(Baltimore, MD – Insurance News 360) – Maryland approves insurance rates for 2016 small group and individual markets

The Maryland Insurance Administration (MIA) has approved premium rates for small group and individual health plans offered statewide starting Jan. 1, 2016. The review process resulted in reductions to rate increases for insurers in the state, saving consumers approximately $66.4 million compared to the proposed rates for 2016.

Small group insurance rates will see a decline of 1.8 percent, which is attributed to increased competition and 20 years of reforms. Eleven companies will sell in the small group market in 2016.

New rates for the individual market affect just 3.2 percent of Maryland residents and 4.2 percent are in the small group market. Most residents are covered by health insurance plans through large employers or those who self-insure, plans purchased before March 2010 or federal plans.

“The new rates approved by the Maryland Insurance Administration reflect the trends we’ve seen in the health insurance market over the last two years,” said Maryland Insurance Commissioner Al Redmer, Jr. “MIA’s adjustments to the requests from insurers will support our primary goal – ensuring that Marylanders benefit from a competitive and effective health insurance marketplace.”

For more information, visit www.HealthRates.mdinsurance.state.md.us

Source: Maryland Insurance Administration.

(Louisiana, LA – Insurance News 360) – After taking control of the Louisiana Health Cooperative (LAHC or the CO-OP) on Sept. 1, Donelon is taking steps to assure healthcare providers that they will be paid for CO-OP services and to discuss the continued treatment of policyholders.

“The new management of the CO-OP will work tirelessly to ensure that the processing and payment of claims will speed up dramatically. All healthcare providers of the CO-OP need to know that their claims will be paid so that they will be comfortable in continuing to provide treatment to policyholders,” said Commissioner Donelon. “As the regulator of the insurance industry, I have authority to enforce contracts with outside vendors of defunct insurers, including vendors that process claims, and will do everything within my power to make sure that policyholders are served and providers are paid and paid faster, and that taxpayers can recover as much money as possible through judicious management of the CO-OP,” Commissioner Donelon said.

There are tens of thousands of in-network providers of the CO-OP and Donelon and court-appointed receiver Billy Bostick want those providers to know that efficiencies in administration and the CO-OP’s ability to pay claims will be satisfied. There will be a series of meetings for providers to get information about this situation.

Source: Louisiana Department of Insurance.

(Jefferson City, MO – Insurance News 360) – Missouri drivers who have coverage from Safe Auto could receive a refund or credit after a market conduct examination led to the discovery that the auto insurer did not provide anti-theft discounts on qualifying vehicles between 2008 and 2015. The insurer is required to pay refunds to customers and pay an $80,000 fine.

“When Missourians purchase insurance coverage, insurers must honor the complete terms of the policies, including providing discounts as promised in the insurance policies,” said Department Director John M. Huff. “Our market conduct team will continue to hold insurance companies responsible for keeping their business practices compliant with the terms of the insurance policies and Missouri law.”

The department’s investigation showed that Safe Auto provided the discount to policyholders who indicated that the vehicle contained anti-theft equipment, instead of giving it to all policyholders whose vehicles had the equipment.

The company also allegedly failed to provide discounts for airbags, anti-lock brakes, daytime running lights and passive restraints on certain vehicles in which insurance quotes were issued via the insurer’s website.

Customers with questions should call 844-248-7021 or talk to their agents.

Source: Missouri Department of Insurance.

(Helena, MT – Insurance News 360) – Those interested in how the first year of the Patient-Centered Medical Home Program (PCMH) went now have a place to find answers to their question. Recently, Montana Insurance Commissioner Monica J. Lindeen released a report related to the program’s first full year of operation.

The recently-released report from Montana’s Patient-Centered Medical Home Program (PCMH) will serve as a baseline for opportunities to improve healthcare.

The program was created in 2013 and is a team-based approach to primary care that emphasizes preventative care, coordinating care and outcomes-based data to determine where gaps in care persist.

Baseline data is encouraging in the one-year-old program, according to a report from the Montana State Auditor’s office.

“The baseline data is encouraging and supports the proposition that the PCMH program advances comprehensive primary care and will keep Montanans healthier. Evidence gathered from PCMH programs across the country demonstrates that in the long term, this program can reduce unnecessary emergency room visits and hospitalizations, especially for patients with chronic disease,” said Commissioner Lindeen. “PCMHs in Montana promote high-quality, cost-effective care by providing primary care providers with better opportunities and resources to enhance care coordination.”

The report includes data from PCMHs application, showing how they are improving patient care, baseline data compared to national estimates and federal Healthy People 2020 targets and rates of emergency room visits and hospitalizations.

“Previously, this kind of information about key health indicators in Montana was not gathered or shared with clinics so they could see where their efforts at disease control and prevention were working – or not working,” Lindeen said.

Source: Office of the Montana State Auditor, Commissioner of Securities and Insurance.

(Tallahassee, FL – Insurance News 360) – In early January, the Florida Office of Insurance Regulation (FLOIR) announced that up to 71,500 personal residential and commercial residential policies may be removed from the Citizens Property Insurance Corporation. The two companies that will participate are Heritage Property & Casualty Insurance Company and Southern Oak Insurance Company. , Heritage Property & Casualty has approval to remove ?  up to 55,000 personal residential policies and up to 1,500 commercial residential policies. Southern Oak Insurance Company got the okay to remove up to 15,000 personal residential policies.

The take-out periods are March 22, 2016 for personal residential impacting both the Personal Lines/Coastal Account policies and March 15, 2016 for commercial residential impacting both the Commercial Lines/Coastal Account policies. This is part of the state’s ongoing depopulation effort to reduce the number of policies in the state-created Citizens and transfer them to the private insurance market.

This announcement means that up to 277,149 policies have been approved for take-outs so far this year.

Policyholders who receive a take-out offer may choose to remain covered by Citizens through the opt-out process.

Source: Florida Office of Insurance Regulation.

(Raleigh, NC – Insurance News 360) – Two Fayetteville residents were arrested in late December on charges of insurance fraud and trying to get property under false pretenses in Lee County, in a case related to a January 2015 motor vehicle accident.

Brian Thomas Bright, 39, was arrested on Dec. 22, while Althea M. Smith was arrested on Dec. 23. Both Fayetteville residents were held on a $50,000 bond. North Carolina’s Department of Insurance investigators allege that Bright and Smith made false statements about a motor vehicle accident that ooccured on Jan. 16, 2015, in an attempt to commit fraud and obtain payment from Sentry Insurance.

Insurance Commissioner Wayne Goodwin announced the arrests on Jan. 6.

Source: North Carolina Department of Insurance.

(Louisiana, LA – Insurance News 360) – On May 4, Insurance Commissioner Jim Donelon made a reuet to the Federal Emergency Management Association to give Louisiana policyholders affected by the August 2016 flood more time to file their proof of loss statements. Typically, the deadline is 60 days after the incident. The requested extension would give them a year.

“I know that many of the affected policyholders are still actively engaged in the rebuilding process and in addition to contractor challenges have experienced a significant increase in the cost of labor and materials since last August,” wrote Commissioner Donelon in his letter to FEMA. “As a result, a great number of those affected policyholders will not be able to file the required Proof of Loss or Supplemental Proof of Loss by the looming May 12 deadline.”

Source: Louisiana Department of Insurance.

(New York, NY – Insurance News 360) – Governor Andrew M. Cuomo announced the initiatives to help New York residents with substance abuse issues in Long Island and New York City’s underserved communities. New regulations limit barriers to insurance coverage for addiction treatment and patient brokering.

Cuomo made these announcements on Sept. 6, at the opening of a new substance use disorder treatment center for women with children, female young adults and those over 55 years of age. The center is located on Wards Island.

“New York is committed to the fight against addiction, and with these latest investments, we are taking necessary steps to ensure individuals and families in underserved communities are connected with the resources and support services they need,” Governor Cuomo said. “These new regulations and expanded services are part of our continued efforts to support New Yorkers dealing with substance use disorders, as we work harder than ever to create a stronger, healthier New York for all.”

New Regulation and Guidance

A new DFS regulation requires insurers who offer large group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications when they are not on the list of covered drugs. Insurers will be issued a checklist to ensure their compliance with new rules for reviewing the medical necessity of substance use disorder medications.

Additionally, OASAS will also take further action to restrict “patient brokering,” where brokers collect payments from treatment providers, in exchange for referring patients to those programs. A new directive will require this service be delivered by OASAS-certified and -credentialed professionals, who are prohibited from receiving referral fees.

Source: New York Department of Financial Services.

(Sacramento, CA – Insurance News 360) – Insurance Commissioner Dave Jones reached out to Sens. Lamar Alexander and Patty Murray to express concern over the instability in the individual health insurance market created by the uncertainty surrounding continuation of the Cost-Sharing Reduction payments (CSRs) provided for in the Affordable Care Act and actions taken by the Trump Administration such as reduced enforcement of the individual mandate.

In the letter to Alexander and Murray, who are members of the U.S. Senate Committee on Health, Education, Labor, and Pensions, Jones noted that about half of the California residents who receive Advance Premium Tax Credits through Covered California also rely upon CSRs to afford the health care covered by their health insurance policies.

Earlier this year, Jones authorized California health insurers to file dual rate submissions, one that reflects certainty in CSRs funding, and another that reflects the additional premium loads that will result from uncertainty regarding the funding.

Without the CSRs, Californians who get Silver plans may see rates that are 12.3 percent higher on average than if the CSRs called for in the ACA are funded.

“We have reached the eleventh hour when you must act to fund the CSRs or it will be too late to prevent double digit premium increases because the rates for 2018 must be finalized before the end of this month,” wrote Jones.

Source: California Department of Insurance.

(Lewisburg, PA – Insurance News 360) – In late August, Acting Insurance Commissioner Jessica Altman urged Congress to include provisions specifically supporting private market residential flood insurance in the reauthorization of the National Flood Insurance Program (NFIP), set to expire on September 30.

“The Wolf Administration has been educating homeowners, renters and condo owners concerning private market flood insurance options for the past year and a half, and has found in many cases that comparable private coverage is much more affordable than what is available through the NFIP,” Acting Commissioner Altman told a group of nearly 100 residents in Lewisburg, Union County.  “I encourage consumers to visit our one-stop-shop flood insurance webpage, where we list insurers and agents selling private flood coverage in Pennsylvania.  After that, it’s a good idea to make some calls to see if a better deal is available for them in the private market.”

In the first year that the Pennsylvania Insurance Department flood insurance webpage included private options, nearly 3,300 policies were issued, which is more than double from previous years.

The NFIP was created in 1968 to provide flood coverage for high-risk properties and included significant subsidies for these properties.  Huge numbers of claims following Hurricane Katrina and Super Storm Sandy contributed to the NFIP falling $24 billion in debt, and Congress passing a series of laws that are phasing out the premium subsidies over time.  The potential impact of Hurricane Harvey in Texas and Louisiana could make this problem even worse.  As NFIP premiums rise to approach the cost of insuring the actual risk each property presents, the private market is entering the residential flood insurance market because it can now compete with the NFIP.

“Specifically, we need Congress to make private flood coverage that is comparable to the NFIP acceptable for federally backed mortgages.  Lenders need to know this insurance is good coverage and they should accept it,” Acting Commissioner Altman said.  “We also need Congress to require the NFIP to allow homeowners to switch to a private policy from an NFIP policy during the policy year, with no penalty, and receive a pro-rated refund of their NFIP premiums covering the remainder of the year.  Bottom line, if a consumer finds a better deal they should not be penalized for taking it.”

Altman encouraged state residents to contact their U.S. congressional representative and senators and ask them to include private flood coverage in their NFIP reauthorization bill.

Source: Pennsylvania Insurance Department.