National Antifraud Task Force takes on new charges to protect consumers

Delaware Insurance Commissioner Trinidad Navarro, Chair of the National Association of Insurance Commissioners’ (NAIC) Antifraud Task Force, announced today the successful creation of the Improper Marketing of Health Plans Working Group, which aims to tackle some of the nation’s most serious consumer-centered health scam efforts and end the siloed approach to addressing the issue.

“Robocalls, search engine advertisements, mailers, and endless telemarketing efforts aim to steal from those seeking comprehensive health insurance. All across the country we have seen scam artists build out networks of communication that center around selling insurance plans that do not offer residents adequate protection. They are merciless in their efforts, and they trick consumers into thinking they will have the coverage they need for their medical care” said Insurance Commissioner Trinidad Navarro. “There’s no need to sugarcoat it – there is deception occurring, and its being directed towards some of the most vulnerable residents. COVID-19 rightfully increased consumer concerns and led more people to seek out affordable insurance – but this concern has been manipulated by scammers. This Working Group will make headway towards ending these efforts to exploit residents.”

The Working Group is a new approach to address concerning increases in consumers being marketed away from ACA-compliant plans to other products that do not offer comprehensive coverage for things like preexisting conditions or hospital visits. Many improperly marketed health plans claim to be compliant, or advertise under look-a-like naming that deliberately creates confusion, such as “Bidencare,” or “Healthcare.com.”

These products may be inadvertently found by consumers searching for legitimate coverage, or on websites where a fraudulent entity has purchased advertising. Often, a consumers’ inquiry can be turned into a request for a quote without consent, and contact information is sold to third parties. The plans use of lead generators and telemarketing is so pervasive that department investigators must purchase dedicated phones for their investigations due to the intrusive, rapid-fire robocalls and text messages that can mount to more than 40 per day from a single webform completion.

The Working Group has meet informally since March 2020 to create a comprehensive conversation on the issue, combining discussions that previously took place in separate health, market conduct, and fraud committees. State and federal level regulators have attended, discussing the latest bad actors and efforts in their jurisdictions, often finding that those efforts are echoed elsewhere. Movement of scams from state to state after regulators shut them down is one of the key reasons that regulators sought approval of the subcommittee and its charges by NAIC’s Executive and Plenary Committees.

“The formation of this Working Group can help stop scams before they start,” shared Delaware Special Deputy Frank Pyle, who has served decades in law enforcement, fraud investigation, and market conduct, and lends his expertise to the new subgroup as Co-Chair. “With greater communication between regulators, those who aim to exploit consumers should be scared. Running from state to state will not be an option.”

The Working Group’s official charges include:

• Coordinate with regulators, both on a state and federal level, to provide assistance to and guidance on monitoring the improper marketing of health plans, and coordinate appropriate enforcement actions, as needed, with other NAIC Committees, task forces, and working groups.
• Review existing NAIC Models and Guidelines, including laws and regulations, that address the use of lead generators for sales of health insurance products and identify models and guidelines that need to be updated or developed to address current marketplace activities.

“The Nebraska Department of Insurance is pleased with the official recognition of this group by the NAIC. When we started this group, our goal was to create open communication between all states and the federal government in order to identify and investigate these bad actors in the improper marketing of health plans. Today, that goal is achieved, but the work is just beginning. We will utilize this group to further investigations and prosecutions of those entities and strengthen our laws so we can protect the insurance buying public from these activities,” shared Martin Swanson, Deputy Director of the Nebraska Department of Insurance and Chair of the Working Group.

Following approval of the Working Group, regulators can now formally join the committee. Ad hoc virtual meetings have consisted of contributors from nearly every state, with meetings regularly engaging 100 to 300 participants. The Working Group’s members have already taken multiple administrative actions against entities and schemes identified by the group to protect consumers. Meetings are regulator-only.

The Working Group is part of the National Antifraud Task Force, which works with insurance regulators across the country, as well as local, state, federal and international law enforcement and antifraud organizations. The Task Force provides guidance and resources for insurance departments across the country and in the U.S. Territories, including tracking and analyzing trends in fraud. Numerous subgroups inform the Task Force’s work, including the Antifraud Education Enhancement Working Group and the Antifraud Technology Working Group.

More information about non-compliant health plans

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

DOVER, DE – The Delaware Department of Insurance, the National Association of Insurance Commissioners (NAIC) and the National Association of State Fire Marshals (NASFM) are teaming up to educate homeowners on a potential safety risk involving yellow flexible gas piping. The gas piping is known as corrugated stainless steel tubing, or “yellow CSST.”

“Homes with yellow CSST are at risk of perforation to the gas line caused by lightning strikes which could cause gas leaks or fires,” says Insurance Commissioner Karen Weldin Stewart. “If you are unsure as to whether your home has CSST or whether it has been properly bonded and grounded, contact a licensed electrician to arrange for a professional inspection.”

CSST is a flexible, stainless steel pipe used to supply natural gas and propane in residential, commercial and industrial structures. Coated with a yellow or occasionally black exterior plastic coating, CSST is usually routed beneath, through and alongside basement floor joists, inside interior wall cavities, and on top of ceiling joists in attic spaces. Although national gas codes and some building codes now require new construction and remodeling projects to reduce the lightning risk associated with yellow CSST, many homes built or remodeled after 1990, but before the codes changed, are still at risk.

If you find CSST after inspecting your home or business, it is strongly recommended that you determine if the CSST system is properly bonded and grounded. A bonding device should be installed on your natural gas system in order to reduce the chances of a natural gas leak or fire. Bonding is provided primarily to prevent a possible electric shock to people who come in contact with the gas piping and other metal objects connected to the grounding system. Nearby lightning strikes can also result in an electrical surge and can potentially puncture a hole in the CSST.

Please see the pictures of CSST below. Not all CSST piping looks exactly the same. More information and pictures can be found at www.csstsafety.com.

Examples of various CSST piping, which is most often covered with a yellow plastic or rubber casing. Some CSST comes with black casing.

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The Delaware Department of Insurance mission: Protecting Delawareans through
regulation and education while providing oversight of the insurance industry to best serve the public.

Delaware Department of Insurance | www.delawareinsurance.gov | 302.674.7300

More news from the Department of Insurance: http://www.delawareinsurance.gov/newsroom.shtml

Questions? Contact Jerry Grant at (302) 674-7303

Dover, DE – Complications within health insurance marketplaces have created challenges for some new enrollees who have not yet received proof of their insurance coverage. As a result, some consumers are unsure if their medical treatments are covered. If you recently purchased a plan, but still haven’t received proof of insurance from your insurance company, the National Association of Insurance Commissioners (NAIC) and the Delaware Department of Insurance have some tips for confirming coverage.

Since open enrollment began on October 1, insurance companies have encountered multiple problems that have prevented the companies from being able to enter new members into their systems. Some companies received incomplete or incorrect information from the insurance marketplaces. Other companies were overwhelmed with the number of applications they received and were unable to process them by the time the new plans went into effect. This delay in providing proof of coverage has many consumers worrying if they really have insurance and wondering what to do next.

Contact the Company
The first thing you should do is contact your insurance company to verify that you do have insurance coverage. Insurance Commissioner Karen Weldin Stewart stated, “The insurance company will be able to verify if you are indeed enrolled in a plan or not. Some people signed up for a plan but never paid the premium so be sure to discuss your payment. And, of course, ask your insurance company for proof of coverage, such as an insurance card or identification numbers. Many insurance companies have a website, which, after setting up your account, will allow you to print a temporary ID card.”

When you speak to your insurance company, take detailed notes of the conversation. Include the date and time that the conversation took place, and the name of the representative. Hold on to copies of any written communication you received from your insurance company such as emails or letters as you may need these materials later. You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage that is retroactively effective to January 1, 2014. Find out your insurer’s deadline and keep any records that can serve as proof of payment.

If you have yet to purchase coverage but are planning on buying insurance through the federal Health Insurance Marketplace, www.healthcare.gov, print out any paperwork or confirmations that you receive during the enrollment process. If you do not have a printer save digital copies of forms or take “screenshots” of any confirmation numbers or account numbers. It never hurts to e-mail those digital forms to yourself so you can access them from anywhere or in case something happens to your computer.

Payment Options
You may need to get a prescription filled or see your doctor before you receive your insurance card. Your provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If verification of coverage cannot be obtained, you still have options. One option is to pay for expenses out of pocket. Once your insurance coverage is established, your insurance company should reimburse you to the extent that the service or medication is covered under your policy. You may also be able to work with your doctor’s office, hospital or pharmacy to delay payment or set up a payment plan until they can verify that you’re insured. Keep your receipts and any bank statements that show that you’ve paid for the services. It can sometimes be easier to track purchases made with a debit or credit card as opposed to cash.

More Information
If you have questions about your health insurance options visit www.delawareinsurance.gov for more info and links. You can also visit Delaware’s Health Insurance Marketplace, www.choosehealthde.com. Individuals have until March 31, 2014 to enroll in a health insurance plan in order to meet the Affordable Care Act’s “individual mandate” without incurring a penalty, or fee, from the IRS. For more info about penalties and subsidies please visit www.healthcare.gov.

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Contact: Marla Blunt-Carter
(302) 577-5259
Marla.Blunt-Carter@delaware.gov

Delaware Department of Insurance: “Protecting Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.”

WASHINGTON, D.C. (May 20, 2013) – Last week, Karen Weldin Stewart met with members of her Congressional delegation to discuss insurance issues affecting the Delaware residents. Commissioner Stewart joined insurance regulators from more than 35 states and territories in Washington, D.C. to meet with representatives from various federal agencies as well as their elected Members of Congress. Coordinated by the National Association of Insurance Commissioners (NAIC), the meetings enhance collaboration between state and federal officials on a national scale. “The intersection of state and federal policy has never been more critical to the insurance sector as it is right now,” said Commissioner Stewart. “My job is to protect consumers, and part of that is to ensure that decisions made in Washington are in the best interest of the citizens of Delaware.”
Regulators were briefed by Secretary Kathleen Sebelius, of the Department of Health and Human Services and Governor Daniel K. Tarullo, of the Federal Reserve Board. Congressman Randy Neugebauer of Texas, chair of the House Financial Services Subcommittee on Housing and Insurance, also addressed the group. Subjects discussed included the impact of Dodd-Frank and Affordable Care Act on states, the agenda of the House Financial Services Committee as well international regulatory developments. Commissioner Stewart was pleased with the outcome of the meetings and stated, “The First State is fortunate to have such dedicated representatives in Washington, D.C., and I look forward to working with them on all matters of insurance that impact the lives of Delawareans.”