(Indianapolis, IN – Insurance News 360) – Tobacco users who are struggling to kick the habit may be able to get a bit of help from insurance companies, and the state is urging individuals to check with insurance companies and employers to learn about tobacco cessation options.

Since 2014, insurance policies in the state have been required to cover services and medications to assist tobacco users who want to quit.

All fully-insured plans issued after March 23, 2010 must cover screening and at least two quit attempts per year. These policies are available during open enrollment or during a special enrollment period with the assistance of an agent through the federal marketplace.

Each attempt to quit using tobacco offers four tobacco cessation counseling sessions (whether by telephone, in a group setting or individual counseling) and all FDA-approved medications aimed at tobacco cessation for a 90-day treatment when prescribed.

“Hoosiers seeking tobacco cessation services should check with their health insurance companies regarding coverage and the specific benefits included in their policies,” said Indiana Department of Insurance Commissioner Stephen W. Robertson.

The Tobacco Prevention and Cessation Commission has information on tobacco cessation programs around the state. Visit the state department of health’s website to learn more: www.in.gov/isdh/#

Source: Indiana Department of Insurance.

(Louisiana, LA – Insurance News 360) – On Sept. 1, Louisiana Insurance Commissioner Jim Donelon took control of the Louisiana Health Cooperative (CO-OP), following the issuance of an Order of Rehabilitation and Injunctive Relief by the 19th Judicial District Court. The CO-OP is a health maintenance organization (HMO) that had announced it would wind not offer coverage in 2016.

“Our on-site review and analysis of the Louisiana Health Cooperative’s operations led us to the decision that placing it in Rehabilitation is in the best interests of its policyholders and providers, as well as taxpayers,” said Commissioner Donelon. “We are convinced that the CO-OP, with the support of the Centers for Medicare and Medicaid Services (CMS), will have the ability to pay claims owed to health care providers and I am confident that we can more efficiently and successfully wind down affairs in a timely and equitable fashion.”

The CO-OP was placed into rehabilitation when the Louisiana Department of Insurance determined it would be best for policyholders, doctors and taxpayers for the CO-OP to wind down. CO-OP policies are effective through the end of the year and the order of rehabilitation will allow uninterrupted healthcare for policyholders and payments to providers. Policyholders will need to enroll in new coverage for January 2016 during the open enrollment period (Nov. 1 2015 to January 31, 2016). For a policy to take effect Jan. 1, policyholders must be enrolled by Dec. 15, 2015.

The Louisiana Department of Insurance will work with healthcare providers to ensure that payment is issued in a timely manner.

Additional information can be found on the LDI website at www.ldi.la.gov. Inquiries may be directed to LAHC@ldi.la.gov or to the Louisiana Department of Insurance Office of Consumer Services at 1-800-259-5300 or 225-342-5900.

Source: Louisiana Department of Insurance.

(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.