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Around the PIA Western Alliance States

Posted By Administration, Wednesday, January 3, 2018

California — Job Deaths: The California Department of Industrial Relations (DIR) has finally tallied 2016’s job deaths. They number 376 and that’s down a few from the 388 in 2015. The other good news is the rate remains below the high average before 2008. It is now 2.2 workers per 100,000.

The national average is 3.6 per 100,000 up from 3.4. 

Also in the report:

  20% of workplace deaths in 2016 were from violence and other injuries caused by people or animals

  20% of workplace deaths were from transportation accidents

  One in six are from tripping, falling and/or slipping

  20% of the deaths are Latinos


Christine Baker of the DIR said, “Even one workplace fatality is too many, and our thoughts are with the families of those that died on the job last year. The fatality data released is a reminder that we must all continue our efforts to reduce workplace safety and health hazards in order to prevent worker deaths.”

Source link: Insurance Journal


California — Jones Announces State Farm/Aflac Settlement: Insurance Commissioner Dave Jones announced two multistate settlement agreements with State Farm and Aflac, as both agreed to use the Social Security Death Master File database to identify life insurance policyholders who have died and to also search for and pay benefits to their beneficiaries. State Farm agreed to a settlement of $250,000 and Aflac agreed to a settlement of $350,000.

"State Farm and Aflac have stepped up and done the right thing for policyholders," said Insurance Commissioner Dave Jones. "I urge other life insurers to follow the lead of the 30 other companies that have agreed to change their practices to benefit their policyholders and to use the Death Master File database to search for life insurance policyholders."

Insurance Commissioners for California, North Dakota, Florida, New Hampshire, and Pennsylvania have led the national investigation into life insurers' use of the Social Security Administration's Death Master File database, which came about after it was discovered life insurers used the database to their benefit to identify deceased annuity holders, so they could stop making payments to them, but failed to use the database to identify deceased policyholders so that benefit could be paid to their beneficiaries. The practice violated California's Unfair Insurance Practices Act and similar laws in other states.  

To date, state insurance regulators have either reached settlements or concluded the investigation of 30 of the top 40 companies, constituting 80 percent of the total life insurance market, based on market share. As a result life insurers have paid over $8.7 billion to life insurance beneficiaries nationwide and more than $890 million to California beneficiaries, alone.

To amplify efforts to match beneficiaries with life insurance policies, the California Department of Insurance and the National Association of Insurance Commissioners' (NAIC) launched the Life Insurance Policy Locator which has matched 583 beneficiaries in California with lost or misplaced life insurance policies or annuities-totaling over $11 million returned to consumers. The NAIC reported 8,210 beneficiaries nationwide have been matched with $92.5 million since the tool's launch last November.


Idaho — Medicare Supplement rule amended for beneficiaries under age 65: The Idaho Department of Insurance would like to remind Medicare beneficiaries who are under the age of 65 that they are eligible for a six month open enrollment period and may now purchase a Medicare Supplement (aka Medigap) policy as early as January 1, 2018. Medigap coverage can help pay some, or all, of the health care costs that original Medicare does not cover, such as copayments, coinsurance, and deductibles. During an open enrollment period, the beneficiary cannot be turned down for coverage. Beneficiaries under age 65 who already have a Medigap policy are also eligible for the open enrollment period, and may change policies without underwriting or denial.

Although the Medicare Annual Election Period ended December 7th, the Medicare Advantage (MA) Disenrollment Period, which is January 1 – February 14, may be an option for those wishing to leave their Medicare Advantage plan and purchase a Medigap policy. During the MA Disenrollment period, eligible beneficiaries switching from an MA plan to original Medicare will also have an opportunity to purchase a Part D plan by February 14.

The Department’s Senior Health Insurance Benefits Advisors (SHIBA) counselors are available to answer questions and provide information to all Idahoans who are eligible for Medicare coverage.  Consumers are also encouraged to consult with a licensed insurance agent before purchasing coverage.

Consumers with questions about this or other Medicare issues are welcome to contact SHIBA at 800-247-4422.


Montana — The Worst Drivers in the Nation: CarInsuranceComparison.com — for the third time in four years — says Montana drivers are the worst in the nation. They missed the designation last year but got that distinction in 2014 and 2015.

Montana drivers top the nation in failure to obey — failure to use safety restraints as well as driving with an invalid license and ignoring traffic signals — and are second in fatalities, fourth in drunk driving, sixth in speed and 29th in careless driving.

The website’s spokesman Josh Barnes said, ”All of our data is sourced from the National Highway Traffic Safety Administration because we believe using verified facts helps us determine the true worst state for driving.”


Here are the states with the worst drivers

10: North Dakota

9: Delaware

8: North Carolina

7: New Mexico

6: South Carolina

5: Nevada

4: Texas

3: Louisiana

2: Arizona

1: Montana


Source link: Billings Gazette


Montana — Wildfire Costs: The Bozeman Daily Chronicle says the wildfires that plagued Montana during the summer cost the state $240 million in spending by tourists. Over 800,000 fewer tourists visited the Treasure State.

The data comes from the University of Montana’s Institute for Tourism and Recreational Research who says tourists spent $3.3 billion this year and created over 53,000 jobs.

Those figures would have been much higher if not for the fires because for every 100 visitors to the state, nine cancelled trips this year because of the fires.

According to the institute’s report released Tuesday, both numbers would have been higher if it had not been for a series of summer fires.

Source link: Insurance Journal


Nevada — Elko Flood: Last February’s floods caused damage to neighborhoods in Elko. A suit has been filed by 60 residents of those neighborhoods against the city saying it is responsible for the damages.

The suit is $3.6 million.

It says the city’s participation in the relocation of the Humboldt River for Project Lifesaver is the cause. A study in 1992 said a levee on the 12th Street Bridge was inadequate.

“The City and Does knew or should have known that there would be instances, including weather events and run off, that would cause the Humboldt River to rise above the level of the culverts. The City should have known the snow pack, coupled with foreseeable and/or predicted weather events would raise the risk of flooding to southside residents unless the flood gates were properly installed and/or utilized within the storm drainage system,” the suit said.

Source link: Elko Daily Free Press


Oregon — From the Oregon Department of Insurance: The Oregon Division of Financial Regulation recently adopted the following rule:

ID 13-2017: Adoption of Valuation Manual for use in establishing principle-based reserves

Amend: OAR 836-031-0605

Amending to specify the edition of the NAIC Valuation Manual insurers must use when establishing principle-based reserves beginning January 1, 2018.

Filed: December 14, 2017

Effective: December 14, 2017

For more information, please visit the Division's website: http://dfr.oregon.gov/laws-rules/Pages/adopted-rules.aspx


The Oregon Division of Financial Regulation recently announced the following Proposed Rulemaking hearing:

Health carrier reporting requirements for alternative payment methodologies offered to PCPCHs

Adopt: OAR 836-053-1520

Establish health carrier reporting requirements related to alternative payment methodologies.

These rules are necessary to implement requirements of Chapter 489 of Oregon Law 2017 (SB 934) which require insurers participating in a national primary care medical home payment model, conducted by the Center for Medicare and Medicaid Innovation (CPC+), that includes performance-based incentive payments for primary care to offer a similar alternative payment methodology (APM) to all Patient-Centered Primary Care Homes (PCPCHs) that serve their members.

Filed: December 18, 2017

Public hearing: January 22, 2018, 10:00 a.m.

Last day for public comment: : January 29, 2018, 5:00 p.m.

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

For more information on this proposed rule, please visit the Division's website:



The Oregon Division of Financial Regulation recently announced the following Proposed Rulemaking hearing:

Primary Care Spending Reporting Requirements

Amend: OAR 836-053-0473

These rules are necessary to implement 2017 Or Laws ch 489 §5 (Enrolled Senate Bill 934) which requires carriers that spend less than 12 percent of total medical expenditures on primary care to submit with each rate filing a plan to increase spending on payments for primary care by at least one percent each plan year.

Public hearing: January 22, 2018, 10:00 a.m.

Last date for public comment: January 29, 2018, 5:00 PM

Filed date: December 18, 2017

The agency requests public comment on whether other options should be considered for achieving the rule's substantive goals while reducing the negative economic impact of the rule on business.

For more information on this proposed rule, please visit the Division's website:



The Oregon Division of Financial Regulation recently adopted the following rule:

ID 14-2017: Adopt changes to NAIC Models 205 and 312, quarterly and annual statement blanks

Amend: OAR 836-011-0000

Amending to specify the edition of the NAIC Valuation Manual insurers must use when establishing principle-based reserves beginning January 1, 2018.

Filed: December 20, 2017

Effective: December 20, 2017

Permanent Administrative Order

For more information, please visit the Division's website:



An open letter to the Portland-area health care community from Director Patrick Allen:

In recent days our partners at FamilyCare announced the company will close its Medicaid health plan at the end of this year due to financial problems. Like many people in the Portland area, I am disappointed FamilyCare is shutting its doors. FamilyCare’s decision stems from a protracted rate dispute between our organizations; however, we both worked hard to keep FamilyCare in the market in 2018.

My top priority is to protect Oregon Health Plan members during this transition. Today I’m pleased to announce FamilyCare accepted in principle our offer to extend their contract another 31 days to ensure a smooth transition for FamilyCare members.

FamilyCare is one of 16 coordinated care organizations, or CCOs, across the state. Coordinated care organizations link vulnerable, low-income Oregonians to effective services that improve health outcomes and lower health care costs. CCOs are private companies paid to deliver services to people on Medicaid. They are responsible for their own business decisions and costs.

Last week FamilyCare asked my agency to plan to transition its members to other coordinated care organizations. We are working with FamilyCare and other coordinated care organizations (Health Share, Willamette Valley Community Health and Yamhill Community Care) to arrange an orderly transition and keep members connected to the care they need.

I want all FamilyCare providers to know they should continue to treat and serve FamilyCare members without delay or disruption during this transition.

What the transition means for FamilyCare members and providers

If you are a FamilyCare member: You are still covered by the Oregon Health Plan and all of your benefits remain in place. Before Feb. 1, 2018, a coordinated care organization will be assigned to serve you. You can continue to see your current doctor and other health care providers. Your new CCO will honor FamilyCare’s prior authorizations, appointments (including transportation), procedures and prescriptions. You'll receive a letter with more information soon.

If you are a provider: Please continue seeing FamilyCare members per your current contract terms. You will be reimbursed for your services. Your patients’ new CCOs will work with you to transition care and pay for pre-approved services.

If you are a FamilyCare employee: I appreciate your commitment to your members and your track record of innovation. Health Share will be announcing job openings in the coming weeks and providing information about on-site job fairs..

OHA’s role in setting CCO rates

When I started at OHA in September, I brought an open mind and fresh eyes to my role. I had experience regulating commercial health plans. I was acutely aware of the difficult relationship between FamilyCare and OHA, and the mistrust on both sides. I told OHA employees I expected our agency to act with integrity, transparency and accountability. I looked forward to a different relationship with FamilyCare.

Like many people, my team and I asked questions about how CCO rates are set and whether FamilyCare’s rates are fair, unbiased and actuarially sound. We brought in two independent firms to evaluate OHA’s rates and the process the agency uses to set them. The independent reviewers confirmed Oregon's rate-setting process is unbiased, applies actuarially sound practices, and complies with federal law. We worked hard to address FamilyCare’s financial problems while respecting the integrity of a rate-setting process that must be fair across all CCOs and accountable to Oregon taxpayers.

I want to clear up some common misunderstandings about CCO rates. The rates are designed to provide CCOs the resources to give Oregon Health Plan members access to the care they need, deliver on 18 health outcome, quality and member satisfaction measures, and manage taxpayer dollars appropriately.

The rates are set based on an objective formula that’s consistent for all 16 CCOs and reflects the risks of the member population each CCO serves. CCOs do not negotiate their own rates with OHA, as health plans do in the commercial market. Rates are not based on a CCO’s unique costs and business model – it’s up to each CCO to adjust its business model to Oregon’s objective rate structure. Oregon’s rates must live up to our promise to the federal government and Oregon taxpayers to hold the growth of Medicaid costs to 3.4 percent or less each year.

I appreciate FamilyCare’s agreement to extend their contract and work together with OHA to ensure a more orderly transition for their members. I ask for the patience and support of all our partners as we undertake this change. I will keep you informed as we go through this process.



Patrick M. Allen

Director, Oregon Health Authority


The Oregon Division of Financial Regulation recently published the following Bulletin:

2017-07: Special enrollment period for individuals losing minimum essential coverage due to plan discontinuation


This bulletin clarifies the Division's expectations for the special enrollment of individuals who have experienced a loss of minimum essential coverage because their 2017 individual health benefit plan was discontinued.



The Oregon Health Insurance Marketplace has been working with the Centers for Medicare and Medicaid Services (CMS) to determine the appropriate course of action for individuals who were enrolled in individual health benefit plans that were discontinued on December 31, 2017. CMS has indicated that these individuals may qualify for a special enrollment period through HealthCare.gov.


The Division issues this bulletin to ensure fairness and equal treatment for all Oregonians enrolled in individual health benefit plans, both on and off the Marketplace.

Oregon Division of Financial Regulation Bulletin DFR 2017-07 -- links.govdelivery.com/ track type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTcxMjI5LjgzMDQwMzMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE3MTIyOS44MzA0MDMzMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3OTIxOTc0JmVtYWlsaWQ9Z2FyeXdvbGNvdHRAcGlhd2VzdC5jb20mdXNlcmlkPWdhcnl3b2xjb3R0QHBpYXdlc3QuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&100&&&http://dfr.oregon.gov/laws-rules/Documents/Bulletins/bulletin2017-07.pdf 

To read this and other bulletins, and to get more information, please visit the Division of Financial Regulation's Bulletins page at: http://dfr.oregon.gov/laws-rules/Pages/bulletins.aspx


The Oregon Division of Financial Regulation recently adopted the following rule:

ID 15-2017 (temporary): Standards and Process for Shortened Period of Market Prohibition

Adopt: OAR 836-053-0014

Summary: To establish standards for shortening the period of market prohibition for carriers that electively withdrew from a market within the state.

Filed: December 22, 2017

Effective: January 1, 2018 through June 19, 2018

Temporary Administrative Order -- links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTcxMjI4LjgzMDA0NzMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE3MTIyOC44MzAwNDczMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3OTIxNzkzJmVtYWlsaWQ9Z2FyeXdvbGNvdHRAcGlhd2VzdC5jb20mdXNlcmlkPWdhcnl3b2xjb3R0QHBpYXdlc3QuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&100&&&http://dfr.oregon.gov/laws-rules/Documents/id15-2017_rule-order.pdf


For more information, please visit the Division's website:



Washington — From the Office of the Commissioner: Geographic rating area rule stakeholder draft posted

We released a stakeholder draft for the geographic rating area rule (R 2017-11). This rule will revise the current geographic rating areas for individual and small-group health plans as established in WAC 284-43-6680 and 284-43-6700 in order to more accurately reflect the current risk pool.


We scheduled a stakeholder meeting to discuss the rule:

When: January 5, 2018, at 1:00 p.m.

Where: 5000 Capitol Blvd SE, Tumwater.

Comments on the stakeholder draft are due at 12:00 p.m. on January 5, 2018; please send them to rulescoordinator@oic.wa.gov.

For more information, including the text of the stakeholder draft, please visit the rule's webpage at https://www.insurance.wa.gov/adjusting-geographic-rating-areas-increase-market-stability-r-2017-11?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=


Kreidler Issues Fines

Last month, Insurance Commissioner Mike Kreidler disciplined and issued fines totaling $145,200 against insurance companies, agents and brokers who violated state insurance regulations.


Sears Roebuck and Co., Hoffman Estates, Ill.; fined $100,000, order 17-0037

Sears was a registered service contract provider in Washington state and was legally selling warranties to consumers. The insurance commissioner suspended the company’s registration in March 2016 because it didn’t fulfill its financial responsibility requirements according to state law. Effectively, the company’s net worth was too low to make the business financially viable. The commissioner issued the fine because the company waited 15 months to disclose its financial difficulty, a violation of state law. During the 15-month period, Sears sold 4,171 jewelry service contracts and 2,836 service agreements to Washington consumers. The company has since transferred the service contracts to its financially solvent company, Sears Protection Co., which is authorized to sell service contracts in Washington state.


Twin City Fire Insurance Co., Indianapolis; fined $30,000, order 17-0389

A consumer filed a complaint with the insurance commissioner when the company failed to bill the consumer for 2015-16, and then asked for the full year’s payment at once. The insurance commissioner asked the company to review its renewals, and the company determined it failed to provide renewal notifications of 92 policies on time. State law requires insurance companies to renew policies and notify consumers in a timely manner about their policy renewals and any premium changes.


Kaiser Foundation Health Plan of Washington, Seattle; fined $2,500, order 17-0181

The company was late in filing several health insurance rates for 2016.


Berkley Insurance Co., Wilmington, Del.; fined $4,000, order 17-0335

The company allowed 145 insurance producers’ appointments to lapse and allowed 29 of the producers to conduct 143 transactions totaling more than $525,108 in premiums. State law requires insurers to file a notice and pay a fee to the insurance commissioner for each licensed producer who will act as an agent of an insurer.


Gadi Binness, Montclair, N.J.; fined $250, order 17-0414

Binness failed to report an administrative action against her by the state of Virginia within 30 days, as required by state law.


Moving Insurance LLC, Upper Montclair, N.J.; fined $250, order 17-0415

The company, a licensed insurance producer, failed to report an administrative action against it by the state of Virginia within 30 days, as required by state law.  


Lisa Dobrus, Reno, Nev.; ordered to cease and desist, order 17-0421

The insurance commissioner ordered Dobrus to cease and desist from attempting to sell, solicit, or negotiate insurance in Washington without a license. Dobrus attempted to sell an insurance policy to a law firm without being a licensed insurance producer.


Far East Broadcasting Co., La Mirada, Calif.; fined $500, order 17-0422

The company, a registered charitable gift organization, failed to file its annual report by the Aug. 29 deadline.


Ralph Villavicencio, Kirkland, Wash.; fined $250, order 17-0408

Villavicencio, a licensed insurance producer, failed to report an administrative action against him by the Financial Industry Regulatory Authority within 30 days, as required by law.


Nicholas Wallace, Spokane, Wash.; fined $250, order 17-0407

Wallace, a licensed insurance producer, failed to disclose a felony conviction on his Washington state insurance producer license application. His application was processed after he paid the fine, and he’s currently licensed.


Ira Paul Green, Plano, Texas; probationary license issued, order 17-0406

Green, a licensed insurance producer, applied for a nonresident insurance producer license in Washington state and disclosed that he is repaying unpaid child support and back taxes. The insurance commissioner issued a probationary license until his taxes and child support are paid in full. 


Lighthouse Estimating and Ronald Shugar, Freeland, Wash.; ordered to cease and desist, order 17-0405

Lighthouse Estimating and Shugar acted as an adjuster without having an adjuster’s license. The insurance commissioner ordered both to cease and desist from acting as an adjuster in Washington state, effective immediately.


Albert Sterling Groff, Reading, Penn.; license revoked, order 17-0403

A Washington state consumer purchased what she thought was a long-term health plan and a dental plan that she could use in Washington and also while traveling. She later found out the policies were short-term and she would not be able to use them while she was traveling. Groff, a licensed insurance producer, signed the policies, which were not authorized to be sold in Washington state. The insurance commissioner revoked his license and he is no longer allowed to sell insurance in Washington state.


Stacey Scott, Seattle; fined $500, order 17-0401

State Farm notified the insurance commissioner that it terminated Scott’s appointment after she took money from an agency’s petty cash drawer on two occasions. Scott agrees to pay the fine and follow state insurance laws and rules to avoid revocation of her insurance producer license.


Michael Goldberg, Austin, Texas; fined $250, order 17-0397

Goldberg, a licensed insurance producer, failed to report an administrative action against him by the state of Texas within 30 days, as required by state law.


David Humphreys, Zillah, Wash.; fined $750, order 17-0393 and

Amber Lynn Humphreys, Zillah, Wash.; fined $500, order 17-0394

David and Amber Lynn Humphreys, a married couple, are licensed insurance producers and are both appointed to sell life insurance through Forethought Insurance. David sold a life insurance policy to a Washington consumer while his appointment with the insurer was suspended; his wife signed the policy as the insurance producer even though she never spoke to the consumer. Both producers’ actions violated state insurance laws.


Clifton Matthews, Puyallup, Wash.; fined $500, order 17-0396

Matthews, a licensed insurance producer, solicited and accepted a $25,000 loan from a client, a violation of state insurance laws.


Milan Uzelac, San Diego; license revoked, order 17-0390

Uzelac sold three life insurance policies to two Washington consumers prior to obtaining an insurance producer license. Later, he falsified the documents for two of the policies to make it look like he sold them in Oklahoma instead in Washington. He is no longer allowed to sell insurance in Washington state.


American Financial Associates, Inc., Easton, Wash.; fined $250, order 17-0344

American Financial Associates, a licensed insurance producer, failed to report an administrative action against the agency by the state of Oklahoma within 30 days, as required by state law. The agency didn’t respond to the insurance commissioner’s inquiries about the matter, so its license was revoked in August 2017. Later, the agency’s representative contacted the insurance commissioner to ask about getting its license reinstated. The agency agrees to pay a $250 fine and to follow state insurance laws to keep its insurance producer license.


BC Ziegler and Co., Waukesha, Wis.; fined $250, order 17-0345

The insurance agency failed to report an administrative action against it by the Financial Industry Regulatory Authority within 30 days, as required by state law.


Insurance Pro Agencies, Inc., Orland Park, Ill.; fined $250, order 17-0348

The insurance agency failed to report an administrative action against it by the state of Illinois within 30 days, as required by state law.


Pamela Roberson, Hutto, Texas; fined $500, order 17-0363

Roberson, a licensed insurance producer, failed to report an administrative action against her by the state of Louisiana within 30 days, as required by state law. She also failed to disclose a misdemeanor conviction on her 2016 insurance producer license application.


Abu Ameena Ward, Lakewood, Wash.; license revoked, order 17-0366

Ward, a licensed insurance producer, was terminated from Farmers Insurance for writing 51 fraudulent renter’s insurance policies that cost the insurer $32,904. Farmers referred the case to the insurance commissioner, and Ward is no longer allowed to sell insurance in Washington state. 


EDisability LLC, San Diego; fined $250, order 17-0281

The insurance agency failed to report an administrative action against it by the state of California within 30 days, as required by state law.


World Financial Group Insurance Agency, Oak Harbor, Wash.; fined $400, order 17-0283

The agency failed to get licenses for two of its Bellevue office locations.


Northwest Title, Bellevue, Wash.; fined $1,000, order 17-0338

The title company co-sponsored and publicized an event with Keller Williams Realty. Title companies are not allowed to co-sponsor events with companies that produce business for them.


Mark Vuchetich, Walla Walla, Wash.; fined $500, order 17-0294

A consumer filed a complaint with the insurance commissioner alleging that Vuchetich, a licensed insurance producer, sold her a universal life policy she did not need. The commissioner's investigation determined that Vuchetich didn't adequately review the consumer’s annual statement to determine the end date of the policy, thereby unintentionally misrepresenting the consumer’s policy and the benefits or advantages to the consumer.


Tasha Lynn McCoy, Selah, Wash.; fined $500, order 17-0376

McCoy, a licensed insurance producer, borrowed $2,000 from a friend who was a client. McCoy wrote a renter’s insurance policy for another consumer without the person’s knowledge or consent.


Kaiser Permanente, Portland, Ore.; fined $800, order 17-0379

The continuing education provider was fined for failing to use a proper attendance register, failing to submit an attendance roster within 10 days of course completion and submitting a roster that did not meet the completion requirements.

Tags:  Around the PIA Western Alliance States  Insurance Content  Insurance Industry  Insurance News  Weekly Industry News 

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