Seattle Children’s Hospital officially withdraws legal complaint

Seattle Children’s Hospital officially withdrew its legal challenge with the OIC on Sept. 5 after it reached an agreement with Regence Blue Shield to include some services in Regence’s health provider networks for 2014 plans.

Seattle Children’s Hospital initiated legal proceedings about a year ago when Premera, Regence Blue Shield and Coordinated Care decided against including the hospital and research facility in their medical networks because of cost concerns. Seattle Children’s argued the OIC shouldn’t have approved 2014 plans from the three carriers because they excluded the facility from their networks for routine pediatric medical care. The plans argued Seattle Children’s charges for routine pediatric medical care would drive up their costs; Insurance Commissioner Mike Kreidler sided with the plans in favor of “narrow networks” to be able to provide cost-effective services for consumers. No families who needed specialty pediatric care were turned away from Seattle Children’s or had to pay out of pocket for those services.

Seattle Children’s and Premera Blue Cross last month reached an agreement to include the hospital in its medical networks, effective Sept. 1. Coordinated Care earlier this year made a deal to include the hospital in its network and was removed from the case.  

OIC is in the process of reviewing 2015 plans that are sold outside of the Washington health benefit exchange. At the end of August, OIC approved 90 health plans for sale inside the Exchange, called Washington Healthplanfinder, with a record low 1.9 percent average rate change.

Pierce County woman ordered to repay insurance company for fraudulent car claim

A Pierce County woman was sentenced to 60 days of electronic home monitoring and ordered to repay $17,426 to Travelers Insurance for attempting to collect insurance money for a car she claimed was stolen and destroyed in a fire. Donica Santos, 40, pleaded guilty to one count of first-degree theft and one count of insurance fraud in Pierce County Superior Court last month.

In March 2012, a driver reported Santos’ vehicle was on fire on the side of Reservation Road in north Thurston County at about 1:40 a.m. on March 16, 2012. Santos reported to Travelers’ Insurance Co. later that day that her car had been stolen from her Tacoma home and was a total loss. Santos told investigators that she had last seen her vehicle the previous night and had not left her house or used her cell phone between 10:30 p.m. and 2:50 a.m., when police arrived at her house to investigate.

However, Santos’ cell phone records showed she used her phone repeatedly late the evening of March 15 and the early morning hours of March 16; several of the calls were made in Thurston County, near where her 2006 Chrysler 300C was found on fire. 

Travelers denied the claim, but was required by state law pay off the car loan balance of $17,426.

Santos was charged in December 2013 after she was investigated by Insurance Commissioner Mike Kreidler’s Special Investigations Unit.

90 health plans approved for next year's Exchange - find one in your area

Health plans and their rates for next year's Exchange, Washington Healthplanfinder were approved by our office and certified by the Exchange board this week.

Consumers shopping inside the Exchange will have 10 companies and 90 plans to choose from, depending on where they live. Not all plans are available in every county, but most people will have more choices and minimal rate changes.

Additional insurers and plans for sale outside of the Exchange are still under review. There may be more plans for sale outside of the Exchange, but premium subsidies are not available.

Open enrollment for inside and outside of the Exchange starts Nov. 15 and runs through Feb. 15, 2015.

Check out the map below to see the 2015 plans and rates available in your county.

ACA’s 80/20 rule saves consumers money

Created through the Affordable Care Act law, the 80/20 rule, also known as the Medical Loss Ratio (MLR) rule, requires health insurers to spend at least 80 percent of premium money on patient care and quality improvement activities or pay a rebate back to consumers.

This month, the U.S. Department of Health and Human Services reported that since the rule took effect, more insurers year over year are meeting the 80/20 standard by spending more of the premium dollars they collect on patient care and quality, and not red tape and bonuses. If an insurer did not spend enough premium dollars on patient care and quality improvement, they must pay refunds to consumers in one of the following ways:

• A refund check in the mail.
• A lump-sum reimbursement to the same account that was used to pay the premium.
• A reduction in future premiums.

If the consumer bought insurance through their employer, their employer must provide one of the above options, or apply the refund in another manner that benefits its employees, such as more generous benefits.

In 2013, 9,605 Washington consumers received refunds totaling $792,846, an average of $122 per family.

Read more about health care reform on our website. Questions? Contact our consumer advocates online or at 1-800-562-6900.

Temporary special enrollment for those stuck in Exchange plans begins today

A temporary special enrollment period begins today for those consumers who have experienced difficulties with enrollment in health plans on the Washington Healthplanfinder. 

Insurance Commissioner Mike Kreidler authorized the special enrollment period this week as another option to those who feel they might need more help. This voluntary special enrollment period starts Aug. 27 and runs through Nov. 14, 2014. Only people who attest to having enrollment, billing, or payment issues with an Exchange plan may change plans during this time.

If you’re considering this option, you should be aware of all of the details involved, including the fact that you could lose a current premium subsidy. Special enrollment may not be the best choice for everyone. But as the commissioner notes, “Hopefully, it will bring relief to some.”

 A list of answers to questions about this temporary special enrollment is available on our website.

Talk to your agent or broker about coverage for college students

Many college students are heading back to college or starting their college careers this time of year. In addition to outfitting students with laptops and dorm room supplies, parents may want to think about whether their students are covered by the right insurance policies. 

Insuring possessions

For students who live in a dorm, typically the parents’ homeowner policy will cover the student’s personal belongings while they are away. The same is true for college students who live at home. Some policies may have a dollar limit for off-premises personal property, so check with your agent or broker to find out what your policy covers.

If the student is renting an apartment or house, it’s worth looking into renter’s insurance. If you have a roommate, read our blog post from earlier this month: Living with someone? You may need your own policy to protect your belongings.

Auto insurance

Auto insurance policies typically don’t change once a driver goes to college, but it can’t hurt to check with your agent or broker if the car will be driven in another state for an extended period of time or, conversely, if the car will stay home while the student is in school and isn’t likely to be driven. You can also ask about any discounts they may have available for good grades or good driving records.

Health insurance

Under the Affordable Care Act, parents can keep children on their health insurance policies until age 26. Read more about health care reform for families.

OIC seeks Senior Financial Analyst to monitor companies

We are hiring a Senior Financial Analyst (Financial Examiner 4) in our Tumwater office to help us monitor the financial health of insurance companies. This position is in our Company Supervision divison and is responsible for monitoring the financial condition of insurers and other entities and taking timely action to help these organizations' financial health so they can fulfill their obligations to consumers. This position also supervises three financial examiners and fills in as acting Chief Financial Analyst, when necessary.

This position is open until filled. Read more or apply at careers.wa.gov.