Company corrections ordered and completed

Commissioner Trinidad Navarro has released a consumer alert for Liberty Mutual policyholders. In early December, the Delaware Department of Insurance became aware of unacceptable difficulties in contacting the company and filing claims by phone. The department ordered these issues corrected when discovered, and recently deemed the problems resolved.

Policyholders reported long wait times and dropped calls when contacting Liberty Mutual by phone, as well as an inability to connect with a live representative. The company’s system was also pushing consumers online to file a claim.

“The digital divide is still present in our state, and consumers must have access to claim filing processes by phone. A person’s access to the internet or technology should not define the level of difficulty they encounter in interacting with their insurer, or amount of time it takes to file a claim,” said Commissioner Navarro.

Liberty Mutual actively worked with the department to investigate the issues when they were uncovered and has now resolved the problems.

If you are a Liberty Mutual policyholder and you continue to encounter this issue, or if you are experiencing an insurance problem with another company, contact the Delaware Department of Insurance’s Consumer Services Division by emailing consumer@delaware.gov or calling (302) 674-7300.

Insurance Commissioner Trinidad Navarro highlights successes, resilience

The Delaware Department of Insurance published today a series of statistics outlining performance and productivity during 2020. These metrics show successes notwithstanding the pandemic and operational changes such as working remotely. These data have been shared visually in the Department of Insurance 2020 Year in Review infographic.

“Despite facing challenges including COVID-19 and natural disasters, our team showed resolve and resilience in serving residents over the past year. From conducting our first ever Mental Health Parity examinations, to returning $21.5 million in health premiums to residents and small businesses, to responding to thousands of consumer inquiries and complaints, the challenges of 2020 did not slow us down,” said Commissioner Navarro. “I couldn’t be prouder to lead a department that makes a difference every day.”

As COVID-19 arrived in Delaware, the department acted swiftly to ensure cost did not hinder residents seeking testing or care and prepared for the eventual vaccine. Over several months, the department kept in frequent contact with both insurers and healthcare providers, supporting the Governor and General Assembly in efforts to increase access to telemedicine and working with the Governor’s office on a temporary moratorium on policy cancellations as the economy adjusted. With the pandemic came increased scam attempts, and as chair of the National Anti-Fraud Task Force, Commissioner Navarro helped identify national trends in these efforts, while also serving on the Coronavirus Anti-Fraud Coalition locally. Throughout the year, the department’s fraud unit took on 545 cases, and joined the Healthcare Fraud Prevention Partnership.

Voices for change sang loud throughout 2020, and the department joined them, participating in the NAIC Special Session on Race and Diversity in the Insurance Sector, and the Special Executive Committee on Race and Insurance. In this group, regulators from across the nation are examining diversity and inclusion within the industry, engaging with stakeholders on these issues and how they impact access to the industry and insurance products, and analyzing the sector to find and correct processes that would disadvantage people of color either directly or by proxy.

In August, Delaware experienced multiple catastrophic storms. Tornadoes ravaged communities and homes, and the department arrived in those neighborhoods shortly after to talk to residents and assure them that assistance would be provided. 7,125 total claims were filed as a result of the estimated $10 million in damages caused by these events.

Throughout the year, the department’s Consumer Services Division managed 3,630 complaints, recovering $941,104 for residents. When the department could not solve claim complaints through contact with insurers, the arbitration team helped residents earn fairer settlements without having to go to court. 302 settlements put a total of $702,000 in the pockets of policyholders.

The Delaware Medicare Assistance Bureau (DMAB), which provides Medicare beneficiaries counseling and assistance with plan selection, enrollment, and any Medicare issues, quickly implemented virtual meeting options and held 24 total outreach education events. DMAB provided 5,118 one-on-one counseling sessions to residents, an increase over 2019 despite the lack of in-person events and meetings. The work of this team in assisting with the selection of plans saved beneficiaries $286,956 in premium costs.

While DMAB worked with Medicare beneficiaries, the department worked to decrease the cost of care for all residents while increasing accessibility, including through long-term efforts like regulating Pharmacy Benefit Managers and standing up the Office of Value-Based Care. Partly as a result of successes in creating affordability, $21.5 million was returned to health insurance marketplace policyholders and participating small businesses, as the insurer’s Medical Loss Ratio calculation showed they were spending less on health claims. For the second straight year, the department approved a decrease to Health Insurance Marketplace rates, and ultimately saw a 5% increase in 2021 plan enrollment.

In 2020, the department completed the state’s first Mental Health Parity exams. Thousands of violations were uncovered, resulting in $597,000 in fines as insurers worked to correct issues and create a less discriminatory environment in the future. In total, the Market Conduct Division completed 12 exams and one multi-state exam. Insurers were fined a total of $1.1 million, the most in recent years.

Commissioner Navarro’s approval of a rate decrease in Workers’ Compensation saved Delaware employers $4 million throughout the year. This fall, he confirmed the fourth consecutive decrease in rates, which will be an 11.56% decrease in 2021 loss costs and an 8.8% decrease in the residual market. Increasing safety in the workplace decreases accidents and helps these costs stay low, and the Workplace Safety Program engaged 1,083 participating companies, earning a total safety credit of $7 million on their combined total premium of nearly $66 million.

After being named a finalist for the International Captive Insurance Domicile of the Year, the Captive Division licensed 70 new captives in 2020, including 67 conditional licenses. To date, no other state has released data to indicate they licensed more captives than Delaware last year. The work of the captive division reduced taxpayer burden by contributing $1 million to the City of Wilmington and $2.9 million to the State of Delaware General Fund in Fiscal Year 2020.

The department licensed a total of 220,977 professionals, 37,885 whose licenses were processed by the department over the last year. The rates and forms team reviewed a total of 1,251 rates, forms, and advertisements related to life and health insurance, and 27,258 property and casualty submissions. Through the department’s participation in the National Association of Insurance Commissioner’s Life Policy Locator, $1.45 million was found and returned to beneficiaries.

The department’s milestone year began with an in-depth, months-long process of accreditation with the National Association of Insurance Commissioners (NAIC) inside the Bureau of Examination, Rehabilitation and Guaranty (BERG) and the department as a whole. While undergoing the arduous accreditation process, BERG also conducted 55 financial examinations of companies in 2020, with 56 exams currently in progress.

“Each year, people ask me what my priority will be,” said Commissioner Navarro. “But my answer is always the same: the residents of Delaware. We will continue to prioritize consumers each and every day, and we are proud to show such strong results after a challenging year.”

Department of Insurance 2020 Year in Review infographic

More ways to receive Medicare counseling and information as Open Enrollment approaches, Bureau earns federal grants to support efforts

When COVID-19 required cancellation of the Department of Insurance Delaware Medicare Assistance Bureau series of statewide Welcome to Medicare in-person events, the team responded rapidly, engaging with residents in new ways and offering their free, one-on-one Medicare counseling remotely. The Delaware Medicare Assistance Bureau (DMAB) has provided more than 2,930 counseling sessions so far this year, saving beneficiaries more than $192,000 in premiums through application assistance.

“We are all facing new challenges due to COVID-19, and I’m proud that our DMAB team has found ways to communicate with Medicare beneficiaries and made Medicare education and empowerment more accessible despite the inability to offer in-person events,” said Insurance Commissioner Trinidad Navarro.

DMAB will engage in thousands of counseling sessions in the coming months, as Medicare Open Enrollment takes place October 15 through December 7. During this time, beneficiaries can make changes to their health insurance coverage and review existing coverage against other options. DMAB will offer virtual Open Enrollment appointments throughout this period, available via Webex, Duo, and Skype, as well as by phone. Residents are encouraged to register for a MyMedicare.gov account prior to their counseling session so that DMAB can generate personalized plan comparisons.

“Many people have questions about Medicare and don’t know where to start, and COVID-19 has only increased the stress of choosing the right healthcare plans. We are here to help people in Delaware deal with the complex and often confusing health insurance system,” said DMAB Director Lakia Turner, “and, we’re more accessible than ever through our new virtual programs.”

DMAB began to offer virtual Welcome to Medicare seminars in May, engaging 150 residents. The Virtual Medicare Seminar, which is now available on-demand online, educates participants on topics including Medicare benefits, supplemental insurance policies, Medicare Advantage plans, prescription drug coverage and details on signing up.

As Medicare Open Enrollment approaches, the department reminds residents to assess any contact during the open enrollment period to ensure it is from a known, credible source. The most frequent fraudulent contact occurs by phone, but residents should review communications carefully.

“If you are receiving contact regarding Medicare that you did not initiate, or contact not from one of your healthcare providers, it could be fraudulent,” said Commissioner Navarro. “Protect your Medicare Number like you do your Social Security number or bank account information, and never give it out to unknown or unexpected callers.”

DMAB has been awarded two significant grants during 2020. The 2020 State Health Insurance Assistance Program Base Grant provides $234,293 in federal funds to DMAB. This is a five-year grant, with annually awards in April. It is a primary source of funding for marketing and outreach, counseling, developing and training the volunteer network, and other strategic efforts. The MIPPA 2020 Grant awarded the bureau $43,270, which has and will assist the bureau’s outreach, education, and one-on-one beneficiary assistance programs over the next year for those beneficiaries who are likely to be eligible for the Low-Income Subsidy program (also called “Extra Help”) or Medicare Savings Programs.

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. Counselors can assist with Medicare, Medicaid, Medigap (Medicare supplement insurance), long term care insurance, billing issues, prescription savings, and much more.

New regulations increase oversight of Pharmacy Benefit Managers

Excessive pharmaceutical costs are a concerning trend occurring across the nation, and today the Delaware Department of Insurance has finalized new regulations for Pharmacy Benefit Managers (PBMs) to proactively combat the issue. The regulations go into effect on August 11 as part of implementing HB 194, and come after extensive stakeholder discussions.

PBMs administer prescription drug plans for health insurers, large employers, Medicare Part D plans, and other groups, determining the list of medications that a plan will cover and the consumer costs of those drugs. These companies hold massive negotiating power and receive billions of dollars in rebates from manufacturers, but to date have widely not used their power to reduce the costs of medications and insurance. The new regulations from the Department of Insurance will begin an increasing level of oversight and transparency, allowing the department to investigate companies, require corrective actions, and to suspend, deny, or revoke a PBM’s registration if they are acting in violation of the Code.

“Increasing the affordability of prescriptions and healthcare increases their accessibility, creating a healthier Delaware. These steps towards regulating this multi-billion-dollar industry will save residents money, and could save residents lives,” said Insurance Commissioner Trinidad Navarro. “I want to commend Pharmacy Reimbursement Task Force co-chairs Sen. Sokola and Rep. Bennett, as well as Chair of the former Interagency Pharmaceuticals Purchasing Study Group Rep. Seigfried, for their passion and hard work towards these regulations and their inclusion of a diverse array of stakeholders throughout the process. Our work on this issue is just beginning, and we are grateful for your partnership.”

The Pharmacy Reimbursement Task Force and the former Interagency Pharmaceuticals Purchasing Study Group each demonstrated the General Assembly’s focus on lowering the cost of care, working on a range of issues surrounding protecting Delawareans from excessive medication costs, negotiating and lowering drug prices, and creating price transparency and corporate accountability.

“One of the most important things we can do as elected officials is work to keep prescription drugs affordable and accessible, particularly for our most vulnerable residents,” said Sen. David Sokola, D-Newark. “I’m proud of our work on the Pharmacy Reimbursement Task Force and proud to have helped develop regulations that will increase transparency around a little-known sector of our health care industry. These regulations from Commissioner Navarro and his team at the Department of Insurance represent a solid beginning to the work I look forward to continuing in 2021.”

The department and the General Assembly plan to work together to advance legislation regarding PBMs in the future. A related bill was proposed during this year’s session, but it did not advance due to the compressed legislative timeline during COVID-19.

“High prescription drug costs can debilitate a person’s finances, hindering how they save and plan for daily and long-term expenses. We owe it to consumers to fight for their best interests, increasing access and affordability to needed medications,” said Rep. Andria Bennett, who sponsored HB 194 to regulate PBMs. “Pharmacy benefit managers should put the consumer first, not profit. That’s why we fought to increase transparency and oversight: so Delawareans are not taken advantage of in such a vulnerable way. Commissioner Navarro’s regulation will provide even more transparency and comfort to our residents, and I thank him for his commitment to them.”

“Pharmacy Benefit Managers are companies that have, through the years, gained significant control over the supply, demand, and cost of pharmaceuticals – around 80% of the market – with little to no regulation at all. They are, in essence, governing both the cost and flow of medicines between people in need of medication and the manufacturer, health insurance company, community pharmacies, and the company providing medication benefits. This has led to higher costs for residents who don’t really have a choice in whether to pay for lifesaving medication,” said Rep. Ray Seigfried, a former Christiana Care senior vice president.

“My colleagues and I pushed HB 194 to require registration of all PBMs doing business in Delaware as a first step to reining in these managers. Commissioner Navarro’s regulations create standards such as having access to books and records of their operation, contract templates, and staffing. It provides the right to denial, suspension, or revocation. This order will provide the first step to begin opening the door to greater transparency. I thank Commissioner Navarro and his team for taking these important steps forward.”

Registration of Pharmacy Benefits Managers Regulation

Commissioner Navarro encourages caution in repairs, meets with community

Tropical Storm Isaias produced tornado activity, heavy rain and flooding, hail, and strong winds throughout the state, causing significant destruction in several Delaware communities. Insurance Commissioner Trinidad Navarro visited residents and assessed damage on Wednesday.

“While measuring the full extent of this storm will take time, we know one thing – we must come together as a community and support those that need to rebuild,” said Commissioner Navarro after touring Amberwood community in Bear, which saw extensive storm impacts, and speaking with those beginning the insurance claims process. “I understand the eagerness of every resident to clean up and make repairs, but I can’t emphasize enough the importance of contacting your insurance company first. Take photos of everything and do not make permanent repairs before working with your insurance adjuster. Make only necessary, temporary repairs to prevent additional damage. Save all documentation, pictures, and receipts.”

The Delaware Department of Insurance Consumer Services Division is working with residents who have questions or concerns about their insurance company’s actions, and can be reached at (800) 282-8611 or (302) 674-6227, or by email at consumer@delaware.gov.

Underscoring the importance of proceeding through the insurance claim and property repair process with caution, Commissioner Navarro highlighted the frequency of fraudulent activity after a storm: “Anytime we experience a big storm like Isaias, we see storm-chasing scammers pop up in neighborhoods, falsely stating they are with an insurance company, or encouraging homeowners to sign on to repair contracts without going through the proper channels – often price gouging residents, or completing shoddy repairs if they make any at all, leaving the consumer on the hook for costs that could have been covered by an insurer.”

Residents who encounter a storm-related insurance scam can contact the Fraud Prevention Bureau at (800) 632-5154 or (302) 674-7350, or email fraud@delaware.gov. Consumers are urged to carefully review contracts for home repairs, ask for references and research companies through the Better Business Bureau.

Consumers may contact the Delaware Emergency Management Agency, DEMA, to see what assistance may be available as a result of the Governor’s State of Emergency. Property insurance policyholders should be aware of the dwelling deductible stated on their insurance declaration page, and take note that there may be a deductible for named storms, wind, hail, or tornadoes that may apply to the claim, most often stated as a percentage of dwelling coverage.

Due to COVID-19 precautions, Department of Insurance offices are not currently open to the public, but residents are encouraged to contact the department at one of the emails or phone numbers above, or call (302) 674-7300 for assistance.