Self-employed and looking for a small group health plan?

We've heard from a lot of self-employed or sole-proprietors who want to take advantage of the new group of one law but are having trouble finding a health plan.

(The new law took effect in Oct. and allows qualified self-employed people buy health insurance in the less expensive small group market.)

We think we have something that can help: We've added a direct link to the federal government's Healthcare.gov site. Just type in your zipcode and you'll get a list of health plans available in your county. Of course you can also contact an agent or broker directly, but this gives you another option. Here's the link to information we've posted on our site.

If you want to bypass our website and go straight to the place that let's you enter your zipcode - here you go

Kreidler proposes health insurance rate reforms

News release issued by Washington State Insurance Commissioner today:

Insurance Commissioner Mike Kreidler is asking state lawmakers to preserve his authority to scrutinize health insurance rates, boost transparency, and to let him—for the first time—consider some insurers’ surpluses when reviewing rates.

“Some non-profit insurers have built up hundreds of millions of dollars in surpluses in recent years, while still seeking double-digit rate hikes,” said Kreidler. “I want the law changed so we can take a closer look at that, while still maintaining a vital insurance market.”

Under current law, surpluses—including investment income—cannot be taken into account when considering a company’s rate request.

Kreidler also will seek more transparency, so consumers can have a full picture on rate proposals by insurers. Today, most information included in a rate filing is not releasable to the public.

“Tens of thousands of Washingtonians who have to buy insurance on their own struggle to find and keep coverage,” said Kreidler. “We can help protect them by continuing to review rate hikes carefully. They also deserve to see how much of their insurance premium is spent on direct medical care versus administrative overhead and profit.”

Rate review: Kreidler gained the authority to review rates in the individual market in 2008, but it’s scheduled to expire after 2011. He’s proposing legislation to do away with that deadline.

Surpluses: The surplus proposal would only apply to non-profit health insurers, which account for most of the health insurance market in Washington. Also:

• Once a company amasses a surplus equal to 3 months of claims expenses, rate hikes would not be approved.

• The insurance commissioner could grant exceptions, however, if limiting the surplus or rates would pose a threat to the financial health of an insurer.

Transparency: The legislation would allow the public to see:

• What percentage of a specific rate request goes to profit, medical costs and administrative costs.

• How much, overall, a health carrier collected in premiums, how much money it made, and how much it paid out in direct medical claims.

• The medical trends the health carrier is using to project future rates.

“It’s simple: We need oversight of the health insurance industry,” said Kreidler. “And families deserve to see where their money’s going and how their rates are set.”

Ice, snow and cars: Filing an insurance claim

Slick roads make for lots of fender benders (or worse), so here's some information on dealing with collisions and insurance companies.

First: Unless you signed a contract with an insurance company requiring you to take your car only to a specified shop, you can choose where to take it for repair. But the shop still needs to work with the insurer to come to an agreed-upon price. If not, and they still fix the car, you may be responsible for whatever the insurer doesn't pay.

For more details on "diminished value", non-OEM parts, getting a rental car, etc., please see our "How the auto insurance claims process works" page.

If you're in a wreck and it's more than a fender-bender, you might want to see our "What happens if my car gets totaled?" page. From it:

You have the right to payment of the actual cash value of your auto, and to expect a prompt and fair settlement. Don’t be surprised if your “value amount” and the insurer’s “value amount” do not match. Be ready to negotiate with the insurer when this happens.

The page has a lot more information on how insurers establish the cash value of the totaled vehicle, what happens if you can't find a comparable vehicle, and -- we get this question a lot -- what happens if you want to keep your damaged car.

If you have questions or problems with an insurer -- we're the state agency that regulates the insurance industry in Washington state -- give us a call at 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.

Issaquah woman sentenced to $300,000 in restitution in insurance fraud case

A King County Superior Court judge today ordered Issaquah's Linda Ann Rose, 67, to pay and forfeit a total of $300,000 in restitution to insurance companies for fraudulent injury claims after a minor accident in a parking lot.

On Nov. 13, 2004, Rose was involved in a parking lot collision in Issaquah. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision.

In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.
Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.
 
Rose entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim. 
 
She was ordered to pay $250,000 to Progressive, $25,000 to Metlife, and to forfeit another $25,000 in a structured settlement from Metlife that had not yet been paid.

Flood coverage: Where to find it -- and what if you can't?

November in the Pacific Northwest generally means rain, and lots of it. (See also December, February, March, April and sometimes May.)

As the rivers swell, we tend to get nervous queries from consumers and businesses about flood insurance. Here are the basics, as well as some special information for businesses in Washington state's Green River Valley.

Does a standard homeowners' insurance cover flooding? No. Many people think it does. It does not.

Where do I get flood coverage? For most consumers and many businesses, the first stop is the National Flood Insurance Program, a federally run program that's been around for decades. But the business coverage maxes out at $500,000 per building and $500,000 for contents, so businesses may need extra coverage as well.

What's it cost? The average federal flood insurance policy costs less than $570 per year.

Am I in a flood zone? Here's a page to search flood maps. You can also get a quick risk estimate by typing your address into the feds' "one-step flood risk profile."

I heard that the federal flood insurance program was suspended. It was, but isn't anymore. The program lapsed several times this year, but Congress in late September reauthorized the program for another year.

Who sells it? Although it's a federally run program, it's sold by many insurance agents. To find a local one who sells it, see the program's agent locator.

And here's the special information for businesses in Washington's Green River Valley, which is in south King County. Last year, businesses in the area reported problems finding additional coverage. To help, we set up a "market assistance plan" that acts as a matchmaker between businesses and insurers. If you live in that area and can't find coverage for your business, the odds are good that the market assistance plan can help you.

For more, please see our flood information page.

More from our case files...

Having trouble with an insurance company, agent or broker? Give us a call; we can often help. We're the government agency that regulates the insurance industry in Washington state. (If you don't live in Washington, here's an easy map with contact info for our counterparts in your own state.)

In Washington state, we're at 1-800-562-6900 or AskMike@oic.wa.gov. You can now also file a complaint easily online.

Here's a sampling of the sorts of things we help with virtually every day:

• A woman contacted us on behalf of her 75-year-old mother, who had forgotten to pay her long-term care insurance premium due to health issues. The company had cancelled the policy for non-payment. After multiple attempts to have the policy reinstated, the daughter sought our help. The policy was reinstated.
• A company that had sold an illegal discount health plan here agreed to pay a consumer $3,825.
• A widow whose annuity request had been delayed complained to us. We contacted the company, which honored the request, sending her a check for more than $250,000.

Job openings

We have a couple of job openings:

We're looking for an administrative assistant 4 for a limited-duration position funded by federal grant dollars related to health care reform. This person will perform "a wide range of complex administrative duties related to planning and implementation of organizational change, grant management and program support functions." The job duties include compiling statistical information and preparing written reports for executive managers and the grant funding agency. The position is funded by federal grants through November 2011.

Here's the link to the job posting, but if you want to apply, please do it quickly. Applications are due by 4:59 p.m. this Friday.

We're also looking for a financial examiner 2 to work in our Seattle office. This person will plan and conduct financial examinations of insurance companies and other regulated entities. From the job listing:

This position works with Financial Analysts (certified public accountants, certified financial examiners, and accredited financial examiners), attorneys, and other regulators on a state, national, and international level. This position examines, audits, and verifies specific groups of insurance companies, including bonds and stocks, mortgage loans, real estate, policy loans, premium notes, collateral loans, policy reserves, and capital stock.

For qualifications, pay, and application information, please see this job posting. The deadline for applications is 5 p.m. on Dec. 3.

We're a small state agency -- we have a total of about 200 workers between our Tumwater, Olympia, Seattle and Spokane offices -- that regulates the insurance industry in Washington state. We have a pretty broad consumer-protection mission. We:

• monitor insurers' finances to make sure they can make good on their promises to policyholders.
• license tens of thousands of agents and brokers, and investigates complaints about them.
• scrutinize rate hike requests and makes sure that policies comply with the law.
• go after scams, both from unlicensed insurance companies and by people trying to defraud insurers.

And our consumer advocates and a small army of volunteers field thousands of calls and e-mails from consumers needing help with insurance claims or struggling to find affordable health coverage.

How Washingtonians can file an insurance complaint online

We've launched a new "online consumer complaint center" this week, and we think we're the first state insurance department in the country to offer this kind of service.

The system lets Washington state consumers file complaints against insurers using a new interactive and password-protected web tool.

The idea is to make it more convenient and efficient for consumers to file a complaint with our office. We help with thousands of complaints, but until now, the process has relied on people mailing documents back and forth. We think this will be faster and easier.

What sorts of complaints? They often involve what insurers are covering -- or not covering . We often get calls from drivers whose cars are totalled, and who are unhappy about the payment offered for their vehicle. We try to help with complaints about delayed payments, policies being canceled, getting companies to reopen a claim or negotiate on payment, etc.

At our site, Washington state residents can file a secure complaint online, track its status 24/7, upload documents/photos/etc. related to the case, add comments, and view, print and save information about the case.

Not a Washington state resident? Here's a map with contact info for your own state's insurance department.

Request for proposals re: insurance rate review

We're looking for proposals from firms interesting in participating in a project to improve our review of health insurance rates and to increase public transparency for how health insurance premiums are determined.

Interested in bidding? The full request for proposals document is here.

The estimated time period for the contract is Feb. 16, 2011 to Sept. 30, 2011. We reserve the right to extend it for up to three one-year periods; see the RFP for details. It includs the scope of work, evaluation procedures, minimum qualifications, etc.

All proposals are due no later than 5 p.m. PST on Dec. 27, 2010.

For additional details, see also our general RFP page, and see this news release, which contains more information about the federal grant that's helping pay for the project.

High winds and storm damage -- what insurance covers and what it doesn't

As you probably know if you live in western Washington, high winds swept across much of that part of the state last night, toppling trees and knocking out power to thousands of people.

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.

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.

Look for some more wind gusts tomorrow. Weather Underground is predicting a south wind 15-25 mph in Seattle and Olympia, and a lighter 10-15 mph in Tacoma.

If you've lost power, here are Puget Sound Energy's updates on progress restoring power, including a handy map of outages and progress.

And if you want the state version of a worst-case scenario survival guide, here's the link (it's a 5-meg pdf, sorry about that) to the Emergency Management Department's "Emergency Resources Guide." It tells you what to do in case of a pandemic, a terrorist bomb, biological weapons attack, or if you're trapped in debris (tap on a pipe). It's got questions to ask someone making a bomb threat, and what to avoid eating after a radioactive "dirty bomb" goes off, etc. etc. etc.

From our case files...

A sampling of recent cases our consumer advocacy staff has handled in the past few days (We get many consumer calls a day; these are very typical of the sorts of cases we deal with):

• A driver got into an accident with a business' truck in Seattle. The truck backed into his car. Yet the business' insurer initially offered to pay for only 70 percent of the nearly $2,400 in damage. The man complained to us. We contacted the insurer, which reviewed the case -- including photos provided by the car's owner -- and agreed to pay for all the damage.
• A Vancouver woman whose insurer wanted to cancel her policy due to a deteriorating roof asked for our help. We helped her get the company to renew the policy and keep her covered.
• An Issaquah man wanted to remove his daughter, who is a college student in another country, from his auto policy. The company refused. We asked them to review the decision. He got a $563 discount as a result.

If you live in Washington and need help with an insurance company, agent or broker, give us a call at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. We won't send you to a phone tree try to sell you anything -- we're the state government agency that regulates the insurance industry in Washington state. We'll do our best to help.

One wrong denial for contraception coverage leads to company reprocessing nearly 1,000 other claims -- and paying $148,000

One consumer's call to our Insurance Consumer Hotline meant good news for nearly a 1,000 additional insurance consumers. A woman sought our help when coverage for her prescription contraceptive was denied by her insurance company. It turned out that the insurer had been violating a rule Insurance Commissioner Mike Kreidler enacted back in 2001. It had to pay her claim and reprocess 984 claims of other enrollees previously denied, making payments totaling more than $148,000.



From Jan. 1, 2002 to May 25, 2010, the insurer had repeatedly denied payment, under a variety of different codes. Among them: "Condition not covered by this contract", "This service for this condition is not covered by your plan", and "Medical necessity for this service or supply has not been established." The contraceptives in question were IUDs, and the requested coverage was payment for removal of the devices.



Of the 985 claims, only 3 women appealed the decision -- and all the denials were upheld.



But one of those women decided to contact our office. And that led to getting those years' worth of claims, for hundreds of women, paid.



Here's the rule: In Washington, all state regulated health plans that have comprehensive prescription drug coverage must cover prescription contraceptives. Want to know more? Here's a page describing your rights under this state law.



If you've got an insurance question or problem and you live in Washington, don't be afraid to call us for free help. We're at 1-800-562-6900 or AskMike@oic.wa.gov.



Note: Post updated to reflect what kind of contraceptive and service was involved.

Update on Chubb fine and suspension: Suspension is stayed pending hearing

On Monday, we called for a $534,000 fine for Chubb & Son and a 9 month suspension of six of its subsidiaries (which would mean that they couldn't write new business; existing policies would remain in force, and renewals could still be done). The companies' attorneys yesterday demanded an adminstrative hearing on both matters. So the suspension, which was slated to take effect Nov. 18, is stayed for now.

In response to some media queries, here's a list of recent enforcement actions we've taken against these companies. All include the same sort of violations -- improper documentation of decisions about rates -- that led to these latest two orders. (All our disciplinary orders, including those for insurers, insurance agents, brokers, etc., are posted online here.)

2000: $67,000 fine for multiple violations, including failure to provide proper documentation for why credits and debits were applied to certain policies. The fine was actually $135,250, but about half ($67,625) was suspended so long as a compliance plan was followed to fix the problems.

2003: The balance of that fine -- $67,625 -- was imposed, after numerous violations continued, despite the compliance plan. From the 2003 order: "The company’s pattern of a continued high rate of filing and other violations are indicative of a systemic problem."

2007: We imposed a $250,000 fine for ongoing violations. Chubb & Son agreed to fully comply with a compliance plan, including multiple self audits, to fix the problems.

2010: We call for a $534,000 fine, based on hundreds of violations. The companies call for a hearing.

2010: Commissioner Kreidler orders a 9-month suspension of six Chubb subsidiaries' ability to sell new coverage. The companies call for a hearing.

Update: The case ended with a consent order that included a significant fine but no suspension. We posted the details here.

Job openings

Due primarily to some federal health care reform grants (and one employee who left for a sunnier climate, think of that), the Washington state insurance commissioner's office has a few job openings. Most are limited-duration posititions based on grant money.

Here they are. Click on the position for details about requirements, salary, duties, application process, etc.

Functional Program Analyst 4: Deadline for applying is Nov. 12. These staff advocate on behalf of consumers to ensure that they're being fairly treated by their insurance carriers and by helping educate consumers about insurance. This person will help develop and test online tools to help consumers. This is a project position funded by federal grant dollars, and the grant period runs from Oct. 15, 2010 to Oct. 15, 2011.

Investigator 3: We're looking for a senior investigator to investigate suspected violations of state insurance law. From the job announcement: The Investigator 3 position is an advanced investigative position responsible for conducting complex investigations from the initial discovery of suspected violations, through the prosecution of those involved in illegal activity. Deadline for applying for this job is Nov. 16.

Communications Consultant 4: This is another project job, funded by a federal grant that runs from Oct. 15, 2010 to Oct. 15, 2011. This person will work with our Consumer Protection division to develop and manage communications strategies for consumer assistance and education. Deadline for applying is Nov. 19.

Management Analyst 5: Another project job, with the same grant timeline as those listed above. This would be a project manager position, leading a diverse project team. See the link for much more information on technical details, duties, etc. Deadline for applying: Nov. 19.

Kreidler calls for $534k fine against insurer, issues order to suspend six subsidiaries from writing new coverage for 9 months

Washington State Insurance Commissioner Mike Kreidler on Monday issued an order that would suspend the insurance certificates of six companies, effective Nov. 18. The move – which does not affect existing policies or renewals – would bar the companies from writing new coverage for 9 months.

Kreidler is also proposing a $534,000 fine, contingent on a hearing, against the parent company, Chubb & Son.

The suspension order includes Federal Insurance Company, Pacific Indemnity Company, Great Northern Insurance Company, Executive Risk Indemnity, Inc., Vigilant Insurance Company, and Northwestern Pacific Indemnity Company. All are property and casualty insurers. All are wholly owned subsidiaries of Chubb & Son. The policies affected are all commercial policies.

“It’s highly unusual for us to suspend a company’s certificate to sell insurance. But we’ve repeatedly tried to work with Chubb and its subsidiaries to fix a number of ongoing violations of state law,” Kreidler said in a press release. “Some of the problems that triggered this decision have been recurring for a decade.”

A key issue is Chubb’s repeated failure since 1998 to properly document the reasons for charging higher or lower rates on certain policies.

Repeated examinations and a series of company self-audits ordered by Kreidler since 2007 found hundreds of violations of state law, including numerous recent ones. In some cases, more than half the sample files checked had violations. The $534,000 fine amount was based on 534 violations of state insurance law, at $1,000 per violation.

Chubb can appeal the suspension. The suspension order does not affect the companies’ obligation to honor policies issued prior to the effective date of the suspension. Nor does it affect their authority to renew existing policies. But it would prohibit them from selling new policies during the nine-month period of the suspension.

Note: We'll add a link to the press release shortly. Done. And we added a link up above to the hearing notice re: the fine.

Update: Chubb has demanded a hearing on both the fine and the suspension. See our post re: that here.

Another update: In the end, Chubb's subsidiaries were fined, but there was no suspension. See here for details of the order.

New health plans for small businesses

Small businesses in Washington state looking for health insurance for their employees should check out the new federally-funded Health Insurance Partnership (HIP). This is a new program administered by the state's Health Care Authority that provides small employers access to the same health insurance coverage available in the commercial market, but at significant savings.

The health plans available through the partnership include:
Kaiser Foundation Health Plan of the Northwest, Group Health Cooperative, Regence BlueShield, and Asuris Northwest Health and vary based on annual deductibles ($500-$5,000), co-pays, co-insurance, and prescription drug coverages.

Small employers (up to 50 employees) who don't currently offer health insurance qualify for the program if at least 50 percent of their employees are considered low-wage (their monthly wage doesn't exceed 200 percent of the Federal Poverty Level).

Also, premium subsidies of up to 90 percent are available to employees who qualify based on their family income. Get the details here.

Issaquah woman pleads to 3 felony charges in insurance fraud case

An Issaquah woman has entered a modified guilty plea to 3 felony counts of using false claims or proof in an insurance claim.

Linda Ann Rose, 67, is scheduled for sentencing in King Couny Superior Court November 19th.

On Nov. 13, 2004, Rose was involved in a parking lot collision. An SUV backed out of a parking stall and struck Rose's rented Ford Mustang. Photos of both vehicles show minimal damage, but Rose claimed that she suffered severe back injuries as a result of the collision. In 2007, her attorney demanded $656,874 from the SUV owner's insurer, and subsequently filed a personal injury lawsuit in the case.

Investigators from the Washington Insurance Commissioner Mike Kreidler's Special Investigations Unit subsequently concluded that Rose knowingly provided altered medical records to her attorney, and that she had had an injured back "well before" the accident.

Kreidler re: health insurance rates: "I share your frustration"

Our office continues to hear from people unhappy with health insurance rate hikes.

These can be particularly severe when you bump up into the next five-year "age band." Health insurance, which varies dramatically by age, is priced in 5-year groups. In other words, turning from 58 to 59 won't increase your rates more than usual, but turning from 59 to 60 will. These increases -- coming on top of annual rate hikes -- can be a very tough burden on folks who find themselves paying more and more for fewer and fewer benefits.

Washington state Insurance Commissioner Mike Kreider has issued an open letter to the state's health insurance consumers. From it:

Many of you have contacted me about your frustration at the rising costs of your health insurance. You’re tired of seeing your premium and out-of-pocket costs increase, at the same time you lose benefits. I don’t blame you for being mad. I share your frustration and take your concerns very seriously.

Kreidler said that his authority remains too limited, and that he'll be asking state lawmakers for more power to protect consumers and new rules to increase transparency, so people can see the details of what actually goes into an insurer's rate request. From the letter:

You deserve to know how your premium dollars are being spent and what's driving the cost increases.

The good news is that relief is coming; the bad news is that in many cases it won't be until 2014. That's when major provisions of the new federal health care reform law take effect, including a health insurance "exchange" where it's easy to comparison-shop, subsidies to help make insurance affordable, and rate caps based on a percentage of salary.

Here's a link to the full text.

Cease and desist order issued to ShieldStar Home Warranty

Washington state’s insurance commissioner on Tuesday ordered a New Jersey home warranty company to stop selling unauthorized service contracts in Washington.

ShieldStar, doing business as ShieldStar Home Warranty and http://www.shieldstar.com/, has sold at least 21 home warranty service contracts in Washington, according to a cease and desist order posted on Insurance Commissioner Mike Kreidler’s website.

This is the third cease and desist order that Kreidler has issued against a home warranty company in the past several months. (The other cases were unrelated to this one.)

In ShieldStar’s case, the contracts cover parts and labor necessary to fix major appliances and systems in the consumer’s home. But neither the company nor several affiliated individuals named in the report are registered in Washington as a service contract provider.

The company has been ordered to mail a copy of the Kreidler’s cease-and-desist order to all its customers in Washington and to report all premiums charged for Washington policies.

The company has the right to demand a hearing. The order is effective immediately.

Update: (12/8/2010) If you purchased a ShieldStar Home Warranty, we want you to know that the cease and desist order does not prevent the company from fulfilling the terms of your contract. Your current contract with ShieldStar is valid under its usual terms and conditions.

Similarly, the order does not prevent the company from providing a refund when requested by a Washington consumer.

If you have any questions or need any assistance with this or any other insurance-related matter, please feel free to call our consumer protection staff at (800) 562-6900