Kreidler examining how proposed U.S. rule may affect Washington’s health insurance market

The federal Centers for Medicare and Medicaid Services (CMS) proposed a rule this week that could significantly affect health insurance plans for 2018. We are working closely with our health care stakeholders, including health insurers, medical providers and consumer advocates, to ensure that any proposed changes to the Affordable Care Act (ACA/Obamacare) do not harm our state’s stable health insurance market.

The federal government's 71-page proposed rule contains several approaches to market stability. We are evaluating the regulations for their effect on Washington state law and our market. One option in the proposal would shorten the annual enrollment period for consumers from three months to six weeks.

All states have been asked to provide comments on the proposed rule by March 7 – a quick turnaround.

Our analysis will consider Commissioner Kreidler’s three key values for any changes to the ACA:
  • No reduction in people covered by insurance.
  • No reduction in benefit levels or affordability.
  • No increased financial obligation for our state.
Washington independently adopted many aspects of the ACA, and we have a state-based Exchange that recently saw more than 200,000 residents enroll in coverage for 2017. Kreidler’s office is coordinating its review of the proposed rule with experts at several Washington state agencies and the national level to ensure a comprehensive analysis.

We are tracking potential changes to the ACA; you can sign up to receive notifications when we have new information. 
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Get a CLUE – it’s a report that can influence your insurance rates

KING 5 recently reported on a little-known database called CLUE—Comprehensive Loss Underwriting Exchange—that can affect consumers’ property and auto insurance rates without their knowledge.

KING 5 interviewed a consumer named Mike Schultz whose auto insurance rates went up because of an error in his CLUE report. After doing some digging, he found out that his CLUE report erroneously listed a collision that he witnessed, but was not involved in.

So what should consumers know about CLUE?
  • It’s a report generated by LexisNexis that contains up to seven years of your personal auto and property claims history. The data comes from insurance companies when they close claims you file.
  • Insurance companies review the CLUE data and use it to set the rates they charge you.
  • You have the right to request a free copy of your report:
LexisNexis, Consumer Center
866-312-8076
Request your personal report online
  • If you find mistakes in your CLUE report that you want to dispute, contact LexisNexis Consumer Center at 888-497-0011. 
Read more about CLUE. Questions? You can contact our consumer advocates online or at 1-800-562-6900.
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Learn how to avoid falling victim to fraud at free event on Feb. 15

The OIC and AARP are hosting a free event in Puyallup on Feb. 15 where people can learn ways to avoid becoming victims of fraud.

Free breakfast starts at 9:30 a.m., followed by presentations and free Medicare counseling. 

The event wraps up at 1:20 p.m.

Who:
Washington state Insurance Commissioner Mike Kreidler will speak first, at 10 a.m. 
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Criminal insurance fraud unit investigated 150 cases in 2015, 2016

Many people don’t know that the Office of the Insurance Commissioner investigates criminal insurance fraud, much of which is referred to us by insurance companies themselves. The work is done by the OIC’s Criminal Investigations Unit (CIU), staffed by law enforcement and criminal analysts. They refer the results of their investigations to state and local prosecutors, who bring charges against the people who are suspected of committing the fraud.


CIU staff conduct a search during
an insurance fraud investigation
In 2015 and 2016, the CIU:
  • Received 3,571 referrals, which are questionable insurance cases that consumers and the insurance industry send to us to review.
  • Opened 150 criminal fraud cases.
  • Submitted 52 cases to a prosecutor.
  • Had 40 criminal cases charged; 37 of those were heard before a judge.
  • Had 44 convictions for various crimes.
  • Saved $3.6 million in immediate and projected insurance claim payouts. These efforts resulted in $857,353 of restitution ordered paid back to victims and $26,760 in court costs ordered back to the judicial system.
  • The vast majority – 73 percent – of the cases we investigate involve personal property or property damage. Bodily injury frauds are 11 percent, fraud by insurance agents and brokers (called producers) is 6 percent, and the rest involve disability, a medical provider, staged auto collisions or other types of cases. 
Other information about CIU:
  • CIU was established by the Washington state Legislature in 2006. Since then, we have pursued 434 cases and adjudicated 105 of them. Our workload has steadily increased each year.
  • It maintains a list of insurance fraud most wanted suspects, who have been charged with a crime but did not appear in court to face the charges. 
  • In November 2016, the CIU earned law enforcement accreditation from the Washington Association of Sheriffs and Police Chiefs (WASPC), joining the 20 percent of law enforcement agencies in the state to have it.
  • CIU hosted the 19th annual 2016 Fraud Directors Conference, a gathering of more than 70 insurance fraud professionals from 26 states and DC. It was the first time the conference has been held in Washington state. 
  • The insurance commissioner is required by law to appoint a 10-member volunteer board to advise him on fraud investigations.
Read more in the CIU’s most recent report to the Legislature.
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New rule protects consumers from unintentional long-term care policy lapses


This week, we adopted a rule that affects consumers who have long-term care insurance policies and their families.

If you are not familiar with long-term care insurance, it pays for the polcyholder to stay in a long-term care facility when their health meets certain criteria. Many consumers purchase polices years or decades before they need it. Because the policies are in place for so long, sometimes people forget to pay if their mental or physical health declines, such as cases of dementia.

We started the rulemaking because of stories like this--a consumer filed a complaint with us about her mother’s long-term care policy, which had lapsed because the mother had stopped paying the premiums without her daughter’s knowledge. The daughter found out the policy had lapsed when her mother needed long-term care and the claim was denied. The company said it had notified the mother and the daughter that the policy was canceled, but neither of them received the notice.

The new rule strengthens consumer protections in cases of lapsed policies:
  • Insurers still are required to notify consumers at least 30 days prior to canceling a policy for nonpayment; however, now they have to prove they notified the policyholder and that person’s designee. 
  • The insurer has to notify the person who sold the policy to the consumer, such as an insurance agent or broker. That gives the agent or broker an opportunity to check with their client to make sure they are intentionally letting the policy lapse. 
  • Insurers are required to ask the policyholder once a year if they would like to change their designee. Previously, they were required to ask every two years. 
Read more about the rule and about long-term care insurance. Questions? You can contact our consumer advocates online or at 1-800-562-6900.





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