In general, everyone is required to have insurance starting in 2014, even people who are unemployed. But you’ll be exempt from the requirement if your income is below the tax-filing threshold (in 2009, that amount was $9,350 for singles under age 65), or if buying even the lowest cost plan on the new health insurance exchanges, set to open that year, would exceed 8 percent of your income.The post also includes details about potential options for Medicaid coverage or subsidies on the exchanges.
Monday, May 31, 2010
Will the unemployed be required to buy health insurance, too?
The New York Times' "Prescriptions" blog describes some of the rules around this. (The short answer is that there are exemptions built into the legislation for people who cannot afford it.) From the blog:
Friday, May 28, 2010
Medicare to start sending out $250 Rx rebates on June 10
One of the first benefits to take effect under the new health reform law is for seniors with Medicare's prescription drug benefit (Part D). If you have Part D and fall into the drug coverage gap - otherwise known as the 'doughnut hole' - and you don't qualify for Medicare's Extra Help, you'll receive a one time check of $250 to help you with your Rx costs. The first checks are scheduled to be mailed on June 10 and will be mailed monthly after people enter the coverage gap.
There's no paperwork to fill out or form to send in - Medicare will automatically send you a check when you qualify. Seniors should beware of potential scammers. If someone contacts you and tells you to fill out paperwork or to give them your personal information before you'll get your check, call 1-800-MEDICARE and report the activity.
There's no paperwork to fill out or form to send in - Medicare will automatically send you a check when you qualify. Seniors should beware of potential scammers. If someone contacts you and tells you to fill out paperwork or to give them your personal information before you'll get your check, call 1-800-MEDICARE and report the activity.
National flood insurance to lapse May 31st, for the fourth time in less than a year
Insurance & Financial Advisor is reporting today that the National Flood Insurance Program (NFIP) will lapse after midnight May 31st. From the article:
Claims Journal has more on the attempted dealmaking to head off this latest lapse, as well as what it means (and doesn't) for property owners. The short form: If you don't have it -- this is particularly relevant to folks trying to get financing to buy a home in a mandatory-flood-coverage area -- you won't be able to get the coverage until the program is renewed. But if you have the coverage, the insurance is still in effect. From Claims Journal:
This would be the fourth time in the last six months the program has been allowed to lapse, with Congress reauthorizing the program retroactively.The federal program protects more than 5 million property owners nationwide.
Claims Journal has more on the attempted dealmaking to head off this latest lapse, as well as what it means (and doesn't) for property owners. The short form: If you don't have it -- this is particularly relevant to folks trying to get financing to buy a home in a mandatory-flood-coverage area -- you won't be able to get the coverage until the program is renewed. But if you have the coverage, the insurance is still in effect. From Claims Journal:
NFIP has previously issued a memo with guidelines for operations during a hiatus. During its suspension, agents will not be able to issue any new or renewal flood insurance policies or increase limits on any existing policies. The hiatus will not affect claims paying.
Wednesday, May 26, 2010
Our little-known run-in with the late Mr. Linkletter..
TV funnyman Art Linkletter has died at 97, which brings to mind our little-known regulatory run-in with the broadcast legend nearly 40 years ago.
In 1972, Linkletter was a pitchman for mail order health insurance. Even for the times, the policies were very limited, paying $15-$30 a day for a hospital visit, for example. And there were waiting periods.
Insurance commissioners in more than a dozen states, including ours, were unhappy with the use of celebrity endorsers for such coverage. Linkletter, for example, advertised coverage with National Home Assurance Co.
The state insurance commissioner at the time, Spokane attorney Karl Herrmann, ordered the ads halted in Washington, on the grounds that Linkletter wasn't an insurance agent. The company was allowed to resume the ads after changes, such as disclosing the fact that Linkletter was on the company's board of directors and spelling out the benefits by the day, rather than the month. The ads -- with Linkletter as spokesman -- resumed.
In 1972, Linkletter was a pitchman for mail order health insurance. Even for the times, the policies were very limited, paying $15-$30 a day for a hospital visit, for example. And there were waiting periods.
Insurance commissioners in more than a dozen states, including ours, were unhappy with the use of celebrity endorsers for such coverage. Linkletter, for example, advertised coverage with National Home Assurance Co.
The state insurance commissioner at the time, Spokane attorney Karl Herrmann, ordered the ads halted in Washington, on the grounds that Linkletter wasn't an insurance agent. The company was allowed to resume the ads after changes, such as disclosing the fact that Linkletter was on the company's board of directors and spelling out the benefits by the day, rather than the month. The ads -- with Linkletter as spokesman -- resumed.
Where to find information -- and file claims -- re: the American Trade Association
The officials in charge of the liquidation of the American Trade Association, Inc. and several affiliates have set up a website that includes claim forms for unpaid medical bills, http://www.americantradeliquidation.com/.
We are aware of dozens and perhaps hundreds of Washingtonians who purchased purported health insurance products from a Tennessee-based company known as the American Trade Association.
We and a number of other states ordered the company to stop selling these illegal products. (Here's our cease-and-desist order, issued in January.)
On May 10, a Tennessee court ordered the liquidation of ATA and several connected entities: American Trade Association LLC, Smart Data Solutions LLC and Serve America Assurance. From the website:
"All policies of insurance or other benefits not previously expired, terminated or replaced by you with other insurance will end at 11:59 P.M. Central Time on May 31, 2010," it says. You can call the liquidator at 1-800-591-6764 for an update and to obtain a "creditable coverage letter," which can be a very important step in finding other coverage that's affordable, particularly if you have pre-existing medical conditions.
There are several key points in the website and recording:
We are aware of dozens and perhaps hundreds of Washingtonians who purchased purported health insurance products from a Tennessee-based company known as the American Trade Association.
We and a number of other states ordered the company to stop selling these illegal products. (Here's our cease-and-desist order, issued in January.)
On May 10, a Tennessee court ordered the liquidation of ATA and several connected entities: American Trade Association LLC, Smart Data Solutions LLC and Serve America Assurance. From the website:
"All policies of insurance or other benefits not previously expired, terminated or replaced by you with other insurance will end at 11:59 P.M. Central Time on May 31, 2010," it says. You can call the liquidator at 1-800-591-6764 for an update and to obtain a "creditable coverage letter," which can be a very important step in finding other coverage that's affordable, particularly if you have pre-existing medical conditions.
There are several key points in the website and recording:
- Leslie A. Newman, the Tennessee Commissioner of Commerce and Insurance, is developing a liquidation plan for court approval.
- No claims will be paid until the court approves a payment plan, which Tennessee officials say could take a year.
- The deadline for filing claims is Aug. 31 at 4:30 p.m. Central Time. And the claims must be received -- not postmarked -- by that date. Here's a copy of the claim form, including the address to send it to.
- Although some ATA customers have been getting letters telling them that they're being switched to other coverage, neither Newman nor the court have approved any such transfer of coverage.
Tuesday, May 25, 2010
$19 million verdict in case involving Bellevue, Wash. insurer
A federal jury in Seattle has issued a $19.3 million verdict against three people and a company for wrongfully siphoning off millions of dollars owed to a Bellevue insurance company.
“You cannot do this in Washington state and get away with it,” said Insurance Commissioner Mike Kreidler. “This was the worst sort of predatory behavior by people who clearly had no qualms about misrepresenting the facts to get what they wanted.”
Jurors on Friday rendered a verdict against Danny Pixler, Anthony and Sheri Huff, and Midwest Merger Management LLC. for a combined $19.3 million to Cascade National Insurance Company. A written ruling from the court is expected soon on remaining claims.
Pixler is in federal prison serving a 5-year sentence for conspiracy to commit wire fraud; the Huffs and Midwest are both based in Kentucky.
Kreidler assumed control of Cascade National in 2004 when the company was placed in receivership by Thurston County Superior Court after failing to meet financial requirements under state law. State officials decided that the company’s deteriorating financial condition meant that it couldn’t be saved or sold. In 2005, at Kreidler’s request, a judge declared Cascade National insolvent and ordered it liquidated.
Kreidler has been overseeing the company’s liquidation since then, ensuring that the company makes good on claims. He filed the lawsuit in 2006, charging that Pixler, the Huffs and their company had defrauded Cascade National.
Money recovered as a result of the lawsuit will be used to reimburse the insurance guaranty fund that has paid the company’s workers’ compensation claims.
Cascade National focused principally on auto and commercial trucking coverage in Washington, Oregon, Alaska, California, Mississippi and Louisiana. In 2004, it provided coverage for approximately 4,600 auto and commercial trucking policyholders.
Its demise followed within a year after it began providing workers’ compensation coverage to nearly 15,000 workers in California.
In 2003, due to its financial woes, Cascade National became a target for takeover and control by Pixler and the Huffs, who were longtime business associates. The defendants were seeking a workers’ compensation insurer licensed in California – which Cascade was – in order to provide coverage for the defendants’ business clients.
Among other manipulations, however, the defendants positioned themselves so that they would collect all the workers’ compensation premiums from their approximately 140 business clients, covering nearly 15,000 California workers. That both concealed the payments and put them out of reach of the workers’ compensation insurer, Cascade National.
Despite not getting those premiums or other payments due from the defendants, Cascade was and is obligated to pay all covered claims to injured workers.
(Note: Updated at 2:08 to fix link to lawsuit document.)
“You cannot do this in Washington state and get away with it,” said Insurance Commissioner Mike Kreidler. “This was the worst sort of predatory behavior by people who clearly had no qualms about misrepresenting the facts to get what they wanted.”
Jurors on Friday rendered a verdict against Danny Pixler, Anthony and Sheri Huff, and Midwest Merger Management LLC. for a combined $19.3 million to Cascade National Insurance Company. A written ruling from the court is expected soon on remaining claims.
Pixler is in federal prison serving a 5-year sentence for conspiracy to commit wire fraud; the Huffs and Midwest are both based in Kentucky.
Kreidler assumed control of Cascade National in 2004 when the company was placed in receivership by Thurston County Superior Court after failing to meet financial requirements under state law. State officials decided that the company’s deteriorating financial condition meant that it couldn’t be saved or sold. In 2005, at Kreidler’s request, a judge declared Cascade National insolvent and ordered it liquidated.
Kreidler has been overseeing the company’s liquidation since then, ensuring that the company makes good on claims. He filed the lawsuit in 2006, charging that Pixler, the Huffs and their company had defrauded Cascade National.
Money recovered as a result of the lawsuit will be used to reimburse the insurance guaranty fund that has paid the company’s workers’ compensation claims.
Cascade National focused principally on auto and commercial trucking coverage in Washington, Oregon, Alaska, California, Mississippi and Louisiana. In 2004, it provided coverage for approximately 4,600 auto and commercial trucking policyholders.
Its demise followed within a year after it began providing workers’ compensation coverage to nearly 15,000 workers in California.
In 2003, due to its financial woes, Cascade National became a target for takeover and control by Pixler and the Huffs, who were longtime business associates. The defendants were seeking a workers’ compensation insurer licensed in California – which Cascade was – in order to provide coverage for the defendants’ business clients.
Among other manipulations, however, the defendants positioned themselves so that they would collect all the workers’ compensation premiums from their approximately 140 business clients, covering nearly 15,000 California workers. That both concealed the payments and put them out of reach of the workers’ compensation insurer, Cascade National.
Despite not getting those premiums or other payments due from the defendants, Cascade was and is obligated to pay all covered claims to injured workers.
(Note: Updated at 2:08 to fix link to lawsuit document.)
Friday, May 21, 2010
Congressional Health Plans, Inc. ordered to stop sales in Washington
A company calling itself "Congressional Health Plans Inc." has been ordered to stop selling illegal insurance-related products to Washingtonians.
Company officials "have represented their product as health insurance and have acted in concert to sell unauthorized health insurance to Washington residents," according to a cease and desist order issued this week by state insurance commissioner Mike Kreidler.
The order names Congressional Health Plans, Inc., also known as Insurance Group USA, Inc., and Rdk Insurance, Inc., based in Hallendale, Fla. The order also includes corporate officers Dan Kaleky, Kevin Caricato and Matthew Herman.
Neither the company nor any of the three men are licensed to act as an insurer, agent or broker in Washington. Nor are they licensed to sell discount health plans in Washington.
They were ordered to turn over a list of all customers in Washington, premiums paid, and to replace any improperly sold insurance with an authorized policy upon any customer's request.
The Better Business Bureau gives the company an F rating, based on 6 unanswered complaints over the past three years.
Company officials "have represented their product as health insurance and have acted in concert to sell unauthorized health insurance to Washington residents," according to a cease and desist order issued this week by state insurance commissioner Mike Kreidler.
The order names Congressional Health Plans, Inc., also known as Insurance Group USA, Inc., and Rdk Insurance, Inc., based in Hallendale, Fla. The order also includes corporate officers Dan Kaleky, Kevin Caricato and Matthew Herman.
Neither the company nor any of the three men are licensed to act as an insurer, agent or broker in Washington. Nor are they licensed to sell discount health plans in Washington.
They were ordered to turn over a list of all customers in Washington, premiums paid, and to replace any improperly sold insurance with an authorized policy upon any customer's request.
The Better Business Bureau gives the company an F rating, based on 6 unanswered complaints over the past three years.
Thursday, May 20, 2010
Wind storm damage: What does insurance cover?
High winds have caused damage over the past 24 hours to several areas of the state, with winds gusting to more than 60 miles an hour in some spots, and thousands temporarily without power.
From the Seattle Times:
An unseasonably strong May storm swept across Washington on Wednesday, bringing high winds, thunderstorms and even a report of a barn-shifting tornado near Moses Lake.Every time this happens, our office gets calls from people wanting to know what damage their homeowners/auto/business insurance covers. (We're the Washington state agency that regulates insurance.)
Here are a few common questions:
Am I covered if my car was damaged by falling limbs? If your car was damaged, that damage should be covered under the comprehensive coverage in your auto insurance policy. (If you opted for comprehensive coverage, that is. Some people, to save money, just get liability coverage.)
My yard is covered with branches from the storm. None of them hit the house or my fence, so there's no property damage. But would the cleanup costs be covered in this case? Sorry, probably not. Standard homeowner's policies typically only pay for such cleanup if your property was actually damaged. In other words, your home, garage, fence, etc. would probably have to first be damaged by the debris for the insurer to pay to remove it. Standard policies don't cover the loss of trees or shrubs because of wind.
My business has an awning over the sidewalk, and it's been damaged by the wind. Is it covered? Probably, but check with your agent or insurer to be sure, since business insurance can vary a lot. Also, many business policies have business interruption coverage, which can be very useful if a covered loss forces you to close the business. But there are often deductibles or other limits, so they may not apply if the business interruption is for just a few days.
Click here for our page with tips and storm-related Q&As re: insurance.
Also: If you have damage and have questions or problems with your insurer (and live in Washington state), call our consumer affairs hotline at 1-800-562-6900. It's not a phone tree; it's staffed by live people.
Tuesday, May 18, 2010
When do the health reforms start? The answer: it depends
We're receiving many questions from consumers on when they can access the new health benefits - from adding their adult kids to their coverage, to getting coverage from the new high risk pool. We wish there was a 'one-size fits all' answer. Believe me, it would make it easier for all of us!
For now, we're updating a general timeline on what takes effect and when. The answer for many will depend on what type of health plan they have and when they or their employer enrolled in the plan. Here's the timeline today.
We're also updating our frequently asked questions and answers almost daily as new information becomes available, so check back early and often. If you or someone you know has questions about the new law, give us a call at 1-800-562-6900 or e-mail AskMike@oic.wa.gov
For now, we're updating a general timeline on what takes effect and when. The answer for many will depend on what type of health plan they have and when they or their employer enrolled in the plan. Here's the timeline today.
We're also updating our frequently asked questions and answers almost daily as new information becomes available, so check back early and often. If you or someone you know has questions about the new law, give us a call at 1-800-562-6900 or e-mail AskMike@oic.wa.gov
Updates to health reform pages
As federal health reform becomes a reality, with a lot of fast-paced, detailed rulemaking, we've been trying to stay up to speed on what the bill means for you -- and when.
We've posted extensive information on the state's planned new high risk pool, whether your health plan can charge out-of-pocket costs for preventive care, detail about extending adult children's health coverage to age 26, and so on.
It's broken down by both timeline -- some of the changes take effect as soon as Sept. 23rd, others won't be implemented until 2014 -- and by who's affected. There are sub-pages for working families, early retirees, children, seniors, small businesses, hospitals and health providers, etc.
Here's the link. Take a look.
We've posted extensive information on the state's planned new high risk pool, whether your health plan can charge out-of-pocket costs for preventive care, detail about extending adult children's health coverage to age 26, and so on.
It's broken down by both timeline -- some of the changes take effect as soon as Sept. 23rd, others won't be implemented until 2014 -- and by who's affected. There are sub-pages for working families, early retirees, children, seniors, small businesses, hospitals and health providers, etc.
Here's the link. Take a look.
Friday, May 14, 2010
WA insurance commissioner orders Nevada company to stop selling illegal health insurance products in Washington
Washington state Insurance Commissioner Mike Kreidler has ordered a Nevada company and the individuals behind it to stop selling illegal health insurance products to Washingtonians.
The order names Pinnacle Health Solutions, LLC, also known as Pinnacle Health Care, and company managers James Parish, Nicholas Wall and “Michael Schultz.” (Schultz is believed to be a pseudonym.)
They previously marketed health insurance products from the American Trade Association, which was named in an earlier order. Since then, the company and these men have continued to advertise and sell other unauthorized health insurance and unlicensed health care discount cards in Washington.
Kreidler on Thursday issued a cease and desist order against the company and the three men, ordering them to stop “engaging in or transacting the unauthorized business of insurance or unlicensed discount plans in the state of Washington.” They are barred from collecting premiums or fees, and cannot advertise or sell such products.
They must also:
• Provide Kreidler’s office with a list of all Washingtonians who have purchased their products.
• Inform all Washington customers about the order.
• And, upon request by any policyholder, replace any illegal coverage with a policy from an authorized insurer.
Washington state insurance investigators have seen a recurring pattern in which companies banned from doing illegal business in the state have attempted to shift their customers to other groups which are also peddling unauthorized insurance products. In a recent letter to an American Trade Association customer, for example, Pinnacle said that benefits were being shifted to a new entity: Best Benefits Association.
Best Benefits Association is also not authorized to sell insurance products in Washington.
Any Washington resident contacted by Pinnacle, Best Benefits Association, or any American Trade Association marketer is encouraged to contact the state Office of the Insurance Commissioner at 1-800-562-6900.
The order names Pinnacle Health Solutions, LLC, also known as Pinnacle Health Care, and company managers James Parish, Nicholas Wall and “Michael Schultz.” (Schultz is believed to be a pseudonym.)
They previously marketed health insurance products from the American Trade Association, which was named in an earlier order. Since then, the company and these men have continued to advertise and sell other unauthorized health insurance and unlicensed health care discount cards in Washington.
Kreidler on Thursday issued a cease and desist order against the company and the three men, ordering them to stop “engaging in or transacting the unauthorized business of insurance or unlicensed discount plans in the state of Washington.” They are barred from collecting premiums or fees, and cannot advertise or sell such products.
They must also:
• Provide Kreidler’s office with a list of all Washingtonians who have purchased their products.
• Inform all Washington customers about the order.
• And, upon request by any policyholder, replace any illegal coverage with a policy from an authorized insurer.
Washington state insurance investigators have seen a recurring pattern in which companies banned from doing illegal business in the state have attempted to shift their customers to other groups which are also peddling unauthorized insurance products. In a recent letter to an American Trade Association customer, for example, Pinnacle said that benefits were being shifted to a new entity: Best Benefits Association.
Best Benefits Association is also not authorized to sell insurance products in Washington.
Any Washington resident contacted by Pinnacle, Best Benefits Association, or any American Trade Association marketer is encouraged to contact the state Office of the Insurance Commissioner at 1-800-562-6900.
Vancouver-based Cascade Auto Glass fined for overbilling
A Washington auto glass company has pleaded guilty to attempted insurance fraud after charging insurers more for repairs billed from a non-existent office.
Cascade Auto Glass, apparently headquartered in Vancouver, will pay a $1,000 fine, $500 victim penalty assessment and $200 in court costs. Cascade, as a corporation, pleaded guilty to one count of attempted fallse claims or proof in an insurance claim, a gross misdemeanor.
The state insurance commissioner’s Special Investigations Unit found multiple cases of overbilling by the company.
Some insurance companies pay auto glass claims at different rates, depending on where the shop is located. Rural windshield replacements, for example, are typically paid at a higher rate due to higher transportation costs compared to urban shops.
Cascade offers a mobile windshield replacement service and generally goes to customers homes, workplaces or schools. The investigation found that the company repeatedly did work in large urban areas, but billed insurers as if the work was done from the rural Port Townsend area.
The company’s Port Townsend location consists of a storage unit. Cascade does not use that location to conduct their business.
Cascade Auto Glass, apparently headquartered in Vancouver, will pay a $1,000 fine, $500 victim penalty assessment and $200 in court costs. Cascade, as a corporation, pleaded guilty to one count of attempted fallse claims or proof in an insurance claim, a gross misdemeanor.
The state insurance commissioner’s Special Investigations Unit found multiple cases of overbilling by the company.
Some insurance companies pay auto glass claims at different rates, depending on where the shop is located. Rural windshield replacements, for example, are typically paid at a higher rate due to higher transportation costs compared to urban shops.
Cascade offers a mobile windshield replacement service and generally goes to customers homes, workplaces or schools. The investigation found that the company repeatedly did work in large urban areas, but billed insurers as if the work was done from the rural Port Townsend area.
The company’s Port Townsend location consists of a storage unit. Cascade does not use that location to conduct their business.
Washington health care authority launches its health insurance program
Washington state's Health Care Authority has launched its "Washington Health Program," which offers relatively low cost, basic health coverage -- albeit with a very low annual maximum compared to comprehensive coverage.
From HCA's web page:
See here for more details about the program.
From HCA's web page:
This unique program offers either $75,000 or $100,000 in health insurance coverage every year. Members maintain low deductibles and, at times, no-cost coverage for basic health services. This provides coverage for those unexpected trips to the hospital. In most cases, $75,000 or $100,000 is plenty of coverage throughout the year.You can estimate your premium here.
See here for more details about the program.
Thursday, May 13, 2010
Insurance news:NV commissioner quits, Prudential buying AIG, and a new product: marijuana insurance
Nevada insurance commissioner resigns, search for replacement underway
NAIC testifies on impact of insurers’ use of credit-based scores
NM: State insurance division may cancel Blue Cross Blue Shield NM rate hike: "Interim state Insurance Superintendent Tom Rushton has been asked to rescind his predecessor’s approval of the 21.3 percent rate increase, King said."
Reuters: Healthcare bill poses credit risk for nonprofits
BusinessWeek: An insurance giant’s make-or-break deal (Prudential’s $35.5 billion bid for a unit of AIG)
BusinessWeek: NC insurance industry opposing tort reform legislation
LA Times: CA insurance broker gets 10-year sentence for bilking investors
And lastly, from the Denver Business Journal: “Here comes another signpost on the medical marijuana industry’s road to legitimacy: insurance. Dispensaries worries about setbacks ranging from inventory theft to accidentally sickening a client have a new option: Greenway Insurance.”
NAIC testifies on impact of insurers’ use of credit-based scores
NM: State insurance division may cancel Blue Cross Blue Shield NM rate hike: "Interim state Insurance Superintendent Tom Rushton has been asked to rescind his predecessor’s approval of the 21.3 percent rate increase, King said."
Reuters: Healthcare bill poses credit risk for nonprofits
BusinessWeek: An insurance giant’s make-or-break deal (Prudential’s $35.5 billion bid for a unit of AIG)
BusinessWeek: NC insurance industry opposing tort reform legislation
LA Times: CA insurance broker gets 10-year sentence for bilking investors
And lastly, from the Denver Business Journal: “Here comes another signpost on the medical marijuana industry’s road to legitimacy: insurance. Dispensaries worries about setbacks ranging from inventory theft to accidentally sickening a client have a new option: Greenway Insurance.”
Wednesday, May 12, 2010
Insurance news: WA medicaid woes, MO to vote on mandate, anger in FL, emergency in OK, autism bill in NC and Allstate's hiring in AZ
CNN: Health insurance for the under-26 crowd
Seattle Times: Hospitals care for hundreds of Medicaid patients others won’t take: “…hundreds of Medicaid patients in Washington state each year who — despite no longer needing hospitalization — have occupied hospital rooms for a month or longer while trying to find a nursing home or other facility to take them in.” A Seattle Times investigation has found at least 2,025 such cases from 2000 to 2008. Overall price tag: $461 million.
AP: Missouri to vote in August on health insurance mandate: Missouri is poised to become the first state to put a new federal health insurance mandate to a vote of its residents.
Regulator getting heat for Florida’s property insurance problems: Florida Insurance Commissioner Kevin McCarty is taking a beating over the health of the state's property insurance market, rising premiums in South Florida and other issues.
In wake of tornadoes, Okla. Insurance regulator declares emergency
Autism insurance bill moves forward in NC
Allstate to hire agents for 50 new offices in AZ
Seattle Times: Hospitals care for hundreds of Medicaid patients others won’t take: “…hundreds of Medicaid patients in Washington state each year who — despite no longer needing hospitalization — have occupied hospital rooms for a month or longer while trying to find a nursing home or other facility to take them in.” A Seattle Times investigation has found at least 2,025 such cases from 2000 to 2008. Overall price tag: $461 million.
AP: Missouri to vote in August on health insurance mandate: Missouri is poised to become the first state to put a new federal health insurance mandate to a vote of its residents.
Regulator getting heat for Florida’s property insurance problems: Florida Insurance Commissioner Kevin McCarty is taking a beating over the health of the state's property insurance market, rising premiums in South Florida and other issues.
In wake of tornadoes, Okla. Insurance regulator declares emergency
Autism insurance bill moves forward in NC
Allstate to hire agents for 50 new offices in AZ
Tuesday, May 11, 2010
Insurance news: Insurer surpluses draw fire, WellPoint in the news, and don't forget the tax benefits if you keep your adult child on your health care
Spokesman-Review: Insurance firms' deep pockets under scrutiny
WSJ: War of words heats up between Obama, WellPoint
NYT editorial: The Anthem saga
Slate: Obama vs. WellPoint: How the insurance giant's bad behavior advances health reform
BusinessWeek: Keeping Junior on parents' insurance is a tax benefit (i.e. the cost is generally deductible from your income taxes)
L.A. Times: A healthcare subsidy for early retirees
USA Today: Staged accidents to bilk insurers increase sharply
USA Today: Many who lost jobs used COBRA subsidy, kept insurance
In wake of devastating gulf oil spill, liability spreads
WA Post: Some families face higher health premiums to insure adult children
AP: Premiums may undermine coverage guarantee for kids
WSJ: What defines a "grandfathered" health insurance plan?
WSJ: War of words heats up between Obama, WellPoint
NYT editorial: The Anthem saga
Slate: Obama vs. WellPoint: How the insurance giant's bad behavior advances health reform
BusinessWeek: Keeping Junior on parents' insurance is a tax benefit (i.e. the cost is generally deductible from your income taxes)
L.A. Times: A healthcare subsidy for early retirees
USA Today: Staged accidents to bilk insurers increase sharply
USA Today: Many who lost jobs used COBRA subsidy, kept insurance
In wake of devastating gulf oil spill, liability spreads
WA Post: Some families face higher health premiums to insure adult children
AP: Premiums may undermine coverage guarantee for kids
WSJ: What defines a "grandfathered" health insurance plan?
Friday, May 7, 2010
Insurance news: Autism mandate in Mo., flood spurs anger against agents in Tenn., and sorry, no homeowner's coverage for bedbugs
A roundup of insurance news:
BusinessWeek: Missouri Senate passes autism insurance mandate: Bill: Some insurers must cover up to $45k/year of intensive therapy for autistic kids.
BusinessWeek: BP Spill biggest energy insurance loss in more than 20 years
NYT: Does homeowners insurance cover the (up to $70k) cost of eliminating bedbugs? (No.)
WP: Safety group urges highway agency to require antilock brakes on new motorcycles: Fatalities would drop by more than 1/3, report says.
Nationwide Insurance to hire 1,400
Allstate hiring 100 agents in FL in push to boost auto insurance business
Anger against Tenn. Insurance agents rises as flood waters subside: Lawsuit brewing against agents who never told residents about flood insurance.
$350m UnitedHealth settlement means payments for doctors, patients
BusinessWeek: Missouri Senate passes autism insurance mandate: Bill: Some insurers must cover up to $45k/year of intensive therapy for autistic kids.
BusinessWeek: BP Spill biggest energy insurance loss in more than 20 years
NYT: Does homeowners insurance cover the (up to $70k) cost of eliminating bedbugs? (No.)
WP: Safety group urges highway agency to require antilock brakes on new motorcycles: Fatalities would drop by more than 1/3, report says.
Nationwide Insurance to hire 1,400
Allstate hiring 100 agents in FL in push to boost auto insurance business
Anger against Tenn. Insurance agents rises as flood waters subside: Lawsuit brewing against agents who never told residents about flood insurance.
$350m UnitedHealth settlement means payments for doctors, patients
Thursday, May 6, 2010
Health insurance help for early retirees to start June 1
The federal government announced plans to start its new reinsurance program for early retirees June 1 - several weeks ahead of the June 21 start date required by the Patient Protection and Affordable Care Act.
The new program will provide $5 billion, over the next three and half years, to both self-funded and insured employer health plans. The funds must be used to help lower the employer's own health costs, provide premium relief to their workers and families or a combination of both.
According to Health and Human Services Secretary Kathleen Sebelius, the number of large firms offering retiree coverage to its workers has dropped more than 30 percent over the last 20 years.
Beginning in late June, employers can apply for reimbursements of up to 80 percent of claims costs between $15,000-$90,000. Claims incurred between the start of the plan year (usually Jan. 1) and June 1 count towards the $15,000 threshold. But only claims that occur after June 1 are eligible for reimbursement.
We've posted some basic information on our health reform pages, but for more details go to www.healthreform.gov
The new program will provide $5 billion, over the next three and half years, to both self-funded and insured employer health plans. The funds must be used to help lower the employer's own health costs, provide premium relief to their workers and families or a combination of both.
According to Health and Human Services Secretary Kathleen Sebelius, the number of large firms offering retiree coverage to its workers has dropped more than 30 percent over the last 20 years.
Beginning in late June, employers can apply for reimbursements of up to 80 percent of claims costs between $15,000-$90,000. Claims incurred between the start of the plan year (usually Jan. 1) and June 1 count towards the $15,000 threshold. But only claims that occur after June 1 are eligible for reimbursement.
We've posted some basic information on our health reform pages, but for more details go to www.healthreform.gov
Seattle couple charged in insurance scheme
The owners of a Seattle construction company have been charged with multiple counts of theft for a scheme that investigators believe bilked insurance companies out of more than $470,000.
James Philo, 59, and Cheryl-Lin Philo, 45, owners of Philo Construction Company of Seattle, each face four counts of first-degree theft and 15 counts of second-degree theft. Arraignment is scheduled for May 11, 2010 in King County Superior Court.
“Fraud and inflated claims mean higher premiums for the rest of us,” said Washington state Insurance Commissioner Mike Kreidler. “In this case, employees and former employees were concerned about what they saw going on and stepped forward to report it.”
In December 2006, a major windstorm swept across Washington, knocking down trees and causing substantial damage to a numerous homes. The Philos hired subcontractors to remove many of those trees from customers’ homes.
In March 2007, a former employee contacted Kreidler’s office, saying that Philo was submitting inflated invoices to insurers. Other workers provided information as well.
An investigation by the agency’s Special Investigations Unit, working with more than 15 insurance companies, found that the Philos had been asking their subcontractors for two invoices for each job. The Philos paid the subcontractors the smaller amount, and then submitted the larger invoice to their customers’ insurance companies for reimbursement.
The markup averaged close to 30 percent, plus another 20 percent that insurers allow for profit and overhead. For example, a $2,150 bill from a tree service company was reported to the insurer as a $2,795 job. Once profit, overhead and sales tax were added, the Philos were paid a total of $3,649.
The Philos also created a fictitious company, Pro Line Construction Resources, to act as a subcontractor when they needed to support a particularly high estimate.
The criminal charges are based on 20 cases of double-invoicing, totaling $31,000 in overcharges to insurers. All told, state investigators documented more than 60 cases of apparent fraud, totaling which they believe represents $470,000 in overcharges.
James Philo, 59, and Cheryl-Lin Philo, 45, owners of Philo Construction Company of Seattle, each face four counts of first-degree theft and 15 counts of second-degree theft. Arraignment is scheduled for May 11, 2010 in King County Superior Court.
“Fraud and inflated claims mean higher premiums for the rest of us,” said Washington state Insurance Commissioner Mike Kreidler. “In this case, employees and former employees were concerned about what they saw going on and stepped forward to report it.”
In December 2006, a major windstorm swept across Washington, knocking down trees and causing substantial damage to a numerous homes. The Philos hired subcontractors to remove many of those trees from customers’ homes.
In March 2007, a former employee contacted Kreidler’s office, saying that Philo was submitting inflated invoices to insurers. Other workers provided information as well.
An investigation by the agency’s Special Investigations Unit, working with more than 15 insurance companies, found that the Philos had been asking their subcontractors for two invoices for each job. The Philos paid the subcontractors the smaller amount, and then submitted the larger invoice to their customers’ insurance companies for reimbursement.
The markup averaged close to 30 percent, plus another 20 percent that insurers allow for profit and overhead. For example, a $2,150 bill from a tree service company was reported to the insurer as a $2,795 job. Once profit, overhead and sales tax were added, the Philos were paid a total of $3,649.
The Philos also created a fictitious company, Pro Line Construction Resources, to act as a subcontractor when they needed to support a particularly high estimate.
The criminal charges are based on 20 cases of double-invoicing, totaling $31,000 in overcharges to insurers. All told, state investigators documented more than 60 cases of apparent fraud, totaling which they believe represents $470,000 in overcharges.
Wednesday, May 5, 2010
Insurance news: New coverage for some adult kids, Hawaii insurance fees up, and Paris pioneers insurance for subway scofflaws
Auburn Reporter: Some health plans covering adult kids early
AP: Health coverage extensions for young not universal: "These voluntary extensions come with a host of qualifications. Whether your child gets one also can depend on your employer."
WP: Quicker coverage sought for federal workers’ adult children: "Lawmakers introduced a measure Tuesday that would allow the Office of Personnel Management to extend health-care coverage to the adult children of federal workers before the new federal health-care law takes effect next year. Several health insurance companies plan to extend health-care coverage to adult children up to age 26 starting in June, but current federal law prohibits OPM from doing the same for workers in the Federal Employees Health Benefits Program."
Hawaii boosts insurance fees to help offset its budget shortfall "One insurance bill, SB 2159, raises the fee insurers pay to obtain copies of a driver’s record, from $7 to $20. HB 1985 doubles more than 30 other fees that are paid by insurance companies, agents, brokers, adjusters and other insurance entities. HB 2600 requires insurance companies to put systems in place to pay premium taxes monthly rather than quarterly, which has been the long-standing practice, according to the Property Casualty Insurers Association of America."
HHS: Sebelius calls on governors and insurance commissioners to re-examine any WellPoint health insurance rate increases in their states (Includes text of letter)
NM Insurance Chief Resigns After Blue Cross Flap
Health insurance ministry members pay claims directly to other believers: "Masters, who lives in Fort Lauderdale, Fla., is part of a growing number of Americans who are members of faith-based "health sharing ministries" where members directly pay for each others' medical bills."
Pharmacist sentenced to 4 years for defrauding insurance company (Iowa case)
(Houston TV station) Saving Cents: Buy car insurance by the mile: "There’s a first-of-its-kind auto insurance company in Texas that sells coverage by the mile. The company is called MileMeter, and is based in Dallas. The policies are great for people who live close to their jobs, those in the military who leave a car behind that is unused, retirees who do not drive much and those with a second car or truck that rarely leaves the garage."
(MI) Wayne County assistant prosecutor to tackle only arson-for-hire cases: "A state insurance coalition has raised enough money to pay an assistant Wayne County prosecutor to handle nothing but arson-for-hire cases."
NPR: Don’t pay your fare on the subway? There’s insurance for that: "Groups of free riders on the Paris Metro have created informal insurance pools that pay the fine when riders get caught. The groups call themselves mutuelles des fraudeurs -- fraudster mutuals. The fraudsters pay into a into a central fund. Then, whoever gets caught riding for free can draw from the fund to pay the fine, which starts at about $75."
AP: Health coverage extensions for young not universal: "These voluntary extensions come with a host of qualifications. Whether your child gets one also can depend on your employer."
WP: Quicker coverage sought for federal workers’ adult children: "Lawmakers introduced a measure Tuesday that would allow the Office of Personnel Management to extend health-care coverage to the adult children of federal workers before the new federal health-care law takes effect next year. Several health insurance companies plan to extend health-care coverage to adult children up to age 26 starting in June, but current federal law prohibits OPM from doing the same for workers in the Federal Employees Health Benefits Program."
Hawaii boosts insurance fees to help offset its budget shortfall "One insurance bill, SB 2159, raises the fee insurers pay to obtain copies of a driver’s record, from $7 to $20. HB 1985 doubles more than 30 other fees that are paid by insurance companies, agents, brokers, adjusters and other insurance entities. HB 2600 requires insurance companies to put systems in place to pay premium taxes monthly rather than quarterly, which has been the long-standing practice, according to the Property Casualty Insurers Association of America."
HHS: Sebelius calls on governors and insurance commissioners to re-examine any WellPoint health insurance rate increases in their states (Includes text of letter)
NM Insurance Chief Resigns After Blue Cross Flap
Health insurance ministry members pay claims directly to other believers: "Masters, who lives in Fort Lauderdale, Fla., is part of a growing number of Americans who are members of faith-based "health sharing ministries" where members directly pay for each others' medical bills."
Pharmacist sentenced to 4 years for defrauding insurance company (Iowa case)
(Houston TV station) Saving Cents: Buy car insurance by the mile: "There’s a first-of-its-kind auto insurance company in Texas that sells coverage by the mile. The company is called MileMeter, and is based in Dallas. The policies are great for people who live close to their jobs, those in the military who leave a car behind that is unused, retirees who do not drive much and those with a second car or truck that rarely leaves the garage."
(MI) Wayne County assistant prosecutor to tackle only arson-for-hire cases: "A state insurance coalition has raised enough money to pay an assistant Wayne County prosecutor to handle nothing but arson-for-hire cases."
NPR: Don’t pay your fare on the subway? There’s insurance for that: "Groups of free riders on the Paris Metro have created informal insurance pools that pay the fine when riders get caught. The groups call themselves mutuelles des fraudeurs -- fraudster mutuals. The fraudsters pay into a into a central fund. Then, whoever gets caught riding for free can draw from the fund to pay the fine, which starts at about $75."
Tuesday, May 4, 2010
Wind damage in Eastern Washington -- what does your insurance cover?
High winds caused significant damage yesterday in parts of Eastern Washington, with winds gusting up to 60 miles an hour.
Every time this happens, our office gets calls from people wanting to know what damage their homeowners/auto/business insurance covers. (We're the Washington state agency that regulates insurance.)
Here are a few common questions:
Am I covered if my car was damaged by falling limbs? If your car was damaged, that damage should be covered under the comprehensive coverage in your auto insurance policy. (If you opted for comprehensive coverage, that is. Some people, to save money, just get liability coverage.)
My yard is covered with branches from the storm. None of them hit the house or my fence, so there's no property damage. But would the cleanup costs be covered in this case? Sorry, probably not. Standard homeowner's policies typically only pay for such cleanup if your property was actually damaged. In other words, your home, garage, fence, etc. would probably have to first be damaged by the debris for the insurer to pay to remove it. Standard policies don't cover the loss of trees or shrubs because of wind.
My business has an awning over the sidewalk, and it's been damaged by the wind. Is it covered? Probably, but check with your agent or insurer to be sure, since business insurance can vary a lot. Also, many business policies have business interruption coverage, which can be very useful if a covered loss forces you to close the business. But there are often deductibles or other limits, so they may not apply if the business interruption is for just a few days.
Click here for a lot more storm-related Q&As re: insurance.
Also: If you have damage and have questions or problems with your insurer (and live in Washington state), call our consumer affairs hotline at 1-800-562-6900. It's not a phone tree; it's staffed by live people.
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