Insurance Information: Mei 2015

Do you know what preventive services are free?

Health care reform - otherwise known as the Affordable Care Act - gives you the right to access certain preventive medical services with no cost-sharing, including co-pays or coinsurance even if you haven't met your deductible.

The list of free services includes immunizations, cancer screenings, depression screening and much, much more. See the full list at Healthcare.gov. There's also specific services covered for women and even for children.

If you've been charged for a preventive service that you believe should've been free, give our health insurance experts a call at 1-800-562-6900 or email us at askmike@oic.wa.gov

We've heard from some consumers who have had their free colonoscopy, but were later charged for the removal and testing of a polyp. Recent guidelines from the federal government should protect you from these charges, but if you have concerns, please contact us. We'll help you understand your rights to these services and others.

Are you ready for a megaquake?

Oregon Public Broadcasting (OPB) ran a series of stories earlier this month about how prepared Northwesterners are for a massive earthquake (or not, in many cases). Some experts say a magnitude 9.0 quake off our coast could hit at anytime. OPB profiled a series of families who tried living off their earthquake supplies for a weekend to as a trial run. The Red Cross recommends storing 14 gallons of water and 42 meals per person in the event of a megaquake. That’s a lot of supplies.

Photo courtesy of FEMA. A sports car lies crushed by earthquake debris in a Seattle parking lot in Seattle on March 4, 2001.

In addition to being prepared for the disaster itself, homeowners should be prepared for the aftermath. Step one is talking to your insurance agent about what your policies will cover. Earthquakes are not automatically covered by a standard homeowner’s policy, most insurers require an endorsement or a separate policy. And you likely won’t be able to buy it after the fact, most insurers don’t sell it for a period of time after an earthquake hits. Additionally, it typically doesn’t cover tidal waves or tsunamis that are a direct result of an earthquake, but be sure to read your policy and talk to your insurance agent.

While you are preparing for an earthquake—or wildfire or any other natural disaster—make sure you include insurance in your planning.

Take a look at the OPB series, Unprepared: Will we be ready for the Megaquake?
Read about earthquake insurance.
Find resources for natural disasters.

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

Help the OIC improve health insurance webpages

We need your help refining the information we provide on the individuals and families section of our health insurance webpages.

You can help by taking a short survey by May 28. It takes less than 15 minutes to complete and your responses are anonymous.

We will use your feedback to improve the way the information on the pages is organized, so it is more user-friendly and easy to navigate.

Thanks for your participation!

OIC hiring two entry-level insurance positions in Tumwater

The Office of the Insurance Commissioner is hiring two entry-level positions atour Tumwater headquarters to help consumers with insurance.

Insurance Technician 1: This is in our Consumer Protection Division and answers calls on our consumer hotline. This position triages calls to consumer advocacy, producer licensing and Statewide Health Insurance Benefits Advisors (SHIBA), explains basic insurance rules and helps consumers and industry users troubleshoot problems with our online applications.
Health Insurance Advisor 1: This is in our Statewide Health Insurance Benefits Advisors (SHIBA) program and is a temporary job through December 2015. This position counsels consumers in person and on the phone about health insurance, Medicare and Medicaid, including screening them for eligibility and enrolling them in subsidized programs. The person in this position delivers presentations to community groups, trains volunteers and attends monthly meetings around the state.

Find more information about these jobs and other openings at http://bit.ly/OICjobs

OIC wants your help to make our website more user-friendly!

Now that open enrollment is over, we want to fine-tune the individuals and families section of our health insurance webpages.

You can help by taking a short survey. It takes less than 15 minutes to complete and your responses are anonymous. We will use your feedback to better organize the information that we provide to consumers. The survey is open until May 19.

Thanks for your help making our website easier to use!

Fraud prosecutor wins Award of Excellence

The Office of the Insurance Commissioner congratulates King County Deputy Prosecutor Andy Hamilton on his Award of Excellence from the national Coalition Against Insurance Fraud. Hamilton works with the Insurance Commissioner’s Special Investigations Unit to prosecute criminal insurance fraud cases in King County. Hamilton has prosecuted more than 55 cases involving more than $5.5 million in losses, including convicted felons Edward Callow and Kevin Kolenda.

Hamilton, who has worked as an assistant U.S. attorney and Deputy Prosecutor for more than 30 years, works in the King County Prosecutor’s economic crimes unit and was a police officer for four years before he earned his law degree.

Andy Hamilton accepts an Award of Excellence from the national

Coalition Against Insurance Fraud

from Insurance Commissioner Mike Kreidler on May 5.

OIC seeks smart, savvy health care policy advisor

The OIC is hiring a highly skilled Senior Health Policy Advisor to acts as Commissioner Kreidler's primary advisor on all issues related to health care and health insurance issues, including the Affordable Care Act (ACA).

This position is the Commissioner's trusted advisor and designee on ACA policy matters and other matters related to health insurance. This position is responsible for developing policy options for the resolution of health insurance issues. Once executive decisions are made concerning the purpose and scope of an initiative, this position will develop programs or initiatives reflected in work products such as reports, legislation or regulations.

Duties of this position include:

Acts as the first point-of-contact for consumer advocates and consumer/labor groups on matters pertaining to the ACA and other health insurance issues;
Coordinates with the Governor's Office, Health Benefits Exchange (HBE), HCA and others on ACA implementation issues and other health coverage related issues and projects;
Acts as the point-of-contact for legislative staff and member inquiries on ACA and other health insurance issues;
Represents the Commissioner and agency at speaking engagements and meetings related to healthcare issues. Meetings may include, but are not limited to: Health Benefits Exchange Board, National Association of Insurance Commissioner (NAIC) , Governor's Health Leadership Team, legislative hearings, rule-making and legislation stakeholdering;
Analyzes existing and proposed laws, rules and proposals concerning health insurance legislation, preparing recommendations as needed for executive decision-making;
Develops strategies, initiatives and recommendations to solve priority health insurance issues; and,
Communicates and works with representatives from the insurance industry, public agencies, legislature and the public in development of initiatives to solve health insurance issues.

View a full list of duties and apply here: Senior Health Policy Advisor (Civil Service Exempt)

Income protection insurance details for You

What is income protection insurance?

Income protection insurance pays you a regular income if you can't work because of sickness or disability and continues until you return to paid work or you retire. Income protection insurance is also known as permanent health insurance.

The amount of income you are allowed to claim will not replace the exact amount of money you were earning before you had to stop work. You can expect to receive about a half to two-thirds of your earnings before tax from your normal job. This is because some money will be taken off for the state benefits you can claim, and also the income you get from the policy is tax free.
You can’t claim income protection payments straightaway if you fall ill or become disabled. You usually have to wait a minimum of four weeks but payments can start up to two years after you stop work. This is because you may not need the money straightaway as you may get sick pay from your employer or you may be able to claim statutory sick pay for up to 28 weeks after you stop work.
There are other types of illness insurance you can take out such as critical illness insurance. You should compare income protection insurance with other types of illness insurance before you decide whether to buy it. For more information about these

What you need to think about before you take out income protection insurance

Before you think about taking out income protection insurance, ask yourself the following questions:

Do I really need income protection insurance?

Check:

that you don't already get income protection insurance through work. Some employers offer this as a benefit. Your employment contract, handbook or personnel department will have details if this is the case
whether you have some other kind of illness insurance combined with another insurance policy or with your mortgage which covers you for serious illness
whether you have savings you can use instead of insurance. However, you need to think very carefully about whether you want to rely on savings. You may not be able to save enough to cover a long period of ill-health. And you may face another emergency, which would use up your savings and leave you with no cover for illness.

Is this the best type of illness insurance for me?

Check out all the different types of illness insurance to see which one would suit you best. For example, if you're worried about the cost of income protection insurance, you could think about taking out critical illness insurance instead which can be a much cheaper option. However, critical illness only covers a very limited range of illnesses and for a shorter period of time than income protection insurance.
If you're not sure which type of illness insurance would be best for you, you can help from an independent financial adviser.

Do you have enough money to pay for illness insurance?

The costs (or premiums) of payment protection insurance can be high and you may never need to use it. You won’t get any money back if you never make a claim.

What you need to know before you take out income protection insurance

You should always check the terms and conditions of any insurance policy very carefully before you sign up to make sure it meets all your needs. You will need to be sure of exactly what you can claim for, when you can claim and how much you're likely to get.
There are rules which say the policy documents must be written in easy-to-read plain English, so you can understand what you're signing up to.

Are there any exclusions?

Illness insurance policies don’t always cover every type of illness.
On top of this, you may not be covered for certain illnesses which either you or a member of your family has had before. These are known as pre-existing medical conditions.
Insurers will look at your family medical history and some policies will cover existing medical conditions but others will not. If your family medical history means that there will be conditions attached to you taking out the policy, your insurer should explain these to you before you sign up for the policy.
You also need to know if you will still be covered if you can do other kinds of work than your own. Some policies say you can’t make a claim if you stop being able to do your own job but can do other types of work. You should check the insurance policy to see if it says this.

How long you have to wait before the policy will pay out

With most policies you usually have to wait a minimum of four weeks after you stop work for payments to start. This is called the waiting period. Some waiting periods last up to two years. The amount of money you pay for the insurance policy (called the premiums) may be cheaper if you can wait longer before you make a claim.

How much you'll get if you make a claim

You will need to know exactly how much you’ll get if you make a claim. The amount of your payments may be affected if you have other income such as state benefits or payments from other insurance policies.
You should also find out whether the payments will go up each year in line with the cost of living.

How the insurers have assessed your job

When they're working out whether to cover you and how much to charge you for your policy, insurers will assess how dangerous your job is. Different insurers may assess the same job differently, so it’s important to know which category your job falls into as you could get a cheaper premium elsewhere.

What you must tell your insurer before you take out income protection insurance

You must give your insurer full details of you and your family’s medical history. If you leave anything out and then later try to make a claim, your insurer may refuse to pay out.
If you already have a pre-existing medical condition, look for an insurer that will be prepared to cover it, although you may have to pay more to take out the policy. A pre-existing medical condition is one you've had before.
You should also tell the insurers if you take part in any dangerous hobbies or have a lifestyle that includes smoking, heavy drinking or drug taking. If you don't tell them about something which later affects your claim, they may refuse to pay out on the policy.
You don’t have to discuss personal or sensitive information with the person who sells you the policy. You can ask to send the information directly to the insurer’s medical officer.
If you are already in ill health, or have a dangerous job, you may not be able to get income protection insurance or you may have to pay more to take out the insurance.

How to work out the level of cover you need for income protection insurance

To work out the level of cover you need for income protection insurance:

start with how much your take home pay currently is
take away the amount you would get in state benefits
take away any work related costs such as travel, food and clothing
add on any extra expenses you might need if you become ill or disabled such as extra heating costs or the costs of medical equipment

For more help on how to work out how much cover you would need, go to the Money Advice Service website at www.moneyadviceservice.org.uk. An insurer or independent financial adviser can also help with working out these costs as some may be difficult to predict in advance.

Income protection insurance details for You

How to buy income protection insurance

You can buy income protection insurance from:

an independent financial adviser, who can look at all the policies on offer and choose the one best suited to you. You may have to pay for this advice
directly from an insurance company.

If you want to buy income protection insurance directly from an insurance company, you should shop around to see who will give you the best deal. You can use a comparison website to do this. You probably won't be able to buy the insurance online as you will need to be assessed by the company for your suitability. But you will be able to apply for a quote online or find details of insurance advisers you can speak to.

What affects the cost of income protection insurance?

The costs of taking out income protection insurance are affected by the following things:

your age. The older you are when you take out the policy, the more you are likely to pay, as your risk of getting ill increases
your sex. Men make slightly more claims than women, so may pay more
your health. If you're in good health, you will pay less to insure yourself
your job. If you do a risky job, you will pay more for cover
hobbies and lifestyle. If you take part in dangerous hobbies or you smoke or drink heavily, you will pay more for cover.
the waiting period The longer you can wait before you make a claim, the cheaper your premiums will be
whether you might be prepared to do other kinds of work than your own if you get ill. It usually costs less to take out income protection insurance if you say you will only make a claim if you are unable to do any work at all, rather than just your own job.

Cancelling your income protection policy

If you take out income protection insurance, you usually have 30 days to cancel the policy and get a full refund.
If you decide to cancel the policy after 30 days, the money you are refunded may be less than the amount you have put in. Check your policy’s terms and conditions.

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