health plan.

After Jan. 31, you’ll have to qualify for a special enrollment period to sign up or make a change to your plan, or wait until the 2017 open enrollment period.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Monday, December 21, 2015

Wednesday is the deadline to get a health plan for Jan. 1

Consumers have until Dec. 23 to sign up for a health plan through Washington Health Benefit Exchange for coverage that begins on Jan. 1. The last day to get health insurance for 2016 is Jan. 31. People who do not have a health plan for 2016 face a penalty on their taxes of 2.5 percent of their income or $695 per person, whichever is higher. Read more about the tax penalty.

If you are still looking for a health plan, you can look for one at our state’s health insurance exchange, Washington Healthplanfinder and find out if you qualify for financial help, including tax credits that may lower the cost of coverage. If you do not qualify for help with your health insurance, you can contact an insurance agent or broker to find out what your plan options are.

Read some tips from our office about things you should consider when shopping for a health plan.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Friday, December 18, 2015

Is there a drone on your shopping list? You might want to talk to your agent or broker

The Federal Aviation Administration (FAA) estimates more than one million drones will be sold this holiday season. Everyone from photographers and farmers to law enforcement and hobbyists are using drones.  Whether for personal or commercial use, there are a number of insurance issues to consider ranging from personal injury and property damage to privacy concerns.

Drones present a significant risk to property and life on the ground in the event of an accident. Drones can crash due to faulty and inappropriate operation, mechanical defects and component failure. Losses and damages could involve bodily injury to humans and animals as well as buildings and structures.

Using a private drone as a hobby is generally covered under a homeowner’s insurance policy—and subject to a deductible--which typically covers radio-controlled model aircraft. This also applies to a renter's insurance policy. Look at the contents section of your policy, or talk to your agent to see if your drone will be covered if it is lost, stolen or damaged. If your drone falls onto your car, damage to your car may be covered if you have a comprehensive coverage auto policy.

A larger concern is liability for an accident caused by your drone. If your drone crashes into someone else's vehicle or a person. If you have a homeowner’s or renter's policy, generally the policy will cover liability for an accident caused by your drone if it is determined that you were negligent and at fault. Check with your agent or insurer to verify your policy contains this important coverage. You can also read a story about drone insurance that was recently posted on the Insurance Journal’s website.

Drones are defined as remotely piloted aircraft systems and the FAA says pilots of unmanned aircraft have the same responsibility to fly safely as manned aircraft pilots. In addition to FAA regulations, state and municipalities may have their own laws regarding drone use.  The FAA has issued these guidelines for drone hobbyists:

  • Don't fly higher than 400 feet and stay clear of surrounding obstacles.
  • Keep the aircraft in sight at all times.
  • Stay away from manned aircraft operations.
  • Don't fly within five miles of an airport unless you contact the airport and control tower before flying.
  • Avoid flying near people or stadiums.
  • Don't fly an aircraft that weighs more than 55 pounds.
  • Use caution when flying your unmanned aircraft.
  • With some drones weighing up to 55 pounds, a fall from the sky can cause significant damage to property or bystanders.



Recently, federal regulators announced that recreational drone operators will soon need to register their aircraft. This will allow authorities to trace a drone back to the owner, which means it's vital that you're in compliance with laws and regulations and have the appropriate insurance coverage.

Wednesday, December 9, 2015

No health insurance for 2015 or 2016? You may be facing a tax penalty

If you can afford health insurance but you choose to not enroll in coverage for 2016, you may be required to pay a fee when you file your 2016 federal income taxes. The fee is also called a penalty, fine, or the individual mandate.

A few facts about the individual mandate:
  • The fee is calculated one of two ways. The fee for not having health insurance if you can afford it is $695 per person in your household who doesn’t have health insurance or 2.5 percent of your income – whichever is higher. HealthCare.gov has a guide to estimate the fee you’ll have to pay if you don’t have health insurance. 
  • The fee for 2015 is lower than for 2016. For 2015, the fee for not having health insurance if affordable insurance is available to you is $325 per person or 2 percent of your annual household income – whichever is higher. The fee is calculated based on the number of months you, your spouse, or your tax dependents went without qualifying coverage, such as an employer-sponsored health plan, Medicare, Medicaid or coverage through Washington Healthplanfinder.

    In some cases, the fee may be higher than buying health insurance through Washington Healthplanfinder. You can look at plans and find out if you qualify for help at www.wahealthplanfinder.org
  • For some people, exemptions from the fee are available. People with very low incomes and individuals who meet other specific conditions can receive an exemption from the requirement to have health insurance and will not have to pay the fee. Additional information about exemptions and a tool that helps you determine if you qualify for an exemption is available on HealthCare.gov. 
If you need health coverage and want to avoid the fee for 2016, the deadline to enroll in a plan is Jan. 31. If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes. If you want coverage that starts on Jan. 1, you need to enroll by Dec. 23.

More information about the individual mandate on the Internal Revenue Service's (IRS) website.

Monday, November 30, 2015

Health insurers must provide transparency tools to consumers on Jan. 1

Health insurers are required to provide transparency tools via their websites starting Jan. 1, 2016, to consumers who are enrolled in their plans. The tools provide information about treatment costs, quality of care and other patients’ experience with the medical providers. These tools have not been readily available to consumers before now. The requirement is in the Affordable Care Act and is being implemented in Washington state now.

Each insurer must provide written verification to the Washington state Office of the Insurance Commissioner by Feb. 1 of each year that the company is in compliance with this state law, which was enacted by the 2014 Legislature. The OIC provides a form for health insurers to fill out and send to us, called an attestation. We are required to post the form 60 days before it's due.

You can read more about the rules the OIC wrote to implement this requirement, which were recently adopted, or about the state law (RCW 48.43.007). The OIC also provided instructions and the attestation form for insurers to return to us by Feb. 1, 2016.

Tuesday, November 24, 2015

Tips for holiday travelers

Are you traveling for the upcoming holiday? Here are some travel tips to help keep you safe and informed.

Driving

Traveling by plane
Other travel tips

Thursday, November 19, 2015

Columbia United Providers will notify enrollees about withdrawal from Washington market


Columbia United Providers (CUP) this week informed the Office of the Insurance Commissioner that it is voluntarily withdrawing from the individual health insurance market.

The company, which is based in Vancouver, Wash., also said that it intends to sell its Medicaid business to Molina Healthcare. That proposal is subject to approval by the Insurance Commissioner.

Here are answers to some questions about CUP’s announcement:

Why did CUP voluntarily withdraw from Washington?

The company cited business reasons for the voluntary withdrawal.

How does CUP’s withdrawal affect the Washington health insurance market?

CUP offered individual plans in Clark County only. As of November 2015, CUP had fewer than 100 enrollees in the individual market. These plans were offered only through the Washington Health Benefit Exchange. The company also managed insurance coverage for about 55,000 enrollees in Medicaid plans in Clark County. The Washington Health Care Authority (HCA) oversees Medicaid in Washington.

HCA is aware of CUP’s withdrawal from the Washington market and its proposal to sell its Medicaid business to Molina Healthcare.

How does this affect those who enrolled in Exchange plans?

The Health Benefit Exchange is aware of CUP’s withdrawal and proposed sale. The Exchange is reaching out to any enrollees who selected CUP for 2016 to assist them in choosing another plan. CUP 2015 enrollees will be covered through the end of the year and can select alternate coverage for 2016. Any CUP enrollee who wants to change coverage for the remainder of 2015 may request a special enrollment.

How will current enrollees be notified CUP’s decision?

The company is responsible for notifying, by Nov. 19, 2015, all individuals who have purchased individual coverage through CUP, to be effective on or after Jan. 1, 2016, that their coverage is terminated. The company’s plans will no longer be listed on the Washington Healthplanfinder.

Even with CUP’s voluntary withdrawal, Washington remains a competitive market with a wide selection of choices. There are five companies that sell individual plans in Clark County. Overall in Washington, there are 14 insurers and more than 200 plans available for consumers for coverage in 2016.

Will existing claims be paid?

Washington state insurance law requires that all claims be paid and that company make plans for payment. At this time there is no concern about the company paying existing claims for enrollees in its Washington plans.

Tuesday, November 17, 2015

OIC has saved auto insurance consumers nearly $26 million since 2010

The Office of the Insurance Commissioner's rate decisions have saved auto insurance consumers nearly $26 million in premiums since 2010.

Personal auto insurers are required to file their proposed rates and rating plans with our office whenever there's a rate change. Our actuaries review the proposed rates, rating plans, and supporting documentation to be sure that the rates are not excessive, inadequate or discriminatory.

From 2010 through 2014, the rates we approved for the top 20 personal auto insurers in Washington saved consumers nearly $26 million in premiums.
  • 2014: $6.2 million 
  • 2013: $8.9 million 
  • 2012: $5.6 million 
  • 2011: $2.7 million 
  • 2010: $2.7 million 
Read more about auto insurance in Washington state.

Friday, November 13, 2015

Washington wildfire victims: Hire smart when repairing, rebuilding

As Washington consumers begin to rebuild and repair their homes and businesses after this summer's wildfires, we are partnering with the Washington State Department of Labor and Industries (L&I) to share this message: Hire registered contractors.

Unregistered contractors often have no bond or liability insurance, don’t get building permits, and fail to provide workers’ compensation insurance to their employees. It’s a risky combination that leaves property owners financially vulnerable if workers are injured on their property or the contractor does shoddy work – or takes a down payment and never returns.

Construction contractors are required to register with L&I. In turn, L&I confirms that they have a business license, liability insurance and a bond – requirements that give property owners some monetary recourse if something goes wrong.

Hiring registered contractors provides the best chance for success and to protect your investment.

Hire Smart to avoid rebuilding and repair headaches
  • Verify your prospective contractor’s registration at www.ProtectMyHome.net or call 1-800-647-0982.
  • Get at least three written bids.
  • Check contractor references.
  • Pay only as work is completed.



Friday, October 30, 2015

Moda will honor health coverage according to current contracts

The announcement this week by Moda Health that it’s withdrawing from the Washington insurance market has understandably raised questions from its current enrollees.

Enrollees should be aware that their current policies will remain in effect according to the terms of the contracts. Moda said it will fulfill its obligations for plans signed on or renewed by Oct. 31, 2015. That includes policies that have already been sold that start on Nov. 1 or Dec. 1, 2015. Policies that start on Jan. 1, 2016 or later will be terminated.

That’s true for individual, small- and large-group employer plans.

Moda this week notified the Washington Health Benefit Exchange of its decision to quit doing business here. The Exchange is reaching out to its customers to let them know.

You can read that notification here.

In Washington state, Moda has:
  • About 18,000 people enrolled in the individual market inside and outside of the Exchange.
  • About 29,000 people covered through large-group plans.  
  • Another 900 enrolled in small-employer plans. 
Moda said it is withdrawing from Washington to focus on its business in Oregon and Alaska.

By the first week of November, the Oregon-based company is expected to notify all of its enrollees of its withdrawal from Washington.

Thursday, October 29, 2015

Do you need flood insurance? Now is the time to do your research

Residents in Eastern Washington are facing increased risk of flooding after extreme wildfires the last two summers destroyed much of the vegetation there that would normally help prevent landslides and mudflows.

Flood damage is not covered by homeowner’s insurance. Consumers who want to protect their property must purchase a policy through the National Flood Insurance Program (NFIP). Most properties qualify for NFIP, as long as it is located in a community that participates in the NFIP.

NFIP has told to us that Okanogan County and most towns within the county will be able to purchase flood insurance.

Typically, there is a 30-day waiting period before your flood insurance policy takes effect. Here is information on how to find an agent near you who sells flood insurance policies through NFIP.

Read more about flood insurance: Are you protected against flood damage?

Eastern Washington fires burned down much of the vegetation that prevents flooding.
Photo courtesy Washington Military Department. 

Wednesday, October 28, 2015

OIC partners with the American Indian Health Commission on Medicare training

 Terri Osborne, SHIBA, right, speaks with 
AIHC Executive Director Vickie Lowe. 
Earlier this year, Insurance Commissioner Mike Kreidler signed a contract with the American Indian Health Commission (AIHC) to support providing Medicare and other related training to tribal staff throughout the state.

The Commissioner's State Health Insurance Benefits Advisors (SHIBA) held its first quarterly training on Oct. 21 at Port Gamble S’Klallam tribal facilities in Kitsap County to 35 staff from several Western Washington tribes.

SHIBA will provide training throughout the year to tribes all over the state. Next up is a training in Spokane for tribes in the region.

The goal of the training to provide tribal assisters with information about Medicare eligibility, benefits and coordination with Medicaid for tribal elders and tribal members who need health care.
Dale Ensign with SHIBA provides
training to tribal staff about Medicare.
























Tuesday, October 27, 2015

Mold, mildew, rot typically not covered by homeowner’s insurance

Living in the Northwest, it is not unusual for homeowners to discover mold, mildew or rot damage to their homes as a result of things like a leaking pipe, a hole in the roof, a failing window seal or improper venting.

Such damage is considered wear and tear and is typically not covered by homeowner's insurance. Insurance is designed to cover sudden and accidental damage caused by specific perils, such as a windstorm, fire or explosion. Some policies may cover mold or mildew damage discovered and reported within two weeks of the leak that caused the damage and some insurers offer limited mold coverage. Consumers should check their policies to find out what is covered.  

We do hear from consumers who are unhappy to find out this type of damage is not covered by their insurance. If the policy specifically excludes such damage, we can't compel the company to pay for the repairs. 

Here are some perils that homeowner's insurance policies typically do not cover:
  • Earthquakes
  • Floods
  • Mold damage
  • Damage due to animals or rodents
  • Foundation settling 

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Thursday, October 22, 2015

Do you have a teen driver? Five tips to cover with your teen

This week is National Teen Driver Safety Week, sponsored by the National Highway Traffic Safety Administration (NHTSA). Motor vehicle crashes are the leading cause of death for 14- to 18-year-olds in the United States. In 2013, 2,614 teen drivers were killed in crashes and an estimated 130,000 teens were injured. Yet, a recent survey shows that only 25% of parents have had a serious talk with their kids about the key components of driving.

The “5 to Drive” campaign addresses the five most dangerous and deadly behaviors for teen drivers. The idea behind the campaign is to give parents the words to use when they talk with their teens about the rules of the road. NHTSA’s website, has detailed information and statistics about the five rules designed to help save the lives of teen drivers.
  1. No drinking and driving: Nearly one out of five (19 percent) of the young drivers 15 to 19 years old involved in fatal crashes had been drinking, even though they were too young to legally buy or possess alcohol. 
  2. Buckle up. Every trip. Every time. Front seat and back: 64 percent of all the young (13- to 19-year-old) passengers of teen (15- to 19-year-old) drivers who died in motor vehicle crashes in 2013 weren’t restrained. 
  3. Put it down. One text or call could wreck it all.: The age group of 15 to 19 years old has the highest percentage of drivers who were distracted by cell phone use and involved in a fatal crash. In 2013, 318 people were killed in crashes that involved a distracted teen driver. 
  4. Stop speeding before it stops you: In 2013, almost one-third (29 percent) of teen drivers involved in a fatal crash were speeding. 
  5. No more than one passenger at a time: The risk of a fatal crash goes up with each additional passenger. 

Thursday, October 15, 2015

New Medicare pages on OIC's website, including new Advantage plans


SHIBA is happy to announce today's launch of the new and improved Medicare webpages on the OICs website. Last spring, SHIBA staff and OIC's Web Services team conducted a usability study on the agency's Medicare webpages. After several months of research, and writing and editing content, the new section should provide content that is more user-friendly and easier to navigate for consumers.

In addition, the 2016 Medicare Advantage and Special Needs plans by county are now available on the OIC's website. Medicare open enrollment started today and ends Dec. 7. Read more about Medicare open enrollment.

Wednesday, October 14, 2015

OIC joins Great ShakeOut drill – are you prepared for an earthquake?

The OIC is joining the Great Washington ShakeOut drill tomorrow, along with more than 1 million other participants in Washington state. 

In addition to practicing drop, cover and hold, in what other ways are you prepared for an earthquake? Here are some tips from the OIC to help you think about ways you can protect yourself and your home in the event of an earthquake:
Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Tuesday, October 13, 2015

Use extra caution when driving in areas near wildlife

October and November are the months with the most collisions between vehicles and deer, which is compounded by fewer daylight hours and animal mating seasons and migrations. The National Highway Safety Administration (NHSA) reports there are about 1.5 million deer-related auto accidents each year. In Washington, more than 1,100 collisions with deer and other wildlife are reported to State Patrol each year, and result in an average of nearly 1,200 human injuries. 

Hitting a deer or other large animal at highway speeds can, at best, damage your vehicle and at worst, injure or kill drivers and their passengers. The Washington state Department of Transportation (WSDOT) reports it removes nearly 3,500 deer and elk carcasses from state highways each year.

Our consumer advocates recommend that consumers check their insurance policies or contact their agents or brokers to find out if wildlife collisions are covered by the insurer. Most auto insurance policies cover such damag­e under the optional comprehensive portion of the policy. If you only have collision coverage or liability coverage, your insurer may not cover damage to your vehicle resulting from a collision with an animal. Comprehensive auto insurance also includes coverage for fire, theft, vandalism or malicious damage, riot, flood, earthquake or explosion, hail, windstorm and falling or flying objects. Filing a claim for an accident covered by your comprehensive coverage means you'll still need to pay a deductible. After that, your insurer will cover the costs of the claim up to your policy limits.

WSDOT reports the following areas of the state have the highest number of collisions with wildlife:
  • Spokane and surrounding areas, where highways intersect with white-tailed deer wintering grounds.
  • Methow River Valley, which is home to one of the state’s largest mule deer herds.
  • Wenatchee and vicinity, also home to a large number of mule deer.
  • Interstate 90 near Easton/Cle Elum has the highest number of collisions with elk.
  • Whidbey Island has a high number of deer collisions
  • Packwood/Randle off Highway 12 and North Bend off Interstate 90 have a high number of elk collisions.
Here are some tips to avoid hitting a deer or other wildlife:
  • Deer tend to travel in herds, so if you see one, watch for more. 
  • Keep an eye out for deer signs, which are placed at known deer-crossing areas. Reduce your speed when you see a sign. 
  • Animals tend to be active during dawn and dusk, so be extra-aware during those times and watch your speed. 
  • Make sure your headlights are in working order to ensure you see well at night. Using high beams can help you spot wildlife, but be considerate of other drivers when using them. 
  • Stay focused while driving. Do not text, talk on your phone or allow passengers to distract you. 
  • Always wear your seat belt. This won't prevent a collision, but it can save your life depending upon the severity of the accident. 
If you are involved in a collision with wildlife:
  • If you can, move your vehicle to a safe place and turn on your hazard lights. This may mean pulling over to the shoulder of the highway. 
  • Stay away from the animal. A frightened or wounded animal can hurt you. 
  • If you can't move your car, or the animal carcass is blocking traffic, call 9-1-1 so emergency responders can clear the roadway. 
  • Document the collision by taking photos of your vehicle damage, the roadway and any injuries. 
  • Check to see if your vehicle is safe to operate. Check for leaking fluid, damaged lights, loose parts or other safety hazards. When in doubt, call a tow truck. 
  • Report the collision to your insurance as soon as you safely can.
Read more about auto insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Friday, October 9, 2015

Homeowners, insurers have responsibilities in repair claims

We often hear from consumers who are concerned about their home repair or rebuild insurance claims and have questions about their insurer's role in overseeing the contractors' work.  

Your insurance company is responsible for paying the claim, as laid out in your homeowner policy. Typically, it is your responsibility to oversee the project with your contractor, and when applicable, your lender. The exception would be if your insurance company has given you assurances or if your policy contains a provision that obligates the insurer to manage a covered home repair or rebuild.

However, if you are using an insurer’s recommended (sometimes called “preferred”) contractor, you should expect assistance from the insurer in answering your questions about the contractor’s actions and performance. 

Many insurers also require the homeowner to stop the damage from getting worse--this is called loss mitigation in your policy. If you don’t mitigate the loss, you could be on the hook for paying for any resulting additional damage. For example, if you have water damage in your home, you must control it as soon as you discover it. If you let it go until you get around to calling your insurance company, you will be responsible for any resulting damage, including rot, mildew or mold. Even if you use an insurer's preferred contractor, you are still responsible for mitigating the loss prior to the contractor showing up and starting the repairs. 

More information:
Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Wednesday, September 23, 2015

What should I know about title insurance?


Buying your home is likely one of the largest investments you'll make and a decision that can affect your finances for years to come. The OIC and the National Association of Insurance Commissioners (NAIC) offer information for consumers about title insurance, a topic that is unclear to many people.

What is title insurance?
When purchasing real estate, your lender will likely require you to purchase title insurance.

Title insurance covers you if title problems come up based upon claims prior to when you purchased or refinanced a property. For example, let’s say there is an unpaid mortgage on the property you just bought. Without title insurance, you might have to pay legal costs to settle a dispute. If you lose a dispute, it could cost you money, the equity you have in your home and perhaps even ownership. Title insurance would pay legal costs to settle the dispute and/or to resolve the problem.

Where can I buy title insurance?
You can buy title insurance from a title insurance company or a title agent who sells title insurance. Title insurance companies and agents must be licensed by the OIC to sell title insurance in Washington state.

Many consumers aren’t aware of title insurance until they sign their closing paperwork. You are not required to use the suggested title company or closing agent. You have the right to shop for and choose your provider of title insurance and settlement services.

You'll need to know the purchase price of the property you are buying to make price comparisons on title services. You can search for licensed title companies and make a list of questions to ask title insurers before you sign a contract. Be sure to ask what services and fees are included in the title premium, any separate fees and whether you qualify for any discounts.

Some title insurers may be affiliated with lenders, real estate companies, developers or home builders. Ask the person making the referral if their company is affiliated with the recommended title agent and what they are receiving or not receiving for referring you to the title agent. Federal law requires affiliated relationships to be disclosed in writing.

Read more about choosing and buying title insurance.

More information
Read more about title insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Friday, September 18, 2015

Do you get health insurance through Washington Healthplanfinder? Payment changes start Sept. 24

Starting Sept. 24, 2015, if you buy an individual or family health plan through Washington Healthplanfinder, you must pay your premium directly to your health insurer or dental insurer. Any financial help – such as tax credits or cost-sharing reductions you’re receiving – won’t be affected by this change.

Washington Healthplanfinder will continue to accept premium payments until 4:59 p.m. on Sept. 23 for coverage for the month of October. As for future monthly payments, deadlines may vary by insurance company.

Tips for an easy transition

  • Pay your insurance company directly by Sept. 23 at 4:59 p.m. for your October coverage.
  • Look for information in early October from your insurance company about your November premium payment deadline.
  • If you have health and dental insurance provided by two different companies, remember to make a payment to each insurance company.

Already pay your insurer directly?

If you’re already paying your insurance company directly, you can keep doing so. If you have auto-pay set up through Washington Healthplanfinder, follow these steps before Sept. 24 to cancel it:

1. Sign in to your Washington Healthplanfinder account at www.wahealthplanfinder.org
2. Click the “Billing &Payments” tab from your account dashboard
3. Select “Edit/Cancel Auto Pay”
4. Select “Delete payment method”

Remember: After canceling auto pay with Washington Healthplanfinder, be sure to set up your premium payment with your insurance company right away! Contact your insurance company to see what payment methods they offer.

If you have auto pay or automatic funds transfer set up through your bank, you’ll need to contact your bank to redirect your monthly payments to your insurance company before Sept. 24, 2015.

For more information

Insurance Commissioner prevails in conviction appeal

Andre Zamora

A man convicted of insurance fraud lost a recent appeal to overturn the conviction.

Andre Zamora-Sarmiento (Zamora) was convicted of one count of felony insurance fraud in July 2014 after attempting to bilk an insurance company of more than $13,000 by altering medical bills that he submitted for reimbursement. Read our news release about his conviction.

In November 2011, Zamora was involved in a car collision in Tacoma. After the collision, Zamora sought medical attention at a Renton hospital emergency room and later sought a second opinion from a Bellevue hospital. Zamora then submitted falsified medical bills to USAA insurance company for reimbursement. He submitted three false claims to USAA totaling more than $14,857; the actual amount of the three claims totaled $1,621.

The insurance company paid Zamora's first two claims, netting him $4,200 more than the actual cost of the bills. He submitted a third claim that was inflated by $9,000. The company sought documentation, which Zamora refused to provide. He also refused to provide authorization for the company to contact the hospital directly for a copy of the bill. The insurance company declined the bill and referred the case to the Insurance Commissioner’s Special Investigations Unit.

The appeal hinged on a legal technicality about the number of offenses versus the number of charges. In this case, attorneys used multiple examples of falsified bills Zamora submitted to prove one act of insurance fraud. There’s also an argument about the technicality of the instructions the prosecutor gave the jury. The appellate court found the state prosecutor did not err and upheld the conviction.

Zamora was sentenced in July 2014 two months in jail with work release and credit for 14 days served, and to pay restitution of more than $7,100.

Thursday, September 17, 2015

Affordable Care Act helps lower state uninsured rate to lowest since 1987

The latest figures from a highly respected national research organization support what backers of the Affordable Care Act said all along – expanding health care coverage would lower the rate of uninsured in the nation and in Washington state.

Two reports came out this week, both from the U.S. Census Bureau.

The first, the Current Population Survey, showed the percentage of uninsured in Washington dropped 317,000 in 2014. This survey reported that roughly 643,000 state residents remained without coverage.

That represents a decline in the overall percentage of uninsured residents from 14 percent in 2013 to 9.2 percent in 2014. And the 2014 figure is even better than the 16 percent of residents without coverage in 2012, according to the Census Bureau.

A second report, the American Community Survey, showed pretty much the same numbers as the Current Population Survey.

The American Community Survey is considered the gold standard among such data reporting because it delves into more detail about health insurance coverage.

Both reports show the lowest rate of uninsured state residents since the Census Bureau began its tracking in 1987.

Much of the success, according to the reports, is due to Washington’s expansion of Medicaid, the health care program that serves lower-income residents, called Apple Health in our state.

Washington was among the 28 states that expanded Medicaid when given the opportunity. The latest reports show that states that took this option have achieved greater success in lowering the rate of uninsured compared to those that rejected expansion.

Nationally, about 9 million citizens have gained coverage since the Affordable Care Act took effect.

The latest figures also match closely with what the Office of the Insurance Commissioner has reported on regarding the uninsured in Washington. An updated report by the OIC is due in November.



Wednesday, September 16, 2015

Small business fair offers free resources on Sept. 26

Learn from the experts how to form and run a successful business at the 19th annual Washington Small Business Fair on Sept. 26 from 8 a.m. to 3:30 p.m. at Renton Technical College, 3000 NE 4th Street, in Renton.


The OIC will have consumer experts on hand who can answer your questions about finding health insurance for individuals or small businesses, and other questions you may have about insurance issues. 

Here's what else you can expect at the Small Business Fair:
  • Attend seminars that cover important, up-to-date topics for all stages of business ownership. Savvy business experts share their knowledge and real-life experiences with you. 
  • Connect with 30 federal, state and local government agencies, and business and trade associations to get the information you need. 
The fair is free, with plenty of free parking and no advance registration. For more information, visit www.bizfair.org or find the fair on Facebook at www.facebook.com/bizfair.

Friday, September 4, 2015

Are you protected against flood damage?

Floods are the most common natural disaster that Washington residents face, and are a threat to life, property and public services. This year, waters in the Eastern Pacific are experiencing what promises to be the strongest El Niño recorded. While the actual effect El Niño will have on weather here in the Northwest is hard to predict, there is a potential for more precipitation. In Eastern Washington, where fires have scorched hundreds of thousands of acres, there will be an increased risk of flooding, landslides, and mudslides due to increased run-off after even moderate rains. 

Despite that, most Washington consumers are not protected--standard homeowner’s insurance does not cover flood damage. Flood insurance is available through the National Flood Insurance Program (NFIP), and offers protection against flood hazards for homeowners, business owners, condo owners and renters. The average residential flood claim exceeds $39,000, while the average flood insurance policy premium is $700 per year.

You don’t have to be in a flood hazard zone to be affected by a flood. People outside of mapped flood-risk areas file 20 percent of all flood insurance claims. See Myths and Facts about the NFIP. Another benefit of purchasing flood insurance is that a policy holder may file a claim regardless of the declaration of a disaster. Check to see if your community participates in NFIP.

Typically, there is a 30-day waiting period before your flood insurance policy takes effect. Here is information on how to find an agent near you who sells flood insurance policies.

The Insurance Commissioner’s website has information for consumers about floods and homeowner’s insurance, including things you should talk to your insurance agent about and tips for protecting your home and belongings. We also have tips for filing a claim after a natural disaster and how to find disaster resources.

The Washington Military Department’s Emergency Management Division provides a number of tools and guides to help you prepare:
Flooding may be extensive this fall and winter. Here are some tips for preparing for the risk of flooding and mudslides: 
Consumers can seek help with their insurance or ask insurance-related questions by calling our consumer advocates at 1-800-562-6900 or contacting us online.

Tuesday, September 1, 2015

Consumer alert: If your insurance cancels your policy, you may have a hard time finding new coverage for a while

We recently received a call from a consumer who had paid the most recent homeowner insurance premium online, but the insurance company canceled the policy. When the consumer called the insurer to sort it out, the insurer said they are not issuing any policies because of the wildfires around the state.

The consumer called us, and we are working with the company to make sure the consumer has the coverage they paid for.

It is not uncommon for property insurers – they insure cars, buildings, homes, property and renters’ contents – to suspend issuing new policies during a natural disaster. President Obama issued an emergency declaration for Washington on Aug. 21. As of today, more than 920,000 acres have burned in our state.

This scenario underscores the need to be vigilant about the information your insurance sends you. Insurers are required to tell you in writing if they are canceling your policy for any reason, including nonpayment. Many homeowners don’t think about their insurance payments because they are rolled into your mortgage payment. If you have multiples insurance policies with the same company, it’s common for all of your premiums to be paid at the same time. For example, if you insure two cars and an RV through the same company, you probably pay for all three at once.

If your insurance company contacts you by mail, phone or email, you should carefully read what they send you. If you are unsure about the standing of your policies, contact your insurance company, agent or broker.

If you can't find homeowner insurance, ask your agent to get a quote through the Washington Washington FAIR (Fair Access to Insurance Requirements) Plan. It provides basic property insurance up to $1.5 million to people who can't get coverage.

If you feel you have been treated unfairly or have questions about insurance in Washington state, contact our consumer advocates online or by phone at 1-800-562-6900.

Monday, August 31, 2015

Some insurance policies may cover living expenses for those displaced by wildfires

Families displaced from their homes due to wildfire evacuations may be eligible to be reimbursed for their additional living expenses if their insurance policy provides for such claims. Examples of those expenses include lodging, meals and purchasing toiletries if a consumer is displaced by the wildfire or as a result of an evacuation order.
One of several Blackhawk helicopters that is fighting wildfires in Eastern Washington. Photo courtesy of Washington state Emergency Management Division. 
Consumers in several areas in Eastern Washington have been ordered to evacuate at different points during the wildfires. We are hearing reports that some insurance companies are requiring consumers to provide a copy of the municipality’s emergency evacuation order before they will pay for additional living expenses. There is nothing in state laws or rules that prohibits an insurance company from asking for this information. If you need a copy of an evacuation order, contact the emergency management teams in your area.

If you have access to your insurance policy, read it to find specific information about what is covered, your deductibles, what kind of documentation is required and policy limitations or exclusions. If you don’t have a copy available to you, contact your insurance company, agent or broker.

Here are more resources from the Office of the Insurance Commissioner:

OIC is hiring IT Specialist 5 in Tumwater

OIC is seeking a highly motivated IT Specialist 5 (IT Security/ Network/ Server Administrator) in our Tumwater headquarters. The IT Specialist 5 is the lead IT security specialist for the agency and is responsible for planning, designing, configuring and supporting the agency’s network infrastructure and servers. The ideal candidate must have strong knowledge of IT network and server infrastructure, Microsoft Active Directory, LAN/WAN administration, configuring network hardware and software and enterprise backup software.

OIC supports employees through regular training and opportunities to implement new technologies and participate on multiple projects teams. We also offer tuition reimbursement, free parking and participate in the state's commute trip reduction program.

If you are interested in joining our team, view this and other jobs at OIC.

Thursday, August 27, 2015

Fires continue to devastate Eastern Washington

More than 780,000 acres have burned in 11 counties and tribal lands in Eastern Washington. President Obama has signed an Emergency Declaration that authorizes FEMA to assist with equipment and resources.

The fires have claimed an estimated 80 homes and displaced families and affected agriculture, businesses and countless communities. The weather forecast calls for rain over the weekend, but there's also a possibility of lightning in some areas. Several of the fires were started by lightning.
A photo from a wildfire in Wenatchee in July 2015 (OIC photo)

The Insurance Commissioner’s website has information for consumers about wildfires and homeowner’s insurance, including things you should talk to your insurance agent about and tips for protecting your home and belongings. We also have tips for filing a claim after a natural disaster and how to find disaster resources.

Here are resources from other agencies:
  • Follow news about the fires on Twitter at #WaWILDFIRE.
  • The Washington Department of Natural Resources has the most recent fire information available on its website and through its @waDNR_fire Twitter feed
  • Governor Inslee has declared a state of emergency and instituted a statewide burn ban in June. You can view the Governor’s Wildfire Resource Page at http://bit.ly/WAwildfire
Some experts are predicting wildfires will continue into September. Here are some tips for preparing for wildfire risk:
  • Check your policy to make sure damage from wildfires is covered. Some policies include coverage for emergency shelter, such as a hotel, if a home is uninhabitable. 
  • Review your policy to make sure you have enough coverage. Things like fine art, jewelry and computer equipment may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection for those types of items, called a rider. Contact your insurance agent or broker to ask about supplemental policies. 
  • Catalog your home’s belongings in case you need to make an insurance claim. The National Association of Insurance Commissioners has a printable home inventory checklist or you can try free iPhone/iPad or Android apps. 
  • You can help protect a rural home and limit the danger by clearing a natural fire break between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has information on how to protect yourself and your home before, during and even after a wildfire. 
  • Have an emergency kit and a family communication plan. Know the location of your valuable papers, including insurance policy and contact information, mementos and anything you can't live without, so you can evacuate with them, if needed. 
  • Here's a list of recommended emergency supplies to keep on hand in the case of an evacuation. 
  • Don’t forget about planning for your pets. Ready.gov has tips for pet owners
Consumers can seek help with their insurance or ask insurance-related questions by calling our consumer advocates at 1-800-562-6900 or contacting us online.

Wednesday, August 19, 2015

Grant aids veterans in need of mental health services in Tacoma area


A $1.6 million grant and expansion of a Tacoma-area golf course that is a second home for many wounded veterans took center stage Aug. 18 at an event focused on the importance of mental health counseling services.

Commissioner Kreidler joined veterans, their families and representatives of the United Health Foundation in the gathering at the American Lakes Golf Course in Pierce County.

The event centered around the presentation of a $1.6 million grant to benefit "Give an Hour," a national nonprofit organization providing free confidential  mental health services to military members and their families.  The award from the United Health Foundation will be split between Tacoma and Houston.

The grant will help "Give an Hour" raise awareness of available programs, grow its mental health care provider network, and help veterans and their families access services.

"No one deserves more than those who wear the uniform," said the commissioner, a retired Lt. Colonel of 20 years in the Army Reserves.

Others speaking at the event were Dr. John Mateczun, president of UnitedHealthCare Military and Veterans; Dr. Barbara Van Dahlen, president and founder of Give an Hour; and Lourdes "Alfie" Alvarado-Ramos, secretary of Washington state Department of Veteran Affairs.

The featured speakers, though, were veterans and devoted golfers Jim Martinson and Aaron Boyle.  Both noted the importance of mental health services for wounded vets.

Martinson lost his legs to a "Bouncing Betty" land mine in Vietnam in 1968. Another land mine blew off the right leg and arm of Boyle in Afghanistan several years ago. Both cited the availability of mental counseling in helping them through their lengthy recoveries, physical and spiritual.

"These services are desperately needed by many veterans and their families in our community," Boyle said.  "Give an Hour will benefit so many who need help."

Tuesday, August 18, 2015

Multiple fires threaten Eastern Washington


Over 40 wildfires are burning in 11 counties in Eastern Washington lands of the Confederated Tribes of Colville Reservation and the Confederated Tribes and Bands of the Yakama Nation, causing Gov. Inslee to request a Federal Emergency Declaration. 


Our hearts go out to the families of the three firefighters  who lost their lives in the fight to save the town of Twisp and to the other firefighters who were injured.


These fires have claimed more than 50 homes and over 235,000 acres of land. Several communities are under evacuation orders. Weather conditions over the next few days will create the potential for these fires to spread to neighboring communities. 


Follow news about the fires on Twitter using #WaWILDFIRE.

The Insurance Commissioner’s website has information for consumers about wildfires and homeowner’s insurance, including things you should talk to your insurance agent about and tips for protecting your home and belongings. We also have tips for filing a claim after a natural disaster and how to find disaster resources.

Here are some other resources:



Wildfires are predicted to be extensive this summer. Here are some tips for preparing for wildfire risk:
  • Check your policy to make sure damage from wildfires is covered. Some policies include some coverage for emergency shelter, such as a hotel, if a home is uninhabitable. 
  • Review your policy to make sure you have enough coverage. Things like fine art, jewelry and computer equipment may have limited coverage under a standard policy. But you can buy special coverage that gives you more protection for those types of items, called a rider. Contact your insurance agent or broker to ask about supplemental policies. 
  • Catalog your home’s belongings in case you need to make an insurance claim. The National Association of Insurance Commissioners has a printable home inventory checklist or you can try free iPhone/iPad or Android apps. 
  • You can help protect a rural home and limit the danger by clearing a natural fire break between your home and surrounding trees, brush and uncut fields. The Federal Emergency Management Agency has information on how to protect yourself and your home before, during and even after a wildfire. 
  • Have an emergency kit and a family communication plan. Know the location of your valuable papers, including insurance policy and contact information, mementos and anything you can't live without, so you can evacuate with them, if needed. 
  • Here's a list of recommended emergency supplies to keep on hand in the case of an evacuation. 
  • Don’t forget about planning for your pets. Ready.gov has tips for pet owners
Consumers can seek help with their insurance or ask insurance-related questions by calling our consumer advocates at 1-800-562-6900 or contacting us online.

 

Thursday, August 13, 2015

Residential mental-health services now on par with medical coverage

Insurance Commissioner Mike Kreidler has clarified to insurance companies in Washington that mental-health services must now be offered in parity with medical services.

The commissioner updated rules on mental-health parity in 2014 and asked insurers to review previous mental-health claims that had been denied under a blanket exclusion. He asked insurers to rectify those denials.

The need for clarification arose after a consumer filed a complaint with our office after being denied for residential mental-health treatment. The individual said this violated federal laws regarding mental-health parity.

The federal Mental Health Parity and Addiction Equity Act of 2008 requires insurers in Washington to provide residential mental-health benefits to consumers on par with similar medical health benefits.

Most insurers were already providing the mental-health services on par with medical services. The consumer complaint prompted further clarification.

Better access to mental-health treatment continues as a top public policy priority in Washington. Consumers with concerns can contact the commissioner’s office at any time for information. Consumer advocates are also available to take calls toll-free at 1-800-562-6900.

Read more about mental-health parity