Monday, September 30, 2013

Five things you should know about flood insurance

1) Your homeowners policy doesn't cover floods. Flood damage is not a covered peril on standard homeowners policies and most commercial policies, although many people assume that it is. That can be a costly assumption.

2) You can get an estimate of your property's flood risk online with a "one-step flood risk profile."

3) You may have to have flood coverage. Mortgage lenders often require flood coverage if a home is located in a flood-prone area (also known as a "special flood hazard area.")

4) Most people buy flood coverage through the government. Flood insurance is widely available through the National Flood Insurance Program, which is run by the Federal Emergency Management Agency, or FEMA. There are limits, however, on how much damage they'll cover. Many local agents sell NFIP policies.

5) Rates may be going up. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which will change the way the National Flood Insurance Program is run. Among those changes: premiums will increase for some policyholders. That's being done to make the program more financially stable.

Wednesday, September 25, 2013

We're looking for a communications and social media manager

Please help us spread the word - do you know a communications expert who's looking for a new challenge? We're currently recruiting for a Public Affairs Communications and Social Media Manager.

This position reports to the Deputy Commissioner for Public Affairs and manages select agency-wide public affairs strategies and communication projects. It also oversees the agency's social media efforts, represents the agency as senior writer and editor on legislatively required reports and high-profile projects for the commissioner and is primary spokesperson for news media and stakeholder groups on agency administrative, civil and criminal enforcement actions.

Here's the full job announcement. Please share with anyone you think might be interested.

We're taking applications through Oct.8.

How to contact Washington's Health Benefits Exchange

Earlier this month, the Washington Healthplanfinder (our state's health insurance exchange) opened its toll-free hotline to start answering questions about health coverage options, how to access financial help and what you need to know about the Exchange's enrollment process. The phone number is 1-855-923-4633 or TTY/TDD 1-855-627-9604. They're available from 7:30 a.m. to 8 p.m., Monday through Friday.

The Healthplanfinder can also help you find other people -- a broker in your local community, say, or a nearby in-person assister -- to help you through the process. Click on the link or image above to find out more.

Friday, September 20, 2013

"I'm on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy"

Don't do it.

That's worth saying again: Do Not Do This.

Here's why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you're eligible for Medicare and will drop you.

Then, if you go back onto Medicare Part B, you'll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B.

And that's not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)

Wednesday, September 18, 2013

"I just got a letter from my insurer saying that I have to switch health plans because of Obamacare. What can I do?"

Tens of thousands of Washingtonians are -- or will be soon -- getting letters from their health insurers telling them that their plans are going away and that they'll need to pick a new one.
"In order to comply with the new health care law, your current health plan will be discontinued on Dec. 31, 2013," reads one of the letters, which are being sent out by about half a dozen insurers. "But don't worry. You have lots of options."
What's going on? Under health care reform, each health plan has to cover 10 essential benefits. Some of those benefits -- such as prescription drug coverage -- aren't included in many health individual health plans today. The new plans also have to include numerous preventive services, and meet standards for what they'll cover.

In some cases, those benefits mean that the premiums for the new plans will cost more, or that deductibles will be higher.

So what can you do?

1) Remember that as part of health care reform, many consumers will now qualify for subsidies to help offset costs. If your household income is less than 400 percent of the federal poverty level (e.g. $62,040 for a family of two, or $94,200 for a family of four), you may qualify for those subsidies. Also, expanded Medicaid coverage will be available -- for free -- for households that are at less than 138 percent of the federal poverty level ($21,404 for a family of two).

In other to get the subsidy, which is technically a tax credit, you would need to buy your health coverage through the Washington Health Benefit Exchange. Enrollment begins Oct. 1, with coverage starting Jan. 1, 2014. Here's a map with links to the rates for health insurance in the Exchange.

2) Shop around for a better deal. You do not need to stay with the insurance company you're with now, although that fact isn't necessarily trumpeted by the insurers in the letters they're sending out. So go on the Exchange -- you can still shop there, even if you don't qualify for a subsidy -- or check with a broker to see what else is available, and what it costs.

What if you have a pre-existing condition and have been turned down for health coverage in the past? It no longer matters. As part of health care reform, insurers must take all applicants. No more health screenings or questionnaires.

3) Remember that the premium is only part of the cost of insurance, particularly if you use the coverage. Your actual out of pocket costs are determined by how much of a deductible you have to meet, how much the co-pays or coinsurance charges are, what drugs are covered, etc. We calculate, for example, that the preventive care included in these policies without any copays, etc. is worth about $500.

"I was turned down for life insurance due to my health. Does this mean I can't get life insurance at all?"

Not necessarily. Different life insurers have different underwriting standards, so another company might insure someone with your health condition.

So try a different company, or try going through a broker, who might know more about which companies might be the best match for your individual situation.

Also, it's a good idea to check with your employer. Some employers offer some life insurance coverage (say $25,000 or $50,000) to their employees without requiring employees to answer health questions.

Tuesday, September 17, 2013

Pierce County man charged with insurance fraud and attempted theft

A University Place man, Leandre Garner, has been charged by the attorney general's office with felony insurance fraud and second-degree attempted theft for filing a bogus claim with State Farm.

On Nov. 8, 2012, Garner got coverage online with the company for his 2007 Chrysler 300. Prior to that date, the vehicle was uninsured.

On Nov. 9, 2012, Garner said, he returned home from an appointment and discovered that his car had been hit by an unknown vehicle. The damage was estimated at $4,339. Garner filed a claim.

The problem: half a dozen people subsequently told investigators from State Farm and our Special Investigations Unit that Garner's car was damaged well before November. His ex-girlfriend said it happened around September, not November. A nearby tenant, an apartment office worker and an apartment groundskeeper also said the accident happened well before Nov. 8. So did the body shop that did the estimate.

Asked if he'd taken photos of the damage, Garner showed a State Farm investigator cell phone images he'd taken. He was surprised when the investigator pointed out that the metadata embedded in the images showed that they'd been taken Sept. 19, 2012.

When asked about this, Garner said that the must be a problem with the phone.

Arraignment is scheduled for Pierce County Superior Court on Sept. 24, 2013.

Monday, September 16, 2013

"I heard I can keep my adult child on my health insurance until age 26. But do I have to?"

Q: I heard I can keep my adult children on my health insurance until they turn 26. But what if I don't want to?

A: Then don't. Health care reform permits -- but doesn't require -- parents to keep their adult children on the parent's health plan up to age 26, unless the children have coverage through their own employer.

That said, you may want to provide coverage if you can afford it. No one is immune from bad luck, and rates for medical care when a person has no insurance can be very high indeed.

Also: if your child doesn't have a job or has a job that doesn't offer health coverage, you may be able to extend your coverage to him/her more cheaply than they could buy an individual policy on their own.

Wednesday, September 11, 2013

Woman who pretended to be employer in lost-wage claim pleads guilty to insurance fraud

A woman who pretended to be an employer to help her son allegedly file a fake lost-wages insurance claim has pleaded guilty to insurance fraud.

Sherryl Rose Brongil pleaded guilty on Monday in King County Superior Court to one count of insurance fraud.

According to an investigation by State Farm and our Special Investigations Unit, Brongil's son, Larry Kwant, was accelerating out of a parking lot in her Cadillac when he lost control of the car and caused $26,000 in damage to it. He filed a claim, including 23 days of lost wages at $25 an hour. The form was signed by a "Linda Lee."

Linda Lee turned out to be Sherryl Brongil. Not only did she sign the form, purportedly showing that her son had worked at a company where he'd never worked. She'd also pretended to be administrative assistant "Linda Lee" when contacted by a claims adjuster.

She was sentenced to three months in jail.

As for Kwant, he's been charged with insurance fraud and identity theft.

Tuesday, September 10, 2013

Common questions about Medicare and health care exchanges

We've been getting a lot of questions about whether the new health care exchanges affect people on Medicare.

The short answer is no. If you have health coverage through Medicare, you don't need to do anything. It will not affect your coverage.

Among the other questions we're hearing frequently:

Do I need to re-enroll in my Medicare plan through the new health insurance Exchange?

Nope. Medicare's open enrollment is not part of the Exchange. If you are on Medicare, do not sign up for a plan in the Exchange.

Will I lose my Medicare coverage due to health reform and the Exchange?

No. Health care reform and the Exchange do not affect your Medicare coverage. You still have the same benefits and security you have now with Medicare.

Will people on Medicare be fined for not buying a health insurance Exchange plan?

No. In fact, it's against the law for someone who knows you have Medicare to sell you an Exchange plan.

Can I go to the Exchange and get a subsidy to help pay for my Medicare coverage?

Sorry, but no. If you're on Medicare, you're not eligible for the subsidies, which are for people buying coverage through the Exchanges.

For more questions -- including how the Exchange and Medicare work for recent immigrants, for those about to turn 65, etc. -- please see our new "popular questions about Medicare and the Exchange" web page.

Changes mean quicker responses to your insurance complaints

We've launched a new complaint response system that's speeding up the time between consumer insurance complaints and resolutions.

As Washington state's insurance regulatory agency and an advocate for consumers, we help with thousands of consumer complaints each year. Typical complaints involve wrongly denied claims, delayed payments and cancelled coverage.

The new online system, which is a secure link between our office and insurance companies we regulate, allows us to quickly get those complaints (along with our questions or concerns) to insurers. They'll look into the case and often reconsider their initial decision.

For years, largely in the interest of protecting complainants' private information, this process was handled by mail. Insurance companies were allowed 30 calendar days to respond to a complaint. 

The new online system is also secure -- and it's dramatically faster. Now insurers must respond electronically within 15 business days.

In other words, we've cut the time to process consumer complaints against insurers by more than 25 percent.

Got a complaint about your insurer? You can file a complaint online or call our Consumer Hotline 1-800-562-6900.

Friday, September 6, 2013

Insurance questions: Does my homeowners policy cover lightning?

In most cases, yes. Lightning is a covered peril in standard homeowners policies. Typically, both direct physical damage -- like burns, shattered windows, melted wiring -- would be covered. And if the lightning sets your home on fire, your fire coverage would also kick in.

How about lightning-caused damage to your electronics, like a TV or computer? Also typically covered.

And what about your car? If that gets hit by lightning, is the damage covered? Again, in most cases yes -- IF you have comprehensive coverage. (A man riding his motorcycle near Chehalis yesterday was struck by lightning, but is apparently doing well, other than a partly melted helmet. Really.)

Wednesday, September 4, 2013

Health care reform questions: Where can I get help?

Q: Will there be health care advocates for people who are not able to understand the complexities of the health care process? I have a family member who cannot work and is in dire medical need and struggling with doctor and drug costs. What help will they get from the health care reform?

A: Yes, there definitely will be advocates to help people navigate the complexities of finding the right health coverage. Health care reform includes a network of navigators and other people to help, and many insurance agents and brokers can help as well. Here's a list of the organizations that have received grants to provide in-person assistance here in Washington state.

Here in Washington state, you can sign up with the Washington HealthPlanFinder to be contacted by assistance staff within the first two weeks of October. They can answer your questions and help with enrollment in the exchange, if that's the best option for you. The coverage would start in January 2014.

In this particular situation, with your relative struggling today to pay for medical care and prescription drugs, feel free to give our consumer advocacy staff a call. They can walk you through the options, including free or low-cost medical, vision and dental clinics, help paying for drugs, and how to appeal when a health insurer won't pay for a treatment or prescription.

The hotline number is 1-800-562-6900. (Don't live in Washington state? Here's how to find your own state's insurance regulator.) You can also email us at

WA: Two more Exchange health plans approved for King, Pierce, Spokane counties

From a press release we put out this morning:

Media contact: Public Affairs (360) 725-7055

Kreidler settles with another health insurer – approves two more Exchange plans for King, Pierce, Spokane counties

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler has reached a settlement with Molina Healthcare of Washington, Inc. (Molina) and approved its two plans for sale in Washington’s Health Benefit Exchange, the Washington Healthplanfinder.

Consumers in Washington will now have 43 choices in the Exchange when open enrollment begins Oct. 1. Molina’s two plans will be available in three counties: King, Pierce and Spokane.

Previously, Molina only participated in the Medicaid market. Its approval to sell inside the new Washington Healthplanfinder guarantees Medicaid enrollees continuity of care and creates even more competition in the marketplace.

Molina was one of five companies Kreidler disapproved for sale in Washington’s new Exchange. Molina, Coordinated Care Corp., Kaiser, and Community Health Plan of Washington (CHPW) all appealed Kreidler’s decision. Molina later dropped its appeal, but reactivated it Aug. 29.

The reactivated appeal allowed a settlement. Specifically, Molina corrected information in its provider contracts to gain approval.

Kreidler began discussions with only those companies he believed could make the necessary fixes in time before the federal deadline of Sept. 5. Ten plans from Kaiser and Community Health Plan of Washington were approved Aug. 30.

The Executive Board of the Health Benefit Exchange is schedule to certify the final list of approved plans today at 1 p.m. It is scheduled to submit its final list to the federal government Sept. 5.

“I made the tough decision to disapprove some plans on July 31 because I didn’t believe they were good for consumers,” said Kreidler. “I’m pleased that we’ve reached a settlement with some of these companies to bring more quality plans to the Exchange and that consumers will be protected.”