2022 Year-End Data Released By The Department of Insurance

Consumers continue to benefit from carrier expansion and insurer oversight

The Delaware Department of Insurance (DOI) has published its annual performance and productivity data, indicating continued success in serving consumers throughout the state.

“In the face of inflation, climate change, the pandemic, and other challenges, our priority remains the same: the residents of our great state. Sharing these statistics each year gives consumers a glimpse into DOI’s broad array of work,” said Insurance Commissioner Trinidad Navarro. “We’re expanding access to health insurance, fighting for affordable prescriptions, advocating for consumers in claims processing, and ensuring that carriers are complying with the law – and we’re not slowing down.”

DOI is made up of 98 employees, including 12 new team members. In 2022, the Department celebrated the internal promotions of 12 workers.

Commissioner Navarro’s national convenings to address the improper marketing of health plans have presented regulators with improved ability to address junk plans and other bad actors. The Department also made progress implementing healthcare affordability standards and increasing investment in primary care, while expanding options on the Health Insurance Marketplace and celebrating the largest enrollment in the state’s ACA history.

During the 151st General Assembly, DOI worked with legislators to pass about 20 DOI bills and engaged in roughly 50 others on topics ranging from consumer protection, to product affordability, to access to healthcare and medications.

Direct consumer assistance programs, such as those within the Delaware Medicare Assistance Bureau (DMAB) continued to report strong results, hosting 5123 one-on-one counseling sessions, and saving beneficiaries a combined $1.5 million. The Consumer Services Division managed over 3459 complaints and inquiries. Helping residents address claim settlement issues outside of court, the Legal Division reported 268 settled arbitration cases resulted in awards totaling more than $690,000.

On top of the sixth consecutive decrease in workers’ compensation insurance premiums, 1122 companies are saving a total of $6,977,337 on their costs through participating in the DOI’s Workplace Safety Program.

In Market Conduct, 5 completed insurer examinations resulted in $494,000 in fines, and 10 examinations are in progress. Almost 98,000 licenses were issued, and licenses total 204,748. Across all lines of insurance, more than 33,600 rates and forms were processed and approved.

The Bureau of Examination, Rehabilitation and Guaranty oversees the financials of 141 domestic companies that manage $768 billion in assets, and more than 2082 other companies operating in the state. They completed 31 financial examinations and have 34 exams in progress.

The Fraud Bureau received 525 insurance fraud referrals and tips resulting in a combined total of 15 substantiated civil and criminal violations of Delaware’s insurance fraud laws in addition to the collection of $9,488 in civil penalties.

The Captive Division welcomed a new Director while pursuing innovative licensing efforts and received 63 new applications. There are 730 captive licenses in effect.

View the 2022 Data Infographic

New Bulletin Provides Recommendations to Insurers During COVID-19

Insurers asked to waive prior authorization requirements, cease cancellations and nonrenewals due to missed or delayed payments

Insurance Commissioner Trinidad Navarro and the Delaware Department of Insurance today issued a bulletin with recommended actions for the insurance industry. Requests included asking health insurers waive all prior authorization constraints for lab testing and future treatment of COVID-19, and that insurers consider ceasing cancellations or nonrenewals of insurance policies due to nonpayment throughout the duration of the declared Delaware State of Emergency.

“The insurance industry has the opportunity to help tens of thousands of Delaware residents, businesses, and healthcare providers during this state of emergency,” said Insurance Commissioner Trinidad Navarro. “Waiving prior authorization requirements would help the entire healthcare system to run more efficiently and allow providers to focus on patient outcomes rather than paperwork.”

Prior authorization is a process that requires certain tests, medications, or other health services to be pre-approved by an insurance company before a medical provider serves an insured consumer, which can at times result in delays. Should prior-authorization be voluntarily waived by insurers, that would not mean that residents should not be in contact with their primary care provider prior to visiting a COVID-19 testing site.

The bulletin also asked insurance carriers to voluntarily freeze cancellations and nonrenewals of policies that might have otherwise occurred due to delays in payments through the duration of the state of emergency.

“Throughout Delaware’s State of Emergency, many companies have had to close or reduce their business, and employees have been laid off or fired as a result,” Commissioner Navarro explained. “After hearing from businesses and residents who were concerned about the choices they will have to make with limited finances, we ask insurers to help alleviate some of that stress and ensure that residents and business owners in this difficult situation can have the peace of mind that insurance provides throughout the duration of the emergency.”

Business interruption coverage will vary policy to policy, and some business interruption coverage may explicitly exclude viral infections. Companies are urged to review their related insurance policies and contact their insurance company with questions about coverage. Hospitality small businesses and nonprofits may be able to apply for no-interest loans from the Division of Small Business Hospitality Emergency Loan Program (HELP). Organizations can receive a $10,000 maximum loan per month for rent, utilities, and other unavoidable, non-personnel bills.

On March 18, Governor Carney’s updated State of Emergency Declaration waived certain telemedicine regulations to expand access to these services. The Governor clarified that residents do not need to see a provider in-person before receiving telemedicine services, and that if a Delaware resident is out-of-state, they can still receive telemedicine services. To increase availability of these services, out-of-state providers who are licensed to provide telemedicine in other jurisdictions will also be able to serve Delaware residents through the duration of the emergency declaration. Telehealth and telemedicine can be provided via phone, webcam, facetime, and a myriad of other easily accessible options, as the department recently reminded insurers via bulletin.

Department of Insurance March 20 Bulletin

National Association of Insurance Commissioner’s COVID-19 and Insurance Brief

Tweet this story

Delaware Issues RFP for Office of Value-Based Health Care Delivery

Delaware’s Department of Insurance is pleased to announce that it is actively recruiting for a qualified independent contractor to staff and run its new Office of Value-Based Health Care Delivery. The Office will assist the Insurance Commissioner and Delaware’s Primary Care Reform Collaborative in evaluating primary care accessibility and affordability statewide.

“Reducing health care costs in Delaware is a key priority of my administration,” said Insurance Commissioner Trinidad Navarro. “The team leading our Office of Value-Based Health Care Delivery needs to possess a high level of expertise in health care transformation and innovation. Together with the Primary Care Reform Collaborative, we intend to identify quantitative tools that will help increase the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.”

Earlier this year, members of the General Assembly passed Senate Substitute 1 for Senate Bill No. 116, in order to create the Office. The Office was a recommendation of the Primary Care Reform Collaborative, which is tasked with evaluating the high costs of care in Delaware. In the months since passage, the Collaborative has been working hard to develop recommendations to strengthen Delaware’s primary care system.

“The legislature’s consideration of pro-consumer bills has allowed us to continue to foster an environment where residents are prioritized over profits,” said Leslie W. Ledogar, Esq, the Commissioner’s representative within the working group. “The Office of Value-Based Health Care Delivery epitomizes that vision, and we are grateful for everyone who spent time working on this effort.”

The Request for Proposal may be downloaded from the Office of Management and Budget website. Applicant questions should be directed to the Department’s Regulatory Specialist Leslie W. Ledogar, Esq.

Delaware Receives Federal Approval to Establish Reinsurance Program for 2020

On June 20, Gov. John Carney signed enabling legislation (House Bill 193) moving Delaware a step closer to a reinsurance program beginning in 2020.

NEW CASTLE (Aug. 20, 2019) – The Department of Health and Social Services (DHSS) received approval today from the Centers for Medicare and Medicaid Services (CMS) for a 1332 State Innovation Waiver under the Affordable Care Act to create a reinsurance program beginning in 2020 as a way to reduce premiums by up to 20 percent in Delaware’s individual health insurance market.

Under Delaware’s reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone on the individual market will be reimbursed through an estimated $27 million fund. The fund will use a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. The Delaware Health Care Commission will administer the program.

Coupled with reduced rates already sought on the individual market in Delaware, the state expects a significant reduction in premiums for 2020. CMS authorized Delaware’s reinsurance program through 2024.

“We are grateful to CMS for approving Delaware’s 1332 State Innovation Waiver application that will enable us to establish a reinsurance program in our state,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “We expect that the reinsurance program will further stabilize the individual health insurance market and make premiums more affordable for Delawareans who need such coverage.”

“The number one complaint/comment we receive from consumers at the Department of Insurance is the high cost of health insurance, especially from those who are not eligible for tax credits,” Insurance Commissioner Trinidad Navarro said. “With this new waiver program, people who earn above 400 percent of the federal poverty level, small business owners, and those who are not covered by their employers will save up to 20 percent on their health insurance premiums in the individual market. My office will continue to work to seek any and all means to help make health insurance more affordable for Delawareans.”

The CMS approval was the final step in a months-long process that included a recommendation from a working group that included DHSS, the Department of Insurance, legislators and other stakeholders, enabling legislation approved by Delaware’s General Assembly in June and signed into law by Gov. John Carney, and public comment periods at the state and federal levels.

Delaware is the 11th state to receive CMS approval for a reinsurance program. A March 2019 analysis by health care consultant Avalere found state-run reinsurance programs reduce premiums by almost 20 percent on average in their first year.

In addition to reducing premiums on the marketplace, the reinsurance program will benefit anyone who buys coverage on the individual market, including people who are not eligible for coverage at their workplace, those who are too young for Medicare or make too much money to be eligible for Medicaid, young people who have aged off their parents’ plans, or those who are self-employed.

In 2019, about 21,000 people enrolled for coverage on Delaware’s Health Insurance Marketplace. Open enrollment for 2020 will begin Nov. 1 and run through Dec. 15. To learn more about the marketplace, go to ChooseHealthDE.com.

-30-

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

Clarifications on Medigap

August 13, 2019 – The Delaware Department of Insurance has received inquiries from Medicare eligible citizens concerning misunderstandings or misinformation they’ve received from some insurance agents and brokers regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As this act is rather complex, it has not been determined if consumers have been misinformed, or if they did not fully understand what was relayed to them by agents and brokers. The lack of complete understanding can have a damaging effect relative to decision making for Medicare beneficiaries or their caretakers. To help alleviate the situation, Commissioner Trinidad Navarro issued a bulletin to agents and brokers last month, clarifying the requirements of MACRA. Listed below are some of the highlights of MACRA.

Please read the following highlights to better understand how MACRA will change the availability of certain Medicare Supplement insurance plans, more commonly known as Medigap.

“Newly eligible” means individuals who turn age 65 on or after January 1, 2020 or first become eligible for Medicare due to age, disability or end-stage renal disease on or after January 1, 2020.
As of January 1, 2020, the sale of Medigap plans C, F and F High Deductible will be discontinued and no longer available for purchase by “newly eligible” Medicare beneficiaries.
“Newly eligible” beneficiaries who turn age 65 on or after January 1, 2020 or first become eligible for Medicare due to age, disability or end-stage renal disease on or after January 1, 2020 can purchase Medigap plans D, G or G High Deductible as a substitute for Medigap plans C, F and F High Deductible.
The discontinuation of plans C, F and F High Deductible will not affect you if you are currently age 65 or will be 65 before January 1, 2020.
The discontinuation of plans C, F and F High Deductible will not affect you if you first become eligible for Medicare due to age, disability or end-stage renal disease before January 1, 2020.
Individuals who were Medicare eligible before January 1, 2020 will still be able to keep their C, F or F High Deductible plans and will be able to repurchase those lettered plans on or after January 1, 2020.
Medigap coverage cannot be canceled and is guaranteed renewable as long as the policyholder pays the premium.
For more information about upcoming changes to Medigap, please visit https://insurance.delaware.gov/divisions/dmab/ or call the Delaware Medicare Assistance Bureau (DMAB) at 1-800-336-9500 to speak to one of our Medicare counselors.

###

The Delaware Department of Insurance protects Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.

Contact: Vince Ryan

Sr. Advisor to the Commissioner

Vince.ryan@delaware.gov

Office: 302.674.7303

Mobile: 302.387.7670