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.


Department of Insurance Recovers Nearly $700,000 in Fines through Company Compliance Exams

Investigations result in discovery and correction of issues impacting consumers

The Delaware Department of Insurance’s Market Conduct Examinations resulted in the receipt of nearly $700,000 in fines during 2019 from more than a dozen companies found to violate the Insurance Code or other related regulations. The fines are contributed to the General Fund, providing funding for state programs and services and reducing taxpayer burden.

“As the state’s largest consumer protection organization, the Department of Insurance takes company examinations very seriously. We don’t just fine a company and move on, we work to ensure that corrective action is completed to improve products and consumer experience while reducing future infractions.” said Commissioner Trinidad Navarro.

The department works to provide remediation requirements to ensure compliance with the Insurance Code and related regulations for violations such as excessive charges, failure to distribute required notices, improper licensing, failure to pay claims in a timely fashion, and other issues impacting consumers. Over 20 exams were completed by the department in 2019, and more than 55 are open or underway.

“It’s important that we emphasize that not all companies being fined are deliberately acting in bad faith,” said Deputy Commissioner Tanisha Merced. “Many companies are unaware of their violations before our team investigates, and act quickly to correct their actions and safeguard consumers.”

For example, LifeShield, whose financial penalty is pending, took immediate action upon release of the company’s examination, implementing positive changes for their customers, and their company as a whole. After thorough consideration, the company decided to cease issuance of new short-term medical insurance policies nationwide and engage a new administrator. It has also hired additional staff to mitigate the risk of future issues. While these actions will cost the company more than $100,000, there will be no impact to consumer premium costs.

“The Department of Insurance’s thorough review process shows how much they care for the wellbeing of Delaware residents, and we hope that our rapid response to their findings does the same,” LifeShield’s president remarked. “Compliance with laws and regulations is of critical importance to us, as is maintaining best practice as we seek to provide the products and services our customers want and need.”

The Department’s examiners conduct investigations of organizations and agents and participate in multi-state enforcement efforts to ensure the consumer safety of residents nationwide. While exams are conducted regularly, the Department also examines companies based on consumer complaints. When issues are discovered through the exam process, positive correction action, fines, and suspension of licenses can occur. In 2018, the Department collected $950,000 in fines. In some cases, where a company’s violations impacted individual customers, the Department will require companies to compensate residents directly.

The Department’s Market Conduct Enforcement Actions and Fines are available online as are all complete and final Market Conduct Examination Reports.

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Insurer Fined $487,000 for Selling Bogus ACA Health Insurance Policies

Commissioner Stewart: Beware of Non-compliant Plans

DOVER, DE  – Insurance Commissioner Karen Weldin Stewart today announced she has fined Companion Life Insurance Company $487,000.00 for numerous violations of Delaware’s insurance code, including misrepresenting its limited benefit and short term health insurance plans as compliant with the Affordable Care Act.

The fine results from a market conduct examination of Companion conducted earlier this year by Delaware Insurance Department examiners following numerous complaints from Delaware consumers. Companion, a South Carolina company, entered into a Stipulation and Consent Order agreement with the Department on November 2, in which the company admitted to multiple code violations, including failure to provide consumers with pertinent information relating to plan coverage and failure to conduct periodic audits of the operations of two third-party administrators employed by Companion.

The examination revealed that 242 Delaware consumers had purchased non-compliant plans from Companion. One hundred forty-five policyholders chose to terminate their plans, and Companion refunded premiums totaling $18,008.99. Some consumers chose to keep the policies as a stop-gap measure.

“Consumers have to be careful when choosing a health insurance plan online,” said Commissioner Stewart. “The different plans can be confusing and some do not comply with ACA requirements. Before you purchase a policy, please visit www.choosehealthde.com to connect with ACA-approved health navigators who can provide you with free help in picking a plan that’s right for you.”

A copy of the Stipulation and Consent Order and the Market Conduct Exam Report for the Companion matter may be found at http://delawareinsurance.gov/departments/documents/enforcement/actions.shtml.

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Commissioner Stewart Fines Three Insurers $114,500 for Market Misconduct

Dover, DE-Commissioner Karen Weldin Stewart fined the following companies a total of $114,500 during the second quarter of 2016 for violations of state insurance laws and regulations:

 

Name                                                                       Fine                                           Date
Bankers Life & Casualty Company                   $55,500.00                             4/27/2016
National Health Insurance Company               $25,000.00                             5/11/2016
USAA                                                                $34,000.00                             5/24/2016

The fines result from a market conduct examination of each company’s practices performed by the Delaware Department of Insurance. Details of the companies’ particular violations may be found in the Stipulation and Consent Order entered into by the parties and listed under “Consent Decrees” in the Enforcement Actions & Fines section of the Department website:
http://www.delawareinsurance.gov/departments/documents/enforcement/actions.shtml.
Click on the PDF link in the right-hand column to read each consent decree in its entirety. The market conduct examination report which provides the basis for the fines can be accessed by clicking on the company’s name in the left-hand column.
For more information, call the Department at 1-800-282-8611.
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For more information please contact Jerry Grant at 302-674-7303

Delaware Department of Insurance | www.delawareinsurance.gov | Main Office Phone: 302-674-7300