State Auditor Kathy McGuiness and Insurance Commissioner Trinidad Navarro Partner for a Fraud Town Hall

DOVER, DELAWARE – Delaware State Auditor Kathy McGuiness and Insurance Commissioner Trinidad Navarro together will host a virtual Fraud Town Hall via Facebook live on Wednesday, October 21, 2020 beginning at 3:00 pm.

The Auditor’s Office and the Department of Insurance want to jointly raise awareness of the types of fraud schemes both agencies regularly encounter and ways consumers can protect themselves from becoming victims.

“Over the past several months, we’ve seen an increase in fraud complaints brought on by the coronavirus pandemic,” said State Auditor Kathy McGuiness. “Our responsibility as a watchdog is to ensure proper safeguards and internal controls are in place to combat it.”

“As the largest consumer protection office in the state, the Department of Insurance reviews more than 525 fraud referrals a year, filing 531 civil and 15 criminal cases last year,” said Insurance Commissioner Trinidad Navarro. “With new technologies entering the insurance and healthcare arena, and Open Enrollment for Medicare and the Affordable Care Act taking place in the coming months, it is more important than ever that we work together to detect, prevent, and respond to fraud.”

Delawareans are understandably fearful of the repercussions from the health and economic crisis and rightfully want to know what their elected officials are doing to protect them from fraud and scams. The Fraud Town Hall will provide them answers.

Watch live at FB.me/DeTv302.

Learn about the Delaware Auditor’s Office and Department of Insurance online at https://auditor.delaware.gov and https://insurance.delaware.gov/.

Contact: Alaina Sewell, Executive Assistant, Alaina.Sewell@delaware.gov, 302-857-3931

 


$21.5 Million in Health Insurance Rebates for Individuals and Small Businesses

Thousands of Highmark 2019 plan participants and groups to receive checks

After announcing a reduction of Delaware Health Insurance Marketplace rates for the upcoming enrollment year, Insurance Commissioner Trinidad Navarro has more good news for residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Blue Cross Blue Shield Delaware plans outside of the exchange in the individual market, and for Highmark small group policyholders, announcing more than $21.5 million in rebates for 2019 participants.

“Now, more than ever, we need to make sure that every resident and small business can afford the health insurance they need for their families and employees. These rebates, combined with the ACA health insurance rate reduction for the coming year, do just that,” said Commissioner Navarro. “This is just one of many ways we are working to reduce the cost-of-care our residents experience in the health care system.

For the first time in the history of Delaware’s individual health insurance market, more than $12.6 million will be returned to 19,273 policyholders, with the average rebate being $656. Highmark small groups, often small businesses, will receive more than $8.8 million in cumulative return. 2,779 groups will receive an average rebate of $3,198, with more than 175 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September and checks for both individual policyholders and small groups will be sent the week of September 21. Those in the individual market with rebate questions can contact Highmark at 800-544-6679. Small group employers with rebate questions can contact their insurance producer, or Highmark at 800-241-5704.

These rebates are required by the Delaware Department of Insurance according to Medical Loss Ratio (MLR) measurements set by the Affordable Care Act, which are meant to ensure that insurers are spending a majority of premiums on health claims and clinical services, not taking those dollars for profit or administrative expenses. The rebate system creates balance when data shows that this ratio was off in a previous year. Not every policy will receive a rebate. MLR review for the 2020 plan year will shine a light on changes in insurance usage due to COVID-19 and will be released in 2021.

On August 31, Commissioner Navarro announced the Delaware Health Insurance Marketplace would see an average decrease in rates of 1% for individual plans. Highmark small group plans will see an average premium decrease of 3%.


Rates To Decrease In Delaware Affordable Care Act Marketplace

Second consecutive year of reductions in health insurance rates

In a year when the nation’s attention is firmly focused on healthcare and its costs, Delaware Insurance Commissioner Trinidad Navarro has announced another reduction in rates on the Delaware Health Insurance Marketplace. Despite insurer costs related to COVID-19 testing and treatment, Commissioner Navarro negotiated an average decrease of 1% in health insurance rates. Highmark Blue Cross Blue Shield Delaware, who offers the state’s Affordable Care Act health plans, initially submitted a reduction of 0.5%. The Commissioner’s final rate announcement comes after an independent actuarial review and public comments on the insurer’s proposal.

“I am proud to announce today the second consecutive rate decrease for Delaware’s Affordable Care Act plans. Amid a global pandemic, it is more important than ever for residents to have access to affordable insurance. Given the difficult economic climate, more people are relying on the Marketplace for the coverage they need,” said Commissioner Navarro. “With this decrease, we send a strong message about the effectiveness of the ACA during its 10th anniversary year. We will continue to fight to ensure access to affordable coverage for all Delawareans.”

In 2019, after successfully applying for a 1332 reinsurance waiver, the state was able to negotiate an average rate decrease of 19% for 2020 plans. This year’s modest reduction reflects market stabilization following the implementation of reinsurance.

After the rate reductions for the 2020 plan year, enrollment spiked by 6.3% during the traditional enrollment period. As of the start of the year, nearly 24,000 Delaware residents participated in marketplace-offered plans. While the federal government has not opened enrollment in response to COVID-19, residents losing employer-sponsored health coverage due to the economic impacts of the pandemic may qualify for special enrollment outside of the traditional enrollment period.

Open enrollment for the Marketplace takes place between November 1 and December 15 each year. However, residents may qualify to enroll or change plans based on special circumstances, such as a loss of qualifying health coverage, change of income, becoming a parent, and several other qualifying factors. Find out if you qualify for special enrollment.

The news of the second consecutive rate decrease comes as the department is implementing other consumer cost-of-care protection efforts, including regulating Pharmacy Benefit Managers to control and reduce medication cost, and continuing efforts to create an Office of Value-Based Healthcare Delivery to focus on primary care affordability and availability.

The proposed rate decrease does not apply to Medicare, Medicaid, or those with group or individual policies outside of the Marketplace.

More information on the rate review process


Trinidad Navarro Statement on Signing of Telemedicine Bill

Temporary codification of expanded telemedicine options helps all Delawareans

Today Governor John Carney signed, via livestream, HS 1 for HB 348, sponsored by Representative David Bentz, which temporarily codifies a number of consumer-friendly provisions developed during COVID-19 that can increase access to health care due to expanding telemedicine.

Insurance Commissioner Trinidad Navarro issued the following statement:

“In response to the unprecedented times we are facing, Delaware residents have been fortunate to have numerous consumer- and provider-friendly provisions enacted over the last several months with the leadership and the support of the Governor, General Assembly, DHSS, medical provider groups, insurers, and our office. Together, we have increased remote access to healthcare, ensuring that those concerned about visiting facilities in-person do not need to do so during coronavirus.

Delaware has long been a leader in telemedicine – as of December 2019, we were one of only ten states that required private insurers to reimburse virtual visits at the same rate, and with the same freedom from restrictions as in-person visits. Now, states across the country are following our lead in creating consumer- and provider-friendly laws like ours.

While I don’t manage the professional regulation components regarding what types of tele-communication are allowable, I am so happy to see that HS 1 for HB 348 will allow for phone-based visits to further assist rural residents and those that fall into the technological divide in accessing care.

Telemedicine isn’t a solution specific to the pandemic – it helps people in areas without local providers, those with limited access to transportation, individuals with disabilities – even parents who would have to find childcare to go to an in-person appointment. Telemedicine helps everyone, and it is here to stay. I look forward to working with the General Assembly next year to review our Code and develop permanent solutions.”

The Delaware Department of Insurance will be issuing a bulletin to the industry to inform them of the continued telemedicine requirements.


Life Insurance Policy Locator finds over $3.5 Million for Users

Over $1 million claimed by Delaware residents in 2019, More than $400,000 in early 2020

The Delaware Department of Insurance has released new data about local use of the Life Insurance Policy Locator, a free tool offered in conjunction with the National Association of Insurance Commissioners (NAIC). In total, 1,116 requests have been submitted, and 387 matches have been reported since the tool’s implementation – a match rate of nearly 35%. Throughout Delaware’s use of the tool, a total of $3,504,850 has been claimed by beneficiaries through located policies, and $1,071,516 during 2019 alone. In the first five months of 2020, residents were able to access $402,574 as a result of successful searches.

“The Life Insurance Policy Locator is a great tool for Delawareans to be aware of. When a loved one passes, there isn’t always a will or a detailed plan for the family’s future financially. Using the Policy Locator, it is easy to find out if a life insurance policy or annuity contract existed, and simple to claim the policy if there was one in place,” said Insurance Commissioner Trinidad Navarro. “This is just one of the many ways our department is offering a consumer-friendly insurance experience.”

Simplifying what can often be a long and frustrating process, only a nominal amount of information is needed to begin a search in the Life Insurance Policy Locator. After a request is submitted by a beneficiary, executor, or legal representative, dedicated NAIC liaisons take on the task of asking participating companies to search their records to identify any policies or annuity contracts in the name of the deceased. Then, if a participating company does have policy information on file, they will respond to the requester if they are authorized to receive information or are the designated beneficiary. Data is typically made available within 90 business days.

Delaware implemented the Life Insurance Policy Locator in November of 2016. Requestor preference and beneficiary specification may result in more matches than claimed policies.

Visit insurance.delaware.gov/services/missingpolicy to access the tool.