Regence to stop selling child-only policies in WA; Kreidler "appalled"

Here's a press release our office is putting out this morning:

Regence BlueShield, one of Washington state’s largest health insurers, intends to stop selling new policies for children in Washington under age 19 as of Oct. 1.

The decision followed days of discussions with Insurance Commissioner Mike Kreidler and his staff, who strongly objected to Regence’s decision.

“I’m appalled,” said Insurance Commissioner Mike Kreidler. “We’ve made regulatory concessions to limit Regence’s exposure. Their overreaction will seriously harm Washington families.”

As of Sept. 23, 2010, the federal Affordable Care Act requires many health plans to cover children’s pre-existing conditions. Kreidler’s office issued an emergency rule last week, allowing individual health plans to limit their risk by creating a special open-enrollment period from Nov. 1 – Dec. 15. During this time, parents can add their children to their individual plans without taking a health screen.

According to Kreidler, “A special enrollment period drastically limits the carriers’ risk and should more than address their concerns. By pulling out of this market, Regence just cut off vital coverage for working families.”

People still can buy individual plans from Regence for themselves and their families, but children only can be added between Nov. 1-Dec. 15. Anyone wanting to buy a health plan for just their child must choose a different health insurer.

Child-only policies are unusual in Washington state. Here, if you buy coverage for your family in the individual market, you’re issued one policy for the entire family. Family policies are not available in some states. There, people looking for family coverage must buy a policy for each member.

Regence Blueshield currently has 2,500 child-only policies in the state and they will remain in effect.

“So far, no other health carrier in Washington state has signaled its intent to leave this market,” added Kreidler. “I hope we can expect better from them.”

Parents looking for health insurance for their children can try the other health carriers in the individual market. Or, if they meet income qualifications, they might be eligible for Washington state’s Apple Health for Kids program. Coverage costs $30 a month per child for a family of four earning $66,150.

Congress gives federal flood-insurance program a one-year extension

The National Flood Insurance Program, which has repeatedly lapsed and been reauthorized by Congress this year, has gotten a one-year extension from Congress. The bill, S-3814, passed the House on Friday, and had earlier gotten the thumbs-up from the Senate. It now awaits the president's signature.

New federal health reforms start today

Beginning today, most health plans sold after March 23, 2010 must include several new benefits when they renew. These provisions, outlined in the federal Affordable Care Act, are designed to increase access to health care. Under the new reforms, plans cannot:

Charge out-of-pocket costs, including co-pays, deductibles and co-insurance, for preventive services.

Cap lifetime benefits.

Cancel or rescind a policy, except in the case of fraud or misrepresentation.

Refuse to cover a child’s pre-existing condition.

If the health plan includes a cap on essential benefits, it can’t be less than $750,000.

And young adults can be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.

However, there are some exceptions. Health plans sold before March 23, 2010, when the law was signed, are considered “grandfathered” and are exempt from some of these new protections.

For example, grandfathered individual health plans still can charge out-of-pocket costs for preventive services, cap lifetime benefits, and refuse to cover an enrolled child’s pre-existing condition. Grandfathered group plans (plans purchased by employers for their employees) still can charge out-of-pocket costs for preventive services.

Plans lose their grandfathered status if they significantly reduce benefits or increase deductibles, copayments, and/or an employee’s share of the premium.

Learn more about the fall reform here or see a general timeline of health reform.

U.S. Senate votes to re-authorize federal flood insurance program, insurers urging House to act quickly

The National Flood Insurance Program, which has repeatedly expired this year, only to be reauthorized by Congress for short stints, is slated to expire on Sept. 30. To prevent that, the U.S. Senate yesterday voted to extend the program through Sept. 30, 2011.

Insurers and insurance associations are now urging the House of Representatives to quickly do the same thing.

Congress created the program in 1968 as a way of getting a handle on the increasing public costs of providing aid to flood victims.

Many homeowners assume that flood damage is covered by standard homeowners coverage. It is not. The same is true for standard renters- and commercial property policies. If you want flood coverage, you have to specifically get flood coverage. (There's one exception to this general rule: comprehensive auto insurance coverage tends to cover flood damage to the vehicle.)

Flood insurance has been a major issue in south King County's Green River Valley, where the Army Corps of Engineers says there's a higher-than-normal risk of flooding due to weakness in an abutment to the Howard Hanson Dam. Work by the Corps and its contractors has dramatically reduced the risk of serious flooding (it was 1 in 3 last fall, now the Corps says its about 1 in 60), but we're still urging property owners and renters in the area to seriously consider getting at least the federal flood coverage.

For businesses, the federal coverage (capped at $500k/building and $500k contents) will not be enough. Many insurers stopped writing coverage in the area last fall. To help, our office has organized the Washington Flood Market Assistance Plan, which acts like a matchmaker between Green River Valley businesses needing coverage and insurers selling it.

The Insurance Information Institute has prepared a lot of flood-related information, including a list of major floods, how to prepare for a flood, what to do during a flood, and how to recover from a flood.

(Post modified 9/23 to add the info and a link for the state's flood Market Assistance Plan.)

How -- and why -- to become a "group of one"

In a couple of weeks, changes to Washington state law will make it easier for sole proprietors and some self-employed individuals to get affordable health insurance coverage.

The change involves small group coverage, which under state law in recent years has meant entities (such as small businesses) of 2 to 50 employees. They could qualify for health coverage in the small group market, which doesn't require a health screening.

One-person businesses, however, have had to seek coverage in the individual insurance market, where health screening is the norm and coverage can be hard to find (and expensive) for folks with pre-existing medical conditions.

By Oct. 1, 2010, however, state law will consider 1 person a "group" for insurance purposes. This means that sole proprietors, for example, will be able to qualify for the group coverage.

There are some provisions to ensure that the business is bona fide, however. In general, the law requires people to show that:

-they've been employed by (or run) the same business for at least the last 12 months,
-they've made at least 75 percent of their income (or 51 percent for agricultural businesses) from the business or trade.

The bill changing the law was Senate Bill 6538, prime-sponsored by Sen. Karen Keiser and co-sponsored by Sen. Cheryl Pflug. Similar changes to federal law have been approved by Congress and signed by the president -- they're included in the federal health reform legislation passed this spring -- but don't take effect until 2014.

To find out more, talk to your insurance agent or broker, or call us -- the Washington state insurance commissioner's office -- at 1-800-562-6900.

Note: This post was corrected to indicate that the federal changes don't take effect until 2014.

WA court ruling says that insurance value of property includes sales tax

Jason Anderson, a Seattle lawyer and longtime author of the Washington State Insurance Law Blog, has put up a post re: a recent Washington State Supreme Court ruling that "actual cash value" of insured property includes sales tax, even if the policyholder hasn't yet purchased replacement property.

The case involves a woman named Laura Holden, who had rental insurance when a fire struck the home she was renting. She had coverage with Farmers, including an extra endorsement for replacement cost coverage. The insurer didn't want to pay sales tax until after Holden had purchased replacement items; she said she couldn't afford to pay first and then wait for reimbursement. Click here for Anderson's blog post summarizing the case and the court's ruling, which reversed a lower court's decision.

While we're at it, we might as well mention that there's at least one other longtime regional insurance law blog, the Northwest Insurance Law Blog, written by lawyers in Seattle and Portland. Both summarize recent rulings in insurance law. (And our usual disclaimer applies: mentioning an entity on this blog ≠ endorsement. But you knew that.)

Small business fair coming up in Renton

More than 30 federal, state and local government agencies -- including us -- and business and trade associations are hosting a Washington Small Business Fair in Renton on Sept. 25.

Here's the slogan, which sums it up nicely: "One day, one place - learn what you need to run a small business."

Our folks will be there with specifics on business insurance, and can answer questions about a wide variety of other insurance topics as well.

The event is free, parking is free, and no advance registration is required. It's from 8 a.m. to 3:30 p.m. at Renton Technical College, 3000 NE 4th Street, in Renton. The fair offers dozens of seminars, covering things like how to start a startup, legal and tax issues, marketing and PR, government contracts, etc.

Here's the event's website, and here's its Facebook page.