Commissioner Stewart Acts to Prohibit Health Insurers from Unlawfully Discriminating against Transgender Delawareans

DOI Bulletin Forbids Denial of Coverage, Benefits

Dover, DE – Insurance Commissioner Karen Weldin Stewart today issued a bulletin to all insurers doing business in Delaware prohibiting unlawful discrimination in the provision of health insurance coverage and benefits because of a person’s gender identity or  transgender status.

Domestic and Foreign Insurers Bulletin No. 86 states that “any blanket policy exclusion for gender dysphoria, gender identity disorder, medically necessary surgeries or other treatments related to gender transition or related services is a violation of the Unfair Trade Practices Act” as found in Title 18, Section 2304 of the Delaware Code.

Citing the Gender Identity Nondiscrimination Act, passed by the General Assembly and signed by Governor Markell in 2013, the bulletin specifically prohibits “the denial, cancellation, termination, limitation, refusal to issue or renew, or restriction, of insurance coverage or benefits thereunder because of a person’s gender identity or transgender status, or because the person is undergoing gender transition.”

“All Delawareans should have access to quality health care, regardless of their gender identity,” said Commissioner Stewart. “The Insurance Department will be vigilant in making sure all insurers comply with the law.”

The Department will take administrative or legal action against any insurance company licensed to do business in Delaware that fails to comply with the Unfair Trade Practices Act, as amended by the Gender Identity Nondiscrimination Act, or other State law.

Any transgender individual with a question or complaint should contact the Delaware Department of Insurance at 1-800-282-8611 or DOI_Consumer_Resource@delaware.gov .

The complete text of Bulletin No. 86 can be found at http://www.delawareinsurance.gov/departments/documents/bulletins/domestic-foreign-insurers-bulletin-no86.pdf?updated

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Sign Up for Health Insurance before January 31 or Pay Higher Penalty at Tax Time

 

Commissioner Stewart Urges People without Coverage to Enroll Now

Dover, DE – The open enrollment period for obtaining health insurance through Delaware’s Health Insurance Marketplace ends on January 31. If you want health insurance coverage to begin on February 1, you’ll need to enroll in a plan by January 15. If you enroll in a plan between January 16 and January 31, your health insurance will not take effect until March 1, 2016.

Insurance Commissioner Karen Weldin Stewart reminds Delawareans who think they can’t afford health insurance that eight out of ten people who enrolled in Delaware received help paying for their insurance. Find out if you qualify for financial assistance now by going to www.healthcare.gov.

If you don’t have health insurance coverage in 2016 you’ll risk having to pay a federal fee at tax time. You’ll pay a penalty of either 2.5% of your income, or $695 per adult ($347.50 per child) — whichever is higher. You pay the fee when you file your federal tax return for the year you don’t have coverage.

After January 31, 2016, you can’t buy a health insurance plan for the rest of 2016 unless you have a specific life change — like having a baby, getting married, or losing other health coverage — that qualifies you for a Special Enrollment Period.

Are you ready to enroll? Consumers can find more details about the various plans and their related premiums and deductibles, as well as any potential premium subsidies they may be eligible for, at www.healthcare.gov. If you need additional help choosing a plan, there are free and local assistance available across the state to help answer your questions. They can also assist you with the enrollment process – find their contact information at www.choosehealthde.com.

Commissioner Stewart also reminds you that scam artists are active as enrollment deadlines approach, so be cautious if you purchase a health plan through a site other than www.choosehealthde.com or www.healthcare.gov. Other websites may offer plans that don’t contain the coverage benefits available through the Affordable Care Act.

Don’t forget, small businesses can apply for SHOP coverage for their employees any time, all year. Go to https://www.healthcare.gov/small-businesses/employers/

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Open Enrollment Starts Sunday for State’s Health Insurance Marketplace

Delawareans have 3 months to sign up for 2016 coverage to avoid penalty

WILMINGTON – Delaware will launch the third open enrollment period of its Health Insurance Marketplace on Sunday, ready to build on the success of the first two seasons in which more than 23,000 Delawareans enrolled in private health plans and activated their coverage.

Department of Health and Social Services Secretary Rita Landgraf joined County Executive Tom Gordon and Paul Reynolds from the Department of Insurance to preview the launch during an event Thursday at Absalom Jones Community Center.

Open enrollment for health coverage in 2016 runs from Nov. 1 through Jan. 31 on HealthCare.gov. Individuals must sign up by Dec. 15 for coverage to be effective Jan. 1. Policies for all current enrollees expire Dec. 31.

Individuals enrolled this year can renew their current plan or enroll in a different plan for 2016. While insurance companies will automatically renew many consumers’ coverage, individuals who bought a marketplace plan are encouraged to go to HealthCare.gov to update their household income and other personal information, review their current coverage, and check out the new plans among the 29 individual plans offered for 2016.

Secretary Landgraf said she is eagerly anticipating the start of the third enrollment season. “Beginning Nov. 1, more Delawareans who previously were denied coverage because of a disability or other pre-existing condition, or who thought health insurance was beyond their monthly budgets, will have the chance to join thousands of their neighbors who are enjoying the peace of mind and possibility of improved health that come with being covered.” She said one common misconception that people have is that tax credits won’t apply to them. Tax credits, which help to lower the monthly premium, are available for individuals making up to about $46,000 a year and for families of four with an annual household income of up to about $95,000.

Giving Delawareans access to health care is just a first step, Landgraf said. “Delivering quality care, producing better health outcomes, and reducing health care costs have always been at the heart of the Affordable Care Act. With the start of open enrollment we will take the next step toward a healthier Delaware.”

The Health Insurance Marketplace in Delaware for 2016 will include:

  • More choice: Individuals who are enrolling for the first time or re-enrolling will have more plans to choose from: 29 plans vs. 25 in 2015. Highmark Blue Cross Blue Shield, Aetna Health, and Aetna Life Insurance administer the plans. A dozen dental plans will also be available.
  • Health benefits that include coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, and pediatric services.
  • Rate changes: Individual-plan premiums will increase an average 22.4 percent for Highmark plans and less than 17 percent for Aetna.
  • Small business employers: Owners will have 15 SHOP (Small Business Health Options Program) plans to choose from for 2016 vs. 16 in 2015. Premiums will decrease 0.5 percent to 1 percent for Aetna plans and increase 12.7 percent for Highmark plans. Small business owners can enroll in SHOP at any time.
  • Federal tax credits that in 2015 helped to lower the cost of coverage for 84 percent of Delawareans who enrolled. Their average monthly tax credit was $260.
  • A new and improved ChooseHealthDE.com, Delaware’s official source of information about the Health Insurance Marketplace and connection to HealthCare.gov, the federal enrollment site. The new site, launched today, has a cleaner look and improved navigation. A penalty calculator will again allow visitors to see how much they could pay for going uninsured.
  • A higher penalty for going uninsured. Those who are not exempt and do not buy insurance for 2016 will pay $695 per adult (plus $347.50 for each child younger than 18 not covered) or 2.5 percent of their household income, whichever is higher.
  • Free in-person enrollment assistance from federally funded and trained specialists at several Delaware organizations, including Westside Family Healthcare, Chatman LLC, Henrietta Johnson Medical Center and La Red Health Center. State-licensed insurance agents and brokers also are available to assist individuals and employers with their enrollments. Go to www.ChooseHealthDE.com for details.
  • A faster, smoother and safer enrollment process on Healthcare.gov that includes new features such as a calculator that estimates total costs – deductible, co-pays, cost-sharing — based on the plan and a consumer’s expected medical needs; a simplified re-enrollment process; and a “privacy manager” that gives users more control over the information they choose to share.

About eight out of 10 current enrollees will be able to buy a 2016 plan with premiums less than $100 dollars a month after tax credits, and about seven out of 10 will have a plan available for less than $75 a month, according to the U.S. Department of Health and Human Services.

Those attending Thursday’s kickoff heard from Nancy Lemus, a 35-year-old woman from New Castle who has struggled to get health care for her and her son, Christopher, 10, who has cerebral palsy and dystonia, a movement disorder that causes debilitating spasms. Lemus, who works part-time jobs as a waitress and a nursing aide, said she is eager to explore her health insurance options through the marketplace.

Delaware’s senators and congressman urged uninsured Delawareans to find out what’s available for them on the marketplace.

“Over the last several years, I’ve had a chance to meet with Delawareans who found affordable health care and peace of mind through the health insurance marketplace,” Sen. Tom Carper said in a statement. “With open enrollment now underway, I strongly urge all uninsured individuals to go to ChooseHealthDE.com to get information about the various health insurance plans available and potential financial assistance they may qualify for to reduce their insurance costs. And because enrolling in health insurance can be overwhelming, there is free, in-person assistance available to help individuals and families. Every Delaware family deserves access to the quality health care they need, and the marketplace is making that a reality for thousands of Delawareans for the first time.”

Sen. Chris Coons reminded Delawareans to enroll as soon as possible. “It’s an important process and a right that all Americans have access to comprehensive health insurance that fits their needs, regardless of age, background, or pre-existing conditions.”

Added Congressman John Carney: “Next week begins another opportunity for Delawareans to get quality health care coverage that works for themselves and their families. While we still have a lot to do to improve on the quality and cost of health care, the marketplace is an important step that provides thousands with access to care. I encourage Delawareans to look at their options.”

Insurance Commissioner Karen Weldin Stewart said she is excited about the start of another open enrollment period. “I intend to keep working with my partners to make sure comprehensive health care is affordable for all Delawareans.”

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage though Delaware’s expanded Medicaid program, which is open year-round. More than 9,000 individuals have received coverage under the Medicaid expansion. To be screened for or to apply for Medicaid benefits, go to Delaware ASSIST.

For more information, go to www.ChooseHealthDE.com or call 1 (800) 318-2596, TTY: 1 (855) 889-4325. You can enroll in marketplace coverage directly at www.HealthCare.gov or through an agent or broker, always with no charge to the individual.

NOTE TO MEDIA: Photos from Thursday’s Delaware Health Insurance Marketplace Kickoff Event will be available for download beginning Thursday afternoon at DHSS’ flickr page.

For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office) or (302) 357-7498 (cell).

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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.


Insurance Commissioner Karen Weldin Stewart Releases 2016 Health Insurance Rates for Delaware Marketplace Plans

(DOVER, DE) – Insurance Commissioner Karen Weldin Stewart today released Delaware’s Qualified Health Plan rates for Plan Year 2016.  The Commissioner, after review, submitted her approved rates to the Centers for Medicare & Medicaid Services (CMS) in August. CMS has final authority on the rates. CMS concurred with the Commissioner’s recommendations and announced their approval on September 21, 2015.

 

It is the Commissioner’s duty to evaluate the reasonableness of rates to ensure rates are not excessive, inadequate or unfairly discriminatory.

 

The Commissioner recommended approval of a 22.4% rate increase in the individual market for Highmark Blue Cross Blue Shield of Delaware, a reduction of 3.0% from Highmark’s June request of 25.4%.  Highmark had made a second request in late August for an additional 8% increase, for an overall rate hike of more than 33% which the Commissioner rejected out of hand.

 

Aetna Life Insurance Company’s request for a 16% increase in the individual market was also approved. In the small group market, Highmark’s request for a 12.7% increase was granted, as was Aetna’s request for a 6.1% decrease.

 

“My actuaries took a hard look at Highmark’s submitted rate request, and we were able to reduce it by 3.0%,” said Commissioner Stewart. “But Blue Cross franchisees across the country are making requests for increases of 25% or more, claiming the Affordable Care Act has unleashed pent-up demand by persons who have not seen a doctor for years.  Regulators have been approving significant rate increases throughout the country.”

 

BCBS plans have requested rate hikes greater than 30% in Oklahoma, Tennessee and Minnesota.  Last month Blue Cross Blue Shield New Mexico pulled out of that state’s healthcare exchange when denied a 51.6% increase.

 

Commissioner Stewart said, “I’m continuing to meet with other insurance companies to persuade them to join Delaware’s Health Insurance Marketplace and increase competition. Insurers have been discouraged by our state’s high health care costs.” According to a 2013 Wall Street Journal report[1] on health care spending nationwide, Delaware ranks third-highest in prescription drug costs, fourth in the cost of physician and clinical services, and ninth in the cost of hospital care.

 

The Department of Insurance held public information sessions in each county in June to receive comment on the proposed rate increases. Written comments can be found at the department’s website. The department expects to post all of the rates on their website by October 15, 2015. For details visit the Health Insurance Rate Filings page, http://www.delawareinsurance.gov/departments/rates/ratefilings.shtml

 

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[1] JOURNAL REPORTS: HEALTH CARE Health-Care Costs: A State-by-State Comparison

By LOUISE RADNOFSKY, Updated April 8, 2013 4:00 p.m. ET, http://www.wsj.com/articles/SB10001424127887323884304578328173966380066

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For Immediate Release

For more information: Frank Pyle @ 302-674-7353

 www.delawareinsurance.gov | Main Office: 302-674-7300


Delaware Officials Gratified by Supreme Court Decision on Health Insurance Subsidies

NOTE TO MEDIA: DHSS Secretary Rita Landgraf will do a media-only call at noon today (12:00) to discuss the Supreme Court decision and what it means for Delaware. Call-in info: 302-255-2725/123147

Delaware Officials Gratified by Supreme Court Decision on Health Insurance Subsidies
Federal Tax Credits for More Than 19,000 Delawareans Will Not Change

NEW CASTLE (June 25, 2015) – Delaware officials are gratified by today’s U.S. Supreme Court decision to uphold federal tax subsidies for enrollees of Health Insurance Marketplaces in every state who are eligible for them, including the more than 19,000 Delawareans who receive tax credits to help pay for their coverage.

While the provision of tax credits will not change, Delaware officials said they would continue to do their due diligence in evaluating Delaware’s marketplace.

“I support today’s decision by the Supreme Court that tax subsidies on the Health Insurance Marketplaces are legal in every state, including Delaware,” Gov. Jack Markell said in response to the 6-3 decision in King v. Burwell. “For the more than 19,000 Delawareans who qualify, the federal subsidies are critical in helping to make health insurance more affordable. And we know that coverage is an important component in connecting Delawareans to care.”

Department of Health and Social Services Secretary Rita Landgraf said she is grateful that the 19,128 Delawareans who qualify for subsidies on Delaware’s marketplace will continue to receive monthly tax credits that average $265.

“For too many people, the federal subsidies are the difference between being able to afford access to care and not being able to afford that access. Or simply, the subsidies can be the difference between being insured or uninsured,” Secretary Landgraf said. “Protecting those subsidies has been and will continue to be one of our highest priorities.”

Delaware is a state-federal partnership state, which means that it is responsible for management and certification of the private insurance plans sold on the marketplace, along with assisting Delawareans in understanding their options during enrollment. To provide year-round information about the marketplace, Delaware officials created www.ChooseHealthDE.com. Under the state-federal partnership model, Delaware outsourced the information technology to the federal government through www.HealthCare.gov.

Because federal start-up funds ended after this year’s second year of enrollment, Delaware officials also are evaluating the long-term operations of the state’s marketplace. One option that officials are exploring is the Supported State-Based Marketplace (SSBM). Under this model provided by the U.S. Department of Health and Human Services (HHS), Delaware would be responsible for operating the marketplace, but would assess insurers a fee to sell plans on the marketplace and the state must pay a fee to the federal government to use HealthCare.gov and the Federal Call Center to facilitate enrollment each year. On June 1, Delaware applied for non-binding, conditional approval of a Supported State-Based Marketplace. HHS Secretary Sylvia Burwell granted conditional approval on June 15.

A final decision on any changes to Delaware’s marketplace will be made later this summer.

Nationwide, Delaware had one of the highest increases in enrollment between 2014 and 2015, with 25,036 Delawareans enrolling in 2015, up 74 percent over the 2014 enrollment of 14,397.

Enrollment for 2016 will begin Nov. 1 and run through Jan. 31, 2016. The penalties for not having insurance in 2016 will increase to $695 per adult ($347.50 for each child under 18), or 2.5 percent of your annual household income, whichever is higher.

NEWS FROM THE DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES

For more information, contact Jill Fredel, Director of Communications, (302) 255-9047 (office)
or (302) 357-7498 (cell).

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.