Major Cybersecurity Event Impacting Health Care, Pharmacy Operations

Delays impacting operations, including payments and insurance transactions

Earlier this month, one of the nation’s largest health care companies experienced a cybersecurity attack immobilizing much of the industry. Change Healthcare, a subsidiary of UnitedHealth Group that also operates as Optum Solutions, states that it interacts with 1 in every 3 patient records. Their systems are integral in many areas of pharmacy operations, provider claim processing, billing and cost estimation services, patient eligibility verifications, and other clinical decision supports.

On February 21, 2024, Change Healthcare locked their systems in an attempt to limit the impact of the cybersecurity attack discovered that day. The ongoing disruption has created adverse impacts for providers and pharmacies, generating delays for consumers, limiting the ability to process payments and consumers’ insurance, and requiring complex workarounds or movement to new systems. It is believed that the attack was completed by a foreign hacking group. Federal entities are involved in the investigation.

“The implications of this cyberattack are wide-reaching and not yet fully known. We hope that raising awareness of this issue will encourage consumers to be patient with any delays in clinical and pharmacy activities. Please know that all parties are working as hard as they can to continue operations despite this issue. If you are in urgent need of medication, or will be soon, please get in touch with your local pharmacy before visiting. You may need to use a different pharmacy, or plan to pay in cash,” said Insurance Commissioner Trinidad Navarro. “No timeline currently exists for resolution, and health care providers and pharmacies have been encouraged to remain disconnected from the impacted systems.”

Insurers have been in contact with the Delaware Department of Insurance about this issue and are in communication with contracted providers to inform them of available portals and processes. The Delaware Insurance Data Security Act has not yet been triggered, but all parties continue to watch the situation closely. Additionally, the department will be closely monitoring any potential prompt payment compliance issues that may arise as a result of this situation.

At this time, there is no indication that consumer data or insurer data has been impacted. However, consumers are still encouraged to engage in personal cybersecurity practices at an enhanced level. To protect from a cybersecurity attack, install anti-malware protection and use complex passwords that cannot be easily guessed. Do not click on suspicious links in emails or pop-ups, including those purporting to be from health care services, providers, insurers, and pharmacies. Residents might consider freezing their credit report to protect data.

View Change Healthcare’s Incident Page


Department of Insurance Releases 2023 Data

Another banner year for consumer protection and insurer competition

In 2023, the Delaware Department of Insurance’s 101 team members served Delaware residents and seniors, attracted new companies, oversaw expansions of coverage and enhanced competition, and contributed substantial funds to the state. Today’s data release details how each team contributed to Delaware’s strong insurance environment.

“Each year, our team gathers and reports data on our efforts to give residents a look at our daily work,” said Insurance Commissioner Trinidad Navarro. “And while the numbers themselves are impressive, within them are tens of thousands of stories. Stories of finding affordable coverage for the first time, stories of storms and fires, stories of injustice, investigation, and resolution, and above all, a story of change. Our state is changing, and our department is changing with it to ensure we continue to protect our consumers and offer them a robust, affordable, competitive insurance market.”

The year began with the announcement of a record-setting Open Enrollment on the Delaware Health Insurance Marketplace, where 35,000 residents got covered, and 6,000 were eligible for plans costing $10 or less per month. As recently as 2022, Delaware consumers only had one insurer and 12 plans to choose from – but during 2023 enrollment, they had four carriers and more than 50 plans offering coverage. Premiums in the individual market have decreased roughly 12% since 2019.

DOI welcomed yet another new carrier to the Marketplace in 2023, and indications are that enrollment for 2024 has again broken enrollment records with likely more than 40,000 enrollees.

Health insurance rates are submitted alongside affordability standards data to the department’s Office of Value-Based Health Care Delivery, which endeavors to support a robust, high-quality primary care environment. As a result of this work, annual primary care investment is projected at over $40 million, an increase of nearly $13 million or 44% year over year. This includes a projected $7 million in direct, prospective payments to more than 775 providers engaged in care transformation.

In addition to supporting healthcare providers, the work of the department also provides substantial funding to the state. For the 2023 calendar year, the department’s work resulted in about $189 million in funds for the state and its funds, including $113 million for the General Fund, and $44.7 million for fire companies.

Strong results were again reported by resident-facing programs. Consumer Services staff processed a total of 4,228 complaints and inquiries. The Medicare Assistance Bureau hosted and participated in 66 public events, and held more than 5,000 one-on-one counseling sessions. Medicare beneficiaries saved an estimated $2.08 million dollars because of the free assistance offered by this team, an increase of over half a million dollars from last year. Helping residents address claim settlement issues outside of court, the Legal Division reported that of 419 cases, 236 settled pre-hearing. Completed arbitration cases resulted in awards totaling more than $611,000. The department also moved to a new office in New Castle County, which offers much improved accessibility to consumers, while also saving the department over $200,000.

Delaware continued to be a national presence in insurance regulation, with Commissioner Navarro being elected Chair of the Northeast Zone of the National Association of Insurance Commissioners. His tenure chairing the National Anti-Fraud Task Force, and Delaware’s leadership on the Improper Marketing of Health Plans Working Group has resulted in improved coordination of efforts across states, and progress in the drafting of an improved model law related to producer licensing. Locally, the Commissioner and staff participate in numerous committees, including the Behavioral Health Crisis Services Board, Delaware Health Care Commission, Foster Youth Drivers’ License and Insurance Working Group, EARNs Board, Non-Acute Long Stay Task Force, Plans Management Board, Primary Care Reform Collaborative, Retiree Healthcare Benefits Advisory subcommittee, and the State Employee Benefits Committee (SEBC).

In 2023 the seventh consecutive decrease in workers’ compensation insurance rates was approved, a double-digit average drop of 13.85% in the residual market and 10.03% in the voluntary market. These lower rates are just one component of several department efforts to help businesses. Nearly 1,000 employers are saving even more on their premiums by participating in the department’s Workplace Safety Program, saving approximately $5.6 million on premiums through safety credits.

Market Conduct staff completed 61 insurer interrogatories, 72 Level 1 market analyses, and 5 exams including 3 introductory PBM examinations. 13 examinations remain in progress.

The most recent data available from the Bureau of Examination, Rehabilitation and Guaranty shows oversight of the financials of 149 domestic companies that manage $769 billion in assets, and more than 2,149 other companies operating in the state. This represents 8 new domestics, 76 new licenses, and an increase of one billion dollars in assets managed. The team completed 34 financial examinations and have 22 exams in progress.

The Fraud Bureau processed 631 referrals, closing 12 criminal cases with 44 charges. They collected $15,525 in civil penalties last year and closed 574 cases. 607 cases are open.
Life and Health staff reviewed 5,782 filings, rates, forms, and advertisements. The Property and Casualty team reviewed 26,915 filings, rates, forms, and rules. In addition, the department issued 57,216 licenses in 2023, bringing total licensees to 253,438.

This past year, the Captive Bureau announced the launch of Delaware Captives 2.0 in conjunction with the Delaware Captive Insurance Association to continue to innovate and compete with other domiciles. 43 new captives were licensed in 2023, for a total of 670 licensed captives.

The department led and engaged with dozens policy efforts with partners in the legislature. Legal staff processed 15 new bulletins and 10 revised or reissued bulletins, 5 new regulations, and 4 exempt orders to regulations.

Staff also participated in outreach events, including the Positively Dover African American Festival, Clayton Fire Prevention Open House, Dover Days, Down Syndrome Walk, Middletown Peach Festival, Milford Freedom Walk Festival, New Castle Ice Cream Festival, the 55+ Expo, and of course, the Delaware State Fair. In addition to robust contributions to the Delaware Employees’ Charitable Campaign, the Department also participates in charitable events including blood drives, food insecurity donations, and breast cancer awareness.


Delaware Launches D&O Guidance, Other Improvements to Foster Captive Industry Growth

Process and regulatory changes developed in partnership with the Delaware Captive Insurance Association

Insurance Commissioner Trinidad Navarro and the Delaware Captive Insurance Association (DCIA) are proud to announce a series of process and regulatory improvements intended to ensure Delaware remains a top domicile for businesses seeking to form captive insurance companies. The news was shared at DCIA’s Fall Forum last week, the premier event for industry leaders.

“As global leaders in captive insurance, we recognize that we must continue to explore improvement, innovation, and industry insight,” said Insurance Commissioner Trinidad Navarro. “This industry is an important economic engine in our state, and I look forward to continuing to foster its expansion.”

After robust stakeholder engagement, the department issued Captive Bulletin No. 14, which outlines the Bureau of Captive & Financial Insurance Products’ requirements for captives formed to write corporate “Side A” directors’ and officers’ (D&O) coverage for Delaware corporations. This progress was made possible by the passage of SB 203 (2022). It is expected that this will help companies access more affordable coverage and increase Side A D&O capacity.

The department also issued revised Captive Bulletin No. 12, adopting a more flexible approach for certain captive applicant’s capitalization requirements, including allowing use of brokerage accounts in certain circumstances. Additionally capital and surplus requirements have been recalibrated to place more emphasis on consulting actuaries’ adverse case projections.

Several process changes are anticipated to improve approval timelines and speed to market. Unless otherwise noticed, review of initial application filings will decrease from a goal of 45 days to 30 days. Conditional licensure applications typically see a significant spike toward the end of the year. Moving forward, those applications received after November 1 each year will be reviewed within 80 days of submission. All routine requests for approvals, such as dividends, business plan changes, statutory dormancy, and changes in approved service providers, will now be reviewed within ten days of receipt. Additionally, captives will now be able to seek contingent Bureau approval for actions requiring Board approval or ratification.

Michael Teichman, President of the Delaware Captive Insurance Association, said “Delaware has been a top global captive domicile since revamping its captive insurance statute almost 18 years ago. While we believe Delaware continues to have much to offer, we recognize other domiciles are not standing still, and we cannot rest on our laurels. Over the past year we have enjoyed the opportunity to work with Commissioner Navarro and Bureau Director Stephen Taylor to develop these helpful and timely domicile improvements.”

Captive insurance companies are owned by the entities that they insure and are usually formed by businesses to better manage the cost and administration of their insurance coverage. Delaware is the world’s fifth largest and the third largest U.S. captive domicile. It is one of four global domiciles recognized by the International Center for Captive Insurance Education as ICCIE Trained. To learn more, visit captive.delaware.gov.

The Delaware Captive Insurance Association is a Delaware non-stock not-for-profit corporation formed in 2005 to serve as the unified voice of the captive insurance industry in Delaware and to support the development and growth of the industry through marketing, networking, education, and legislative initiatives.


Navarro Announces Seventh Consecutive Workers’ Comp Rate Decrease

New rates will be effective December 1

UPDATE: Following a review of the Delaware Compensation Rating Bureau (DCRB) filing by independent actuaries and a public hearing with DCRB and the State’s Ratepayer Advocate, the final Workers’ Comp rates have been approved. Commissioner Navarro is proud to announce that additional decreases have been negotiated from the initial filing:
Residual Market: Average decrease of 13.85%
Voluntary Market: Average decrease of 10.03%

Insurance Commissioner Trinidad Navarro announced today that workers’ compensation insurance rates will decrease for the seventh year in a row, effective December 1, 2023.

“From the start of my administration to today, Delaware’s local businesses have never seen a worker’s compensation rate increase. We started with some of the highest costs in the country, and endured a pandemic, yet our reforms are still proving themselves to be effective. Most importantly, businesses are doing their part by committing to reducing risk through employee protections and creating safe work environments,” said Insurance Commissioner Trinidad Navarro. “I’m proud to announce yet another decrease, Delaware businesses deserve it.”

This year’s decrease in worker’s compensation insurance rates continues the reversal of voluntary and residual market trends. With the residual market expected to see a greater rate decrease, it shows that companies who previously could only obtain coverage in this ‘last resort’ market, due to cost, high risk, or claims history, can now obtain traditional voluntary market coverage. This is the second year of this trend, which indicates substantial improvement in coverage affordability and employee safety.

Workers’ compensation insurance provides coverage when an employee is hurt on the job and can provide medical coverage as well as payments for lost wages if a person is unable to work due to their injury. Lower premiums don’t change the amount of compensation an injured employee receives.

Final rates are expected to be announced later this fall, following a confirmation of the Delaware Compensation Rating Bureau (DCRB) filing by independent actuaries, and a public hearing with DCRB and the State’s Ratepayer Advocate. Actual savings will vary by policy.

These lower rates are just one component of several department efforts to help businesses. More than 1,100 employers are saving even more on their premiums by participating in the department’s Workplace Safety Program, saving approximately $6.9 million last year. Eligible businesses can earn up to a 19% discount on their insurance by successfully undergoing annual safety inspections and complying with recommendations. Importantly, employees may also benefit directly from employer-based safety goals – for example, a workplace may offer bonuses if there are no injuries in a given timeframe and pass on the savings to workers.

Businesses eligible for the Workplace Safety Program are notified each year seven months prior to their renewal date. Organizations interested in participating can access questionnaires online and contact safety@delaware.gov to begin the process. The department has updated the Inspection Fee Schedule for program participants, as indicated on the questionnaire. Workplace Safety Program inspectors are independent safety professionals contracted by the department, not state employees or OSHA. Only benefits can be gained by participating; failure to qualify cannot be the basis for premium increases or sanctions imposed by other safety officials.

View the DCRB website


Medicare Assistance Bureau: Open Enrollment Reminders

Free one-on-one counseling saved Delawareans $1.5M in 2022

As Medicare Open Enrollment approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information update. From October 15 to December 7, consumers can join, switch, or drop a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan. DMAB’s free, confidential, unbiased one-on-one assistance can help residents determine if making a coverage change is the right choice. In 2022, the team completed 5,123 counseling sessions, saving beneficiaries a combined $1.5 million.

When selecting 2024 coverage, there are important changes to keep in mind. Extra Help is expanding to offer full subsidy benefits to those up to 150% of the federal poverty level, allowing more people access to $0 premiums for coverage and fixed prescription copays. Additionally, those with Medicare Part D who fall into the catastrophic phase of their benefits will no longer have to pay 5% coinsurance for covered drugs during that period of coverage. And, on July 1, 2024, CMS will institute a new cap on Part B payment amounts for new biosimilars when average sales price data is not available.

2023 Medicare changes will continue into the new plan year. As of July 1, people with Traditional Medicare who take insulin through a traditional pump pay no more than $35 a month for their supply, and deductibles do not apply. Free vaccine coverage has expanded, and as of April 1 persons with Part B have lower coinsurance for drugs whose price increased faster than the rate of inflation.

“Delaware’s Medicare Assistance Bureau provides consumers with the education and empowerment they need to find the coverage they need at a cost they can afford,” said Insurance Commissioner Trinidad Navarro, who reminded residents to be smart shoppers this enrollment season.

“Part of being a smart shopper is knowing what to ask, and where to find trustworthy answers,” shared DMAB Director Lakia Turner. “There is no shortage of marketing during Open Enrollment, and bad actors may disguise themselves by offering information about changes for 2024. Our team can help you cut through the noise by answering your questions and identifying the best plan for your needs.”
In addition to scheduled phone and virtual appointments, DMAB is offering weekly appointments at all three Department of Insurance offices from October 17 to November 30:

  • Tuesdays from 9:30AM-3:00PM at 503 Carr Road, Suite 303, Wilmington DE 19809
  • Wednesdays from 9:30AM-3:00PM at 28 The Circle, Suite 1, Georgetown, DE 19947
  • Thursdays from 9:00AM-3:30PM at 1351 West North St., Suite 101, Dover, DE 19904

Top Tips for a Successful Medicare Open Enrollment

  1. Know that enrolling in a Medicare Advantage plan means it becomes your primary coverage. Original Medicare will no longer pay for services. You will receive a new ID card from the new plan, and should store your Original Medicare card in a safe place.
  2. When moving from Original Medicare to a Medicare Advantage plan, be prepared to pay both a monthly Medicare Advantage premium and a monthly Medicare Part B premium.
  3. Medicare Advantage plans do not automatically give you “more money in your Social Security check every month.” To qualify, you must be eligible for the Medicare Savings Program by having an income below Medicaid limits.
  4. Check that additional benefits, like dental, vision, hearing, fitness, or over-the-counter medications are actually accessible if offered. Some network providers of these services may be farther away than anticipated, including in neighboring states, so only factor them into your decision if you feel they are usable.
  5. Know that premium costs aren’t the only out-of-pocket costs you may face. Medicare Advantage plans may have co-pays or cost-sharing that differ from Original Medicare.
  6. Call your preferred healthcare providers and facilities to understand if your prospective plan contracts with them. You may experience additional out-of-pocket expenses, service denial, or referral requirements if providers are considered out of network.
  7. Check if a prospective plan is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). HMO plans require healthcare to be completed by a provider contracted with the plan’s network, otherwise the consumer will need a referral. PPO plans have both in-network and out of network providers and facilities, with consumer costs differing based on the network. HMO and PPO plans are not Medicare Supplement Plans, and may have out-of-pocket costs each visit.
  8. Check if the plan provides Prescription Drug (Part D) coverage that meets your needs.
  9. Be aware that in many cases, enrollment locks a person into a plan for the full upcoming calendar year.
  10. Scrutinize any contact carefully during Medicare Open Enrollment to ensure it is from a known, credible source. Commercials, cold calls, and other contact may be scams or can provide deliberately misleading information about a plan.

About the Delaware Medicare Assistance Bureau

The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more. DMAB has a Virtual Welcome to Medicare Seminar helpful for new and soon-to-be Medicare beneficiaries and those exploring enrollment changes.

The department does not manage benefits offered to state employees, pensioners, or spouses. While DMAB can counsel Medicare-eligible state plan members, questions about the state’s proposed Medicare Advantage plan or transition, they should first contact the Office of Pensions at 1 (800) 722-7300 and explore their online guide.

Medicare Advantage plans are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

Be aware of non-compliant alternative health plans