Insurer Fined $487,000 for Selling Bogus ACA Health Insurance Policies

Commissioner Stewart: Beware of Non-compliant Plans

DOVER, DE  – Insurance Commissioner Karen Weldin Stewart today announced she has fined Companion Life Insurance Company $487,000.00 for numerous violations of Delaware’s insurance code, including misrepresenting its limited benefit and short term health insurance plans as compliant with the Affordable Care Act.

The fine results from a market conduct examination of Companion conducted earlier this year by Delaware Insurance Department examiners following numerous complaints from Delaware consumers. Companion, a South Carolina company, entered into a Stipulation and Consent Order agreement with the Department on November 2, in which the company admitted to multiple code violations, including failure to provide consumers with pertinent information relating to plan coverage and failure to conduct periodic audits of the operations of two third-party administrators employed by Companion.

The examination revealed that 242 Delaware consumers had purchased non-compliant plans from Companion. One hundred forty-five policyholders chose to terminate their plans, and Companion refunded premiums totaling $18,008.99. Some consumers chose to keep the policies as a stop-gap measure.

“Consumers have to be careful when choosing a health insurance plan online,” said Commissioner Stewart. “The different plans can be confusing and some do not comply with ACA requirements. Before you purchase a policy, please visit www.choosehealthde.com to connect with ACA-approved health navigators who can provide you with free help in picking a plan that’s right for you.”

A copy of the Stipulation and Consent Order and the Market Conduct Exam Report for the Companion matter may be found at http://delawareinsurance.gov/departments/documents/enforcement/actions.shtml.

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Commissioner Stewart: Beware of Unscrupulous Tax Preparers

Por favor, encuentre la traducción al español de esta nota de prensa debajo de la versión en inglés.

Dover, DE  – Commissioner Karen Weldin Stewart has received reports of tax preparers who are wrongly informing Delawareans without health insurance that they are subject to penalty payments under the Affordable Care Act (ACA). Some unscrupulous preparers actually tell clients that the payments can be paid directly to that preparer, who then pockets the money.

These reports follow a January 26 Internal Revenue Service alert warning that preparers are targeting consumers with limited English skills, primarily Spanish speakers. Undocumented immigrants, who may seek legal status in the future and are careful not to run afoul of the law, are particularly vulnerable to such a scam. According to the IRS, immigrants who are not lawfully present in the United States are actually exempt from the requirement to have health insurance, because they are not U.S. citizens.

In fact, most consumers are not subject to the ACA tax penalty, because they have already purchased coverage, are covered through their employer or Medicaid, or qualify for an exemption. A complete list of exemptions can be found at https: https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Exemptions.

Commissioner Stewart advises: “The IRS maintains a list of credentialed tax preparers at http://irs.treasury.gov/rpo/rpo.jsf. If you believe you do owe an ACA penalty payment, follow the advice of the IRS: the payment should be made only with your tax return or in response to a letter from the IRS. The payment should never be made directly to an individual or return preparer.”

The complete text of the IRS alert is below. Please note: the IRS refers to the ACA penalty payment as an individual shared responsibility payment.

 

Affordable Care Act Consumer Alert: Choose Your Tax Preparer Wisely
IRS Health Care Tax Tip 2016-10, January 26, 2016

The IRS urges you to choose your tax professional carefully in response to reports from last year describing unscrupulous preparers. In some cases, these preparers were instructing their clients to make individual shared responsibility payments directly to that preparer. In some cases, this was happening even though the taxpayer had Medicaid or other health coverage. Under this circumstance, the taxpayer didn’t need to make the shared responsibility payment at all. In some parts of the country, unscrupulous return preparers were targeting taxpayers with limited English proficiency and, in particular, those who primarily speak Spanish.

Most people don’t owe the payment at all because they have health coverage or qualify for a coverage exemption. However, if you owe a payment, remember that it should be made only with your tax return or in response to a letter from the IRS. The payment should never be made directly to an individual or return preparer.

Preparers who inappropriately ask for direct payment use a variety of invalid reasons that include:
• telling individuals that they must make an individual shared responsibility payment directly to the preparer   because of their immigration status
• promising to lower the payment amount if the client pays it directly to the preparer
• demanding money from individuals who are exempt from the individual shared responsibility payment

If you are not a U.S. citizen or national, and are not lawfully present in the United States, you are exempt from the individual shared responsibility provision and do not need to make a payment. For this purpose, an immigrant with Deferred Action for Childhood Arrivals (DACA) status is considered not lawfully present and therefore is exempt. You may qualify for this exemption even if you have a social security number.

If you believe you have been targeted by an unscrupulous preparer or you have been financially affected by a tax return preparer’s misconduct or improper tax preparation practices, you can report it to the IRS on Form 14157, Complaint: Tax Return Preparer.

You can use our Interactive Tax Assistant tool – Am I required to make an Individual Shared Responsibility Payment? to help determine if you qualify for an exemption or owe the payment.

Choose a Tax Preparer Carefully

The vast majority of tax professionals provide honest, high-quality service. However, the IRS encourages taxpayers to avoid dishonest and unscrupulous preparers by choosing their preparer wisely. To help, the IRS offers a new, online, searchable public directory of tax preparers who currently hold professional credentials recognized by the IRS or certain other qualifications.

For information on choosing a preparer, filing a complaint about an unscrupulous preparer, or using the new directory, see our “Choosing a Tax Professional” page on IRS.gov.

Find out more about the tax-related provisions of the health care law at IRS.gov/aca.

Using tax preparation software is the easiest way to file a complete and accurate tax return. Visit the E-File Options page on IRS.gov for information.

Subscribe to IRS Tax Tips to get easy-to-read tips from the IRS by e-mail.

IRS Health Care Tax Tip 2016-10, January 26, 2016

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Comisionada Stewart: Cuidado con los Preparadores de Impuestos Inescrupulosos

Dover, DE (Marzo 10, 2016)- La Comisionada Karen Weldin Stewart ha recibido reportes de preparadores de Impuestos que están mal informando a personas de Delaware sin seguro médico que corren peligro de multas bajo la Ley del Cuidado de Salud (Affordable Care Act). Algunos preparadores de impuestos mal intencionados  les informan a sus clientes que las multas se las pueden pagar directamente a ellos, y después se quedan con el dinero ellos mismos.

Estos reportes se han dado después de la alerta brindada por la Administración Federal de Ingresos Públicos (IRS por sus siglas en inglés) en Enero 26, advirtiendo que algunos preparadores están dirigiéndose a los consumidores que hablan poco inglés; sobre todo, aquellos que hablan español. Los inmigrantes indocumentados, que buscan legalizarse en un futuro y están siendo cuidadosos de no faltar a ley, son más vulnerables a este tipo de estafa. Según el IRS, los inmigrantes quien no residen legalmente en los Estados Unidos están en realidad exentos del requisito de tener un seguro médico, porque no son ciudadanos de los Estados Unidos.

De hecho, la mayoría de consumidores no están sujetos a pagar la multa bajo la Ley del Cuidado de Salud, porque ya han comprado cobertura, están cubiertos bajo su empleador o por Medicaid, o califican para una exención. Una lista completa puede ser encontrada en la siguiente página web: https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Exemptions

La Comisionada Stewart aconseja: “El IRS mantiene una lista de preparadores de impuestos acreditados en esta página web: http://irs.treasury.gov/rpo/rpo.jsf. Si usted cree que debe una multa bajo la Ley del Cuidado de Salud, siga el consejo del IRS: el pago debe ser hecho solamente con su declaración de impuestos o en respuesta a una carta de parte del IRS. El pago nunca debe ser echo directamente a una persona o a un preparador de impuestos.

El texto completo de la alerta del IRS puede ser encontrado abajo. Por favor tome nota: el IRS se refiere a la multa bajo la Ley del Cuidado de Salud como una responsabilidad de pago compartida individualmente.

Alerta de la Ley del Cuidado de SaludEscoja a su Preparador de Impuestos Sabiamente

IRS Health Care Tax Tip 2016-10, January 26, 2016 

El IRS urge a que usted escoja su preparador de impuestos cuidadosamente en respuesta a los informes del año pasado que describen preparadores de impuestos mal intencionados. En algunos casos, estos preparadores mal intencionados instruían a sus clientes que hagan pagos individuales de responsabilidad compartida directamente a ellos.

En unos casos, esto estaba pasando aunque la persona pagando impuestos tuviera Medicaid u otro tipo de seguro médico. Bajo estas circunstancias el pagador de impuestos no tenía por qué pagar ninguna multa. En unas partes del país, los preparadores de impuestos estaban enfocándose principalmente en los consumidores que hablan poco inglés, predominantemente los que hablan español.

La mayoría de las personas no deben ninguna multa porque tienen seguro médico o califican para una exención de cobertura. Pero si debe un pago, recuerde que debe ser hecho solamente con su declaración de impuestos o en respuesta a una carta de parte del IRS. El pago nunca debe ser hecho directamente a una persona o a un preparador de impuestos.

Los preparadores que inapropiadamente solicitan un pago directo utilizan una variedad de razones inválidas. Estas son algunas:

  • Le dicen a las personas que el pago de la multa bajo la Ley del Cuidado de Salud debe ser hecho directamente al preparador de impuestos debido a su estatus legal.
  • Prometen que se reducirá el monto del pago si lo hacen directamente al preparador de impuestos
  • Exigen dinero de personas que están exentas del pago individual de responsabilidad compartida.

Si usted no es un ciudadano de Estados Unidos ni nacionalizado, y no reside legalmente en los Estados Unidos, usted está exento de la multa bajo la Ley del Cuidado de Salud y no necesita hacer ningún pago. En este caso, un inmigrante con Acción Diferida para los Llegados en la Infancia (DACA) está considerado como una persona que no reside de manera legal en los Estado Unidos, por lo cual también está exento a pagar la multa. Es posible que usted califique para la exención aun cuando tenga un número de seguro social.

Si usted cree que ha sido víctima de un  preparador de impuestos mal intencionado o ha sido afectado económicamente por la conducta inapropiada de un preparador de impuestos, puede reportarlo al IRS usando esta forma: Form 14157, Complaint: Tax Return Preparer.

(https://www.irs.gov/pub/irs-pdf/f14157.pdf)

Puede usar nuestra herramienta interactiva de Asistente de Impuestos- ¿Estoy obligado a pagar la multa bajo la Ley Del Cuidado de La Salud para ayudar a determinar si usted califica para una exención o debe pagar la multa.

Escoja al Preparador de Impuestos Cuidadosamente 

La mayoría de los profesionales de impuestos proporcionan un servicio honesto y de alta calidad. Sin embargo, el IRS aconseja a pagadores de impuestos que eviten a los preparadores de impuestos mal intencionados y sin escrúpulos, escogiendo cuidadosamente a su preparador. El IRS ofrece un nuevo directorio público de preparadores de impuestos quienes actualmente tienen credenciales profesionales reconocidas por el IRS o ciertas otras cualificaciones.

Para obtener información sobre cómo elegir un preparador, cómo presentar una queja sobre un preparador sin escrúpulos, o cómo utilizar el nuevo directorio, vea nuestra página sobre la “Elección de un Profesional de Impuestos ” en IRS.gov

Encuentre más información sobre temas relacionados con los impuestos y la Ley del Cuidado de Salud en IRS.gov/aca

Usar un software de preparación de impuestos es la forma más fácil de presentar una declaración de impuestos completa y exacta. Visita la página de opciones de E -File en IRS.gov para obtener información.

Suscríbase a Consejos sobre Impuestos del IRS para obtener consejos y fáciles de leer de parte del IRS por correo electrónico.

IRS Health Care Tax Tip 2016-10, January 26, 2016

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Commissioner Stewart Announces That Non-Compliant Health Plans Cannot Be Extended in Delaware

Dover, DE–Delaware Insurance Commissioner Karen Weldin Stewart announced today that the recent Obama administration decision to allow for the two-year extension of health plans that are not compliant with the Affordable Care Act (ACA) does not apply to the state of Delaware, as per state law.

Commissioner Stewart stated, “Delaware law, as currently written, does not allow for the extension of non-compliant health plans after January 1, 2014. Furthermore, allowing the two-year extension of previously cancelled and non-compliant plans has the potential to raise premiums for everyone and could disrupt the market in Delaware.”

House Bill 162 with House Amendment 1 was passed in 2013 by the 147th General Assembly to bring the Delaware code into compliance with the ACA. The law applies to all individual and group health insurance contracts, as applicable, issued or renewed on or after January 1, 2014.

On November 14, 2013 the Obama administration provided insurers the option, if permitted by their state, to renew their current policies, for one year, for current enrollees without adopting all of the 2014 market rule changes. On November 25, 2013, Commissioner Stewart announced that an agreement had been reached with carriers to offer early renewals for cancelled or non-compliant policies that were to end on, or before, March 31, 2014.

Consumers that were affected by that agreement had until December 31, 2013 to renew their policy. Consequently, any individuals that renewed their policy for one year by December 31, 2013 will not be affected by this new announcement.

Commissioner Stewart further stated, “I would like to take this opportunity to remind consumers who do not have health insurance coverage that the open-enrollment period to sign up for a new plan will close on March 31, 2014. Individuals who do not have health insurance after this date may be subject to a tax by the IRS next year. Many individuals may qualify for subsidized plans through the Delaware’s Health Insurance Marketplace, Choose Health Delaware. Plans are also offered outside the marketplace but they are not eligible for federal subsidies to help offset the cost, if you qualify for assistance.”

Please note that the Delaware Department of Insurance does not run the state’s Health Insurance Marketplace, Choose Health Delaware. Individuals with questions about subsidies and plans offered through the marketplace should visit www.choosehealthde.com or call 1-800-318-2596.

For more information about health insurance please visit the Delaware Department of Insurance website at www.delawareinsurance.gov.

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Delaware Department of Insurance: “Protecting Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.”


Insurance Commissioner Stewart Announces an Agreement with Carriers in Delaware to Extend Cancelled Policies

DOVER – As a result of President Obama’s federal waiver, Commissioner Stewart entered into a dialogue with the health insurance carriers in an effort to provide earlier renewals of existing health insurance plans. The Commissioner is pleased to announce that an agreement has been reached with the carriers to offer early renewals for current policies whose term of coverage was to end on or before March 31, 2014. Commissioner Stewart is very concerned with individuals that may be in a position of being without any coverage as a result of the inability to renew these policies. Commissioner Stewart stated that she is, “very happy that the carriers have agreed to provide an early renewal opportunity for these policyholders.”

Consumers that are affected by this agreement and take advantage of this option must renew their policy on or before December 31, 2013. All policies with an effective date after January 1, 2014 must be in compliance with Delaware law. The carriers have indicated that individuals with questions regarding their policies should direct those questions to their agent or broker.

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DOI Seal
Delaware Department of Insurance Seal

“Protecting Delawareans through regulation and education while
providing oversight of the insurance industry to best serve the public.”

http://www.delawareinsurance.gov/

Contact: Marla Blunt-Carter
(302) 577-5259
Marla.Blunt-Carter@delaware.gov


Department of Insurance Reaches Tentative Agreement with One Carrier and Continues Discussions with Other Carriers to Offer Renewal Opportunities for Policyholders with Terminated Coverage

NEWS FROM THE DELAWARE DEPARTMENT OF INSURANCE
AND THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Department of Insurance Reaches Tentative Agreement with One Carrier and Continues Discussions with Other Carriers to Offer Renewal Opportunities for Policyholders with Terminated Coverage

DOVER– In order to assist individual and small group policyholders whose current coverage is being terminated between January 1, 2014, and March 31, 2014 because it is not compliant with the Affordable Care Act, the Department of Insurance has reached tentative agreement with one carrier and is in ongoing conversation with remaining carriers to provide opportunities for policyholders to renew their existing coverage.

Even those who had previously been offered this option and did not opt to utilize it will be provided an additional opportunity to renew the existing policy. While the details are still being developed, these offerings will not preclude the opportunity to enroll/purchase an ACA-compliant policy.

“I welcome today’s announcement as a significant step toward our goal of providing access to health care for all Delawareans,” said Rita Landgraf, secretary of the Delaware Department of Health and Social Services. “Making sure individuals and families are covered remains our priority, and this first tentative agreement will bring peace of mind to many state residents as they weigh their coverage options for the coming year. I thank our sister agency, the Department of Insurance, and representatives of the carriers operating in the state for their hard work.”

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Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

 

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