See if you'll save money on health insurance next year

Curious about what will happen to your health insurance rates after health reform? Our state Health Benefit Exchange, charged with creating a new online marketplace for health insurance, just launched a consumer-focused website, www.wahealthplanfinder.org and it includes a calculator for estimating your costs.

You can't choose a health plan until the site launches on Oct. 1, but you can use the calculator to see if you might qualify for a subsidy to help with your insurance costs. Keep in mind, it's only an estimate, but it should give you a sense of what to expect.

 

"Is there a grace period for a newly licensed driver to get insurance?"

Nope, not in Washington state. In order to operate a motor vehicle here, the driver must have the state minimum liability insurance. There is no grace period to obtain that insurance.

So parents, check with the insurance agent (or insurer) to see if your young driver is covered under your automobile insurance or if they need their own insurance policy.

New report on health insurance: 84 million in U.S. are uninsured/underinsured

The Commonwealth Fund this morning issued its latest report on uninsured and underinsured adults. Among the key points, in 2012:

• 84 million Americans were uninsured or underinsured.
• Due largely to the ACA, the share of young adults w/o insurance dropped by 1.9 million between 2010 and 2012
• 41 percent of adults ages 19-64 are having difficulty paying medical bills
• Costs prevent many Americans from getting needed health care
• Of the 55 million uninsured for all or part of 2012, 87 percent had incomes that would qualify them for subsidized health insurance under the ACA
• Of the 30 million underinsured, 85 percent would qualify for subsidies

Among the remaining challenges noted in the report:

 "...the law does not provide subsidized coverage to people who are not in the U.S. legally. Jonathan Gruber, an economist at the Massachusetts Institute of Technology, has estimated that of people who will remain uninsured in 2016, about 5 million will be undocumented immigrants. Second, both the Congressional Budget Office and Gruber predict that many Americans will not be insured, even though they are eligible for the new coverage options, whether because they are not aware of their eligibility, they are unable to find an affordable premium, or they elect not to enroll."

 

"I filed an insurance claim. How long will it take for the company to investigate?"

Here in Washington state, insurers should generally complete their claims investigations within 30 days unless there are good reasons why that cannot be done.

That said, all people involved in the investigation of a claim must provide reasonable assistance -- usually meaning providing information as requested -- so the insurer can process the claim.

The law that includes the 30 day standard is WAC 284-30-370.

If you have a claim that you feel is taking unreasonably long -- and you live here in Washington -- feel free to contact our consumer advocacy staff and we'll try to help. You can fill out an online complaint form 24/7, or you can call us toll-free at 1-800-562-6900.\

Here are more tips about filing an auto insurance claim, as well as tips on filing a homeowners insurance claim, and tips on how to file an appeal when your health insurer says no to a payment or treatment.

Job opening: senior market analyst

We're recruiting for a senior market analyst to fill an opening in our main building in Tumwater, Wash.

The position is responsible for conducting market analyses of regulated entitites under the direction of our chief market analyst. The goal is to protect consumers' interests and promote a health business environment in Washington, both of which we help do by providing regulatory oversight of market interactions between consumers and insurance carriers.

For more specifics, including detailed duties, salary, timeline, etc., please see the full job listing.

We knew it! Actuary named best job of 2013.

The jobs website CareerCast.com has named the best (and worst) jobs of 2013. Topping the list (again, yes) is actuary.

The ratings, according to this summary in the Wall Street Journal, were based on physical demands, work environment, income, stress and hiring outlook.

And there are some surprises on the list. Dental hygienist came in among the top jobs, as did veterinarian. Actors, roofers and dairy farmers are among the worst, no surprise there, but so are senior corporate executives and military generals.

The police cited the other driver, but his insurer says I'm partly at fault? How can that be?

We get a lot of consumer calls like this.

Police have the authority to issue citations based on their interpretation of the accident scene and the rules of the road. Drivers who disagree can make their case in traffic court.

But here's the key thing when it comes to insurance: A citation doesn't necessarily establish the issue of negligence, which can include factors including your own driving behavior, weather, speed and visibility. And the reality is that insurers sometimes attribute some portion of fault to both drivers rather than rely solely on who got a ticket at the scene. If an insurer does that, however, they should explain the basis for their decision.

Want to know more? Here in Washington state, the law that allows for this apportionment of fault is RCW 4.22, titled "Contributory fault."

Here's more about your rights when you file an auto insurance claim, and guidelines on what to do if you're in an accident and what to do if you're hit by an uninsured driver.

"Is there an insurance law that says when my car has to be totaled?"

Not that we're aware of, at least here in Washington state.

That said, we're aware that sometimes there is hidden collision damage to a car that can add substantially to the cost of the initial estimate.

With that in mind, insurers may decide to total a car when their initial repair estimate is around 70 percent of the vehicle's current market value. Otherwise, if the repairs are started and costs due to hidden damage escalate another 30 percent or more, they can end up spending more to fix the vehicle than it's actually worth.

The short answer: there is no "official" formula in the law for totalling a vehicle. But insurers look at the repair cost potential. If it's close to the value of the car, they may decide not to even begin repairs, and to simply compensate you for the value of the vehicle.

How do they establish that value? The insurer owes you the actual cash value -- i.e. the retail market value -- of your car. Insurers have to look at local values for comparable vehicles, although with your permission, your insurer can extend the search beyond 150 miles.

If you disagree on the value -- and we get these calls all the time -- you can hire an appraiser and go through the appraisal process in your auto policy. If the dispute is with someone else's insurer, you can either file a claim with your own insurer, or you may want to consider taking the matter to court.

Please see our "What happens after your car gets totalled" page for  much more on totalled car values, disputes, and what happens if you opt to keep your totaled car.

We saved Washington consumers $5.6 million in auto insurance premiums last year

Little-known fact: When many types of insurers want to change their premium prices, they must file the new rates with us. Our actuaries and analysts go over the numbers, and -- where justifiable -- we hold those increases down.

Through this process, we've saved Washington state consumers nearly $11 million over the past three years. Here's the annual difference between requested rates and approved rates during that time:

• 2010: $2,655,927
• 2011: $2,714,917
• 2012: $5,603,182

Got an insurance question or problem? We'll try our best to help. (And we won't try to sell you anything.)

Got an insurance question or problem? Call or email our consumer hotline staff at 1-800-562-6900 or AskMike@oic.wa.gov.

We're the state agency that regulates the insurance industry in Washington state.

Our analysts help Washingtonians get millions of dollars in denied or delayed insurance claims each year. They help people get insurance reinstated when it's wrongly canceled, and they can show you how to appeal if your health insurer denies a treatment.

We can tell you what your rights are, help you file a complaint, and would be happy to contact your insurance company on your behalf to find out more. If you don't have health insurance -- or can't afford the insurance you have -- we may be able to find options that are a better fit for you. We can give you some tips on how to push for the maximum value for your totaled car.

And on and on. Just email us or call.

What if you don't live in Washington? Most state insurance departments offer similar help. Here's a handy map, courtesy of the National Association of Insurance Commissioners, showing how to contact your local department.

"My insurer wants me to repair the roof and paint the siding or they won't insure me. Can they do this?"

A written, advance notice is required when an insurer is going to cancel (or "non-renew") a policy. If you got that notice in writing at least 45 days beforehand, then yes, the insurer can do this.

Often, the problem for homeowners is the timing. They simply don't have enough time to find contractors or do the work themselves. In such a case, you might be able to talk to your insurer and figure out a repair plan that will satisfy them. If not, you'd better start shopping for alternative coverage.

You might also ask your agent to talk the insurance company. There's no guarantee that the company will change its mind, but it might help.

Two job openings for financial examiners

We're recruiting for two financial examiner positions, both based at our building in Tumwater, Wash.

These positions plan, conduct, and document financial analysis examinations of less-complex regulated entities to determine their compliance with laws and regulations, and to detect fraudulent activity.

Among the duties:

Examining and analyzing eight annual filings to check compliance and and financial conditions.

Reading and interpreting applicable laws, regulations and standards to ensure that analyses and exams are conducted appropriately.

Writing analysis-examination reports, including updated the risk assessment, profile summary and supervisory plan.

For more details, including other duties, salary information, timeline and benefits, please see the link to the full job listing.

We also have a couple of other jobs open, including a deputy commissioner for legal affairs, a management analyst, and a senior market conduct examiner. To keep current on what we're recruiting for, please check our job openings page frequently.

Do I have to buy personal injury protection (PIP) coverage?

We get this question all the time. The short answer, at least here in Washington state, is no. But agents and insurance companies are required to offer Personal Injury Protection coverage, and when you get a quote, it will include PIP coverage.

If you don't want PIP coverage, you'll need to sign a waiver to eliminate the coverage from your policy. If you don't, then the insurer must issue your policy with the coverage, and you will be charged for it. (If you get a policy with this coverage and don't want it, you can still get it removed if you sign that waiver.)

The same is true, incidentally, for uninsured motorist coverage, which goes by the acronym UIM. It's included when you get a quote, and if you don't want it, you'll need to sign a waiver to eliminate the coverage from your policy. Otherwise, you'll get the coverage and be charged for it.

"It's difficult - and expensive -- to find insurance for my log home. Why is that?"

Here's the situation: Log homes are often considered to be specialty construction by the insurance industry. That's not necessarily a bad thing, but it does mean that log homes have unique construction and repair considerations. That translates into costs that may be above and beyond those associated with modern, conventional home construction.

It's also often the case that log homes are in rural or remote areas where such structures are allowed. That can mean longer response times for firefighters, who may have fewer capabilities than an urban or suburban fire department. All of that means that your homeowners insurance may be more expensive or harder to find.

And these challenges are not unique to log homes, by the way. These same challenges often apply to other specialty structures, such as domes, wood/earth mixed construction, subterranean structures (looking at you, old missile silo owner...), and some types of experimental construction.

Here's our advice: If possible, before you buy one of these types of homes, or decide to finance and build it yourself, please be sure to talk to an insurance agent about the availability of coverage. This can be very important, because if you have a loan on the home, your lender will no doubt insist on proof of insurance coverage in order to protect their interest in the property.

Job opening: Market conduct examiner

We're recruiting to fill a job opening for a senior market conduct examiner in our Seattle office. (It's one of several jobs we have open at the moment; click that link to see the others.)

The position is responsible for performing analysis and examinations under the direction of our chief market conduct examiner. The position would be a lead position, and would lead teams of co-workers in evaluating company activities in the marketplace.

For more specifics, including duties, salary, timeline, etc., please see the full job listing.

Guilty: Man claimed car burglarized at mall; but mall's video indicated otherwise

An Eatonville man has pleaded guilty to felony insurance fraud after falsely claiming that someone burglarized his car while parked at the Tacoma Mall.

Joseph Thomas Rebic, Jr., 48, pleaded guilty Wednesday in Pierce County Superior Court. He was sentenced to 240 hours community service and $1,300 in fees.

On June 11, 2012, Rebic reported that his car had been burglarized while parked for 45 minutes at the Tacoma Mall. He filed reports with Tacoma mall security and the Tacoma Police Department. He immediately filed two claims with his insurer, State Farm.

The car's rear driver's door window was broken, and there was damage to the trunk liner. Rebic said that the thief had stolen several items, including a $179 GPS device, an $1,189 Canon camera and lenses, and a $1,200 bow and arrows. All told, he said, the stolen valuables were worth about $2,880, and the damage to the car totaled about $350.

The problem: The mall's parking lot video showed none of that. The video shows no one approaching the vehicle or taking items from it after Rebic leaves.

State Farm eventually closed Rebic's claim without payment after he canceled an appointment with a State Farm investigator. They then forwarded the case to our anti-fraud Special Investigations Unit.

Note to agents and brokers wondering about their role under health care reform and the Exchange

Are you an agent or broker wondering what your role will be with Health Care Reform and the Washington Healthplanfinder, also known as the Washington Health Benefit Exchange? We get frequent questions from agents about this.  

How the Exchanges are set up varies by state. Here in Washington, the exchange is a separate entity from the state's insurance regulator (that's us).

The Exchange holds monthly public meetings to discuss agent requirements, business processes and to help determine agent/broker training and certification in order to access the Exchange system.

To participate in future meetings and find out what you need to do in order to become Exchange trained and certified,  information is posted at  http://wahbexchange.org/committees/agents-brokers-tac/. 

If you want to attend the next teleconference on May 1, 2013 contact the Exchange at info@wahbexchange.org .

(Note: This is actually a repost of a post we put up early this morning. It was the easiest way to fix a font error. The wording's unchanged.)

"My agent told me I had to add all my cars to my policy, even if I don't use them. Is this true?"

We are not aware of any Washington state law requiring the addition of all owned cars to a policy. If your agent claims there is -- and we hear this from consumers with some frequency -- he or she should be able to tell you what section of law it is.

There is a section of state law (RCW 46.30, regarding mandatory liability insurance) that requires drivers operating certain vehicles on state highways to be able to show proof of liability insurance if asked to do so by law enforcement officers or a court. However, simply owning a vehicle that's not driven doesn't appear to require proof of insurance under that law.

If you're driving it around, yes, of course get insurance on it. The fines for driving without insurance are steep, and the potential losses in an accident could be much steeper.

For more specifics on the mandatory insurance law, including requirements and types of vehicles that are exempt, please see our mandatory auto insurance page.

Update on Commissioner Kreidler

As you might recall from a post last week, Commissioner Kreidler is recovering from planned heart surgery on April 2. His doctors had been monitoring his health status over the past several months, leading to the scheduled bypass and valve-replacement surgery.

He's doing very well. After three days of recovery at Providence St. Peter Hospital, he returned to his home in Olympia on Friday. Like most people who have major surgery, he's happy to be home with his family, and pleased that things went so well.

He's been checking in regularly via phone and email, and appreciates the cards, emails and Twitter messages of support. He wanted to be sure that we posted an update here to let folks know how he's doing.

During his recovery, the commissioner's duties are being handled by Acting Chief Deputy Deb McCurley, who's been with the agency since 2006.

Cowlitz County driver faces multiple charges in insurance fraud case

A Cowlitz County woman faces multiple charges after she allegedly ran into another vehicle, fled the scene, and falsely filed reports with police and her insurer claiming that her car had been stolen.

Kaitlyn D. Karthauser, 21, was charged March 27th in Lewis County Superior Court with hit and run, second-degree perjury, insurance fraud, and making a false statement to police.

On Oct. 20, 2012, around 3:30 a.m., according to investigators, Karthauser was driving her gray Saturn north on Interstate 5 when she rear-ended a white car in front of her. She allegedly pulled over, looked over her car for damage, then drove off. The other driver sustained head and back injuries and was taken to a hospital in nearby Centralia. Troopers discovered the front license plate from Karthauser's car among the collision debris at the scene.

About 40 minutes later, the Chehalis Police Department spotted Karthauser's Saturn abandoned in a city park one freeway exit up from where the collision took place.

Eight hours later, Karthauser called the Castle Rock Police Department and reported that someone had stolen her car the night before. She signed a theft report. An hour after that, she called her auto insurer and filed a claim for her stolen car.

On Oct. 22, when told that the State Patrol would check her cell phone records to determine where she was during the time of the crash, Karthauser allegedly admitted to a State Patrol investigator that she lied when she reported the car stolen. The following morning, she called her insurer and told them the same thing.

She said she was driving to a friend's house late at night when she fell asleep and hit the other car. She was jarred awake by the collision, and upon seeing the damage, she said, she panicked and drove off.

"My insurer's using values from all over the country to value my totaled car. Can they do this?"

Under Washington state law, unless you gave your insurer permission to search over 150 miles from your home, no, they cannot use cars from all over the country when trying to find comparables. Feel free to refer them to the insurance rule on this issue, which is known as WAC 284-30-391 ("Methods and standards of practice for settlement of total loss vehicle claims.")

And even if you are dealing with someone else's insurer, they still need to look for comparable cars in and near where the vehicle is normally garaged or parked.

If you have problems with this -- and you live in Washington state -- feel free to file a complaint with our office so we can help ensure that the rules are followed. If you live in another state, check with your state's insurance department.

Cease and desist order issued to Charles D. Oliver, American Equity Advisory Group, and "the Chuck Oliver team"

A few minutes ago, we issued this cease and desist order telling Charles D. Oliver, American Equity Advisory Group LLC, and "the Chuck Oliver team," as well as their employees, agents and affiliates, to immediately stop selling insurance products in Washington without a license.

We received a complaint from a woman who -- despite the fact that she is unmarried and has no children -- had bought  two $1 million life insurance policies and an annuity from Oliver and an associate, Steven H. Minnich. From the order we issued today:

"In the end, Mr. Minnich and Mr. Oliver sold (the woman) two life insurance policies and an annuity, as part of a complex scheme they call `maximum funding' or the `Missed Fortune' concept. Essentially, the plan was to deposit a large amount of premium into the plans for the first five years, and then stop paying on the contract.

"Mr. Minnich and Mr. Oliver told (her) that, if she did not touch the life policies for 10 years after that, she would be able to borrow $75,000 per year against the life insurance death benefit to use as retirement income, without paying any taxes and with minimal or no interest. They told her she would be able to do that without paying any further premiums on the policies, and for as long as she may live.

"This is not correct. Based upon the non-guaranteed amounts in the illustrations provided, there is a theoretical possibility that it could occur. However, the guaranteed amounts show that, within a few years (the buyer) would run out of cash value in the policies against which to borrow. This would happen by operation of the loans themselves, in addition to the accrued interest. In addition, the death benefits would decrease when (she) reached certain age milestones. Thus, not only would (she) not be able to use the policies for retirement income, she would also need to pay additional premiums simply to keep the policies in force. Thus, it is vastly more likely that the plan would not have performed as represented to her by Mr. Minnich and Mr. Oliver, and would leave her in a far worse financial state than if she had left her money where it was.

"Neither Mr. Minnich nor Mr. Oliver even suggested to (the buyer) that this was a possibility, let alone informed (her) of the extreme risks she was taking."

In this case, the premiums amounted to $110,000 a year. The woman, who had minimal annual income, was only able to make the first two years' payments by borrowing from one life insurance policy, cashing in another, borrowing from her IRA, and opening a home equity line of credit. Mnnich and Oliver, according to our order, "knew that she does not, and never did, have the assets to be able to make the $110,000 payments for five years."

Our order alleges that these transactions included nearly a dozen violations of Washington state law, including Oliver's selling insurance without a license, selling an unapproved policy, taking a commission without being licensed, describing the plan in a way that could be misleading, engaging in unfair or deceptive practices, and "by knowingly making, publishing or disseminating false, deceptive or misleading representations" of an insurance transaction.

The respondents can demand a hearing. The order, which was signed today, takes effect immediately.

"My lender wants my homeowners policy to cover the home AND the land value. Can they do that?"

No, not in Washington state.

Since the land itself is not considered covered property, including it would inflate the cost of your insurance premium. And you could never collect on a claim for the value of that land, since it's not covered property.

To preclude such a waste of your premium dollars, Washington state law bans insurers from issuing a policy that includes the value of non-covered land. The title of the relevant section of law says it all: "Over-insurance prohibited."

That said, however, you can get a policy for what's called "replacement cost" coverage for your home. With that kind of coverage, you could collect the cost to replace the home in the event that it was totally destroyed by a covered event and had to be rebuilt. And that replacement cost can be more than a home's current market value, particularly if the home is older or in less-than-sterling condition.

Questions? The law we're referring to is RCW 48.27.

Kreidler recovering from planned heart surgery

Washington Insurance Commissioner Mike Kreidler is recovering after successful heart surgery.

 Kreidler’s doctors had been monitoring his heart status over the past several months, leading to the scheduled bypass and valve-replacement surgery, performed Monday at Providence St. Peter Hospital in Olympia.

“The commissioner was upbeat and confident about the operation,” said Sandi Peck, Deputy Insurance Commissioner for Public Affairs. “He called our office this morning, and he sounds as if he’s well on the road to recovery. As a staunch advocate for health care reform, he’s definitely looking forward to getting back to work.”

During Kreidler’s recovery, Acting Chief Deputy Deb McCurley will be handling the commissioner’s duties. McCurley has been the deputy insurance commissioner for operations since 2006.

“The consumers we serve and industry professionals we regulate shouldn’t notice any changes,” said McCurley. “We have a dedicated, professional staff, many of whom have long experience dealing with insurance.”

Kreidler, 69, was re-elected to a fourth four-year term in November 2012. He is a former member of Congress, state lawmaker and doctor of optometry.

 

Health insurance tips: What if the billing code is wrong?

We often hear from consumers who tells us that they're having health insurance problems related to billing codes. People think the wrong code was used, but don't know how to find out for sure. And then they're not sure how to change it.

Billing codes are the shorthand way that doctors and other health care providers describe their services. The most widely used type are called "CPT codes." They were created by the American Medical Association.

You see these codes all the time on those letters -- which are known as Explanations of Benefits, or EOBs -- that your insurer sends you after each health care appointment. Sometimes there's an accompanying line indicating what the service was, but it's not always clear.

If you're trying to figure out more about what a particular code means, you can go to this web page set up by the AMA. It will tell you the definition of a particular code. With that information, you can go to your health care provider and ask them to redo the coding.

If that doesn't work and you still feel that the CPT code doesn't correctly describe the services you received, you can ask your health care provider for a copy of the chart notes. You can send these notes to the insurance company, where one of the insurer's billing specialists can review the notes to decide whether to use a different code. (Note that the provider's office can make you pay for the copy of the chart notes, so be ready for that if it comes up.) We have seen consumers win insurance disputes using this technique, though, so it's worth a try.