Posts by: Britney Han

LH BULLETIN NO. 2020-06

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LH BULLETIN NO. 2020-06


To: All Health Insurance Companies, Health Maintenance Organizations and Other Interested Parties

From: Glen Mulready, Oklahoma Insurance Commissioner

Date: October 30, 2020

Re: Expediated Hospital Transfer Determinations


Throughout the COVID-19 pandemic health carriers and other industry representatives have responded to the Department’s request to address operational accommodations and adjustments related to the impact of the pandemic.  The response is acknowledged and appreciated.  The State of Oklahoma is again experiencing a surge of confirmed COVID-19 positive cases resulting in high hospitalization rates and challenging hospital capacity limits.

The Department is issuing this bulletin to regulated carriers and entities to assist with expediated authorizations dealing with patient transfers to other, in many cases, less intensive settings of acute care.

  • All health carriers shall make transfer determinations within 24 hours upon request from an acute care hospital. Health carriers shall verify that operational capacity exists prior to transfer.

 

  • To ensure the timely handling of transfer determinations, requests received late Friday or Saturday/Sunday will be prioritized for a Monday determination before addressing other requests for authorization to transfer a patient.

 

  • When and where possible, carriers are instructed to work with discharge planning departments of acute care hospitals at the time of an insured patient’s admission to facilitate an understanding of the availability of needed or necessary hospital beds.

 

  • Health carriers shall verify their provider networks are adequate to handle a potential increase in discharge determinations. If a health carrier does not have a provider or facility in-network with the appropriate capacity or experience to meet the particular health care needs of an insured, health carriers shall make exceptions to provide access to an out-of-network provider/facility at the in-network cost sharing level and include restrictions on balance billing.

 

  • Medical transportation costs to transfer a patient from a hospital to a lesser intensive setting of care shall be paid by the carrier.  Transportation costs related to a lateral patient transfer between hospitals shall be negotiated between the sending and receiving hospitals and not cause the patient or carrier to bear the cost of the transportation.

 

The Department, in support and recognition of the Governor’s October 24, 2020 Executive Order – Sixth Amended Executive Order 2020-20, will continue to monitor the ongoing developments of the public emergency. Questions or comments applicable to this bulletin should be directed to the Legal Department at the Oklahoma Insurance Department, 400 NE 50th Street, Oklahoma City, Oklahoma, 73105.

Ice Storm and Home Insurance: Are You Covered?

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For Immediate Release:
October 30, 2020

Ice Storm and Home Insurance:
Are You Covered?

Many Oklahomans are cleaning up after the ice storm that swept through the state this week. But the clean-up is just part of the recovery effort. Navigating through the insurance claim process during this time can be confusing and stressful. Here are some commonly asked questions and the answers about ice storm and home insurance coverage to help make this process a little bit easier. Please note the answer depends on your policy.

  1. Will my insurance company pay to repair a roof damaged by the weight of ice or snow?

    A collapse of a structure, such as your roof, due to the weight of ice or snow is often covered under a standard home insurance policy. However, some nonstandard policies, such as the HO2 form do not have coverage for the weight of ice and snow, and therefore, that risk would not be covered. The best thing to do is to contact your insurance agent. They know the ins and outs of your specific policy’s coverages and limits.

  2. A tree fell and landed in my yard. Will my insurance pay to remove it?

    Typically, fallen trees are not covered unless it has fallen on your house or driveway. It will cover damage to your fence, roof, troughs, windowsporches and outbuildings. However, debris removal from your yard, in the absence of physical property damage, will generally be at your own expense.

  3. If a neighbor’s tree caused damage to my property, are they responsible for damages?

    Only if your neighbor was negligent would their policy pay for your damage. If the damage is from an act of nature, then the neighbor is not liable, and you would need to file the loss with your insurance company or agent.

  4. An ice storm caused my tree to fall on my car. Will my homeowners insurance pay for the damage to my car and to remove the tree?

    No. The homeowner’s policy pays for damage to the home and for liability when an insured is negligent. In this case, you would need to file the claim with your auto insurance carrier to have the vehicle repaired. If you only had liability coverage, then you would be out of pocket for repairs or replacing the vehicle.

  5. Does homeowners insurance cover the cost of a hotel in the event of loss of power?

    In the event of a covered loss, like fire, and your house is uninhabitable during repairs, unsafe living conditions or loss of utilities, temporary lodging costs are often covered. However, homeowner’s insurance policies generally wouldn’t pay for additional living expenses such as a hotel room simply because of an off-premises power outage. You would have to have a direct/physical on-premises loss before most insurance carriers would consider Additional Living Expenses (ALE) reimbursements for hotel stays. I encourage you to contact your insurance agent to determine if your policy would provide ALE for your particular situation.

  6. Does homeowners insurance cover spoiled food after a power outage?

    As long as the power outage was caused on your premises, the homeowner’s insurance generally pays for food spoilage. Again, talk with your agent to verify how this scenario would affect you. Finally, take pictures and keep a detailed list of the food items you had to throw away and share it with your adjuster. This will assist the adjuster in assessing the loss. 

 

When it comes to effectively submitting home insurance claims, the most important thing is to immediately document the damage to your property. Take photographs of the damage and make a list of everything you want to show the adjuster.

Contact your insurance provider to get clarification and details regarding your policy. Understanding your coverage and deductible amount will allow you to make an informed decision on whether you want to file a claim. If your damages do not exceed your deductible, the repairs will be an out-of-pocket expense. For more information, visit our ice storm resource page at www.oid.ok.gov/ice.

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov. 

Open Enrollment Period Begins Next Week for Affordable Care Act

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For Immediate Release:
October 28, 2020

Open Enrollment Period Begins Next Week for Affordable Care Act

 

OKLAHOMA CITY – The 2021 Open Enrollment Period for individual health insurance plans under the Affordable Care Act (ACA) runs from Sunday, November 1 to Tuesday, December 15. Oklahomans who do not have health insurance through their employer, Medicare, or Medicaid may be eligible to purchase coverage through the health insurance marketplaceDue to COVID-19’s impact on Oklahoma employers and communities, the Oklahoma Insurance Department expects to see increased demand for ACA individual health insurance plans, including on and off-exchange health plans.

We strive to support all Oklahomans looking for coverage and recognize many who lost their employer coverage due to the pandemic may be new to the marketplace,” said Oklahoma Insurance Commissioner Glen Mulready. “I made it an early priority to increase options for consumers and I am excited to meet our goal and double the number of plans on the marketplace.”

The same three insurers that offered individual health plans on the 2020 Exchange will return for 2021 — Blue Cross Shield of Oklahoma (BCBSOK) , Bright Health and Medica Insurance Company. In  2021, Oscar Health, UnitedHealthCare (UHC) and CommunityCare Oklahoma (CCOK) will join the marketplace in OklahomaBCBSOK and Medica offer statewide plans while Bright Health, CCOK, Oscar and UHC serve limited areas of the state.

Shop around and look for plan that truly meets your needs. I encourage you to talk with your insurance agent to become familiar with marketplace options,” Mulready said. 

  • If you are currently uninsured: you can visit healthcare.gov to compare plans and enroll in a plan that meets your health care needs. 
  • If you already have health insurance: you will be automatically re-enrolled in your existing plan if it is still available. Even if you are satisfied with your current plan, review your coverage and compare plans to ensure you can select the best option for you. 

Visithttps://www.healthcare.gov/see-plans/to view plan options, estimate monthly premiums and total annual out-of-pocket costs for each plan and learn how to buy a plan. You can also determine if you qualify for Medicaid and the Children’s Health Insurance Program (CHIP) at https://www.healthcare.gov/medicaid-chip/.

If you have questions about other insurance issues, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov 

Oklahoma Completes First Insurance Business Transfer in the United States

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For Immediate Release:
October 15, 2020

Oklahoma Completes First Insurance Business Transfer in the United States

 

 

OKLAHOMA CITY – Today, Oklahoma Insurance Commissioner Glen Mulready announced that the District Court of Oklahoma County approved Providence Washington Insurance Company (PWIC) to complete its Insurance Business Transfer (IBT) Plan.

With this approval by the Court, the Plan will transfer substantially all the insurance and reinsurance business underwritten by PWIC to Yosemite Insurance Company, an insurance company in Oklahoma. The transfer will include the liabilities associated with those policies as well as $38.5 million from PWIC to Yosemite as consideration for assuming those liabilities. Both PWIC and Yosemite are wholly owned subsidiaries of Enstar Group Limited.

The process began in 2019 when PWIC filed its IBT Plan with the Oklahoma Insurance Department. The IBT Plan includes extensive financial documents, the independent expert’s report and a proposed procedure for how the transaction will be communicated to policyholders and other interested parties. The Plan was reviewed by an independent expert, the Commissioner and department staff. The Commissioner approved the IBT Plan and authorized PWIC to petition the District Court for approval.

“Completing the first IBT in the United States is a huge milestone for Oklahoma and the Oklahoma Insurance Department,” said Commissioner Mulready. “This is a big step forward in transforming and invigorating the run-off market. We look forward to completing additional IBT’s in the coming months.”

“We are honored to be the first company to complete an IBT in Oklahoma,” commented Robert Redpath of Enstar (US) Inc. “This transaction is beneficial to all parties involved and we are passionate about the benefits it will bring to the insurance industry.”

“I congratulate Commissioner Mulready and the Oklahoma Insurance Department for their success in creating a market for insurance business transfers. Completing the first IBT in U.S. history is a landmark accomplishment for Oklahoma, and I thank Commissioner Mulready for his leadership,” Oklahoma Governor Kevin Stitt said.

Oklahoma’s IBT law became effective in November 2018 and is the most expansive such law in the country. The Oklahoma process closely mirrors Part VII Transfers of the Financial Services & Markets Act of 2000 in the United Kingdom, which has resulted in over 300 successful transfers during the past 20 years. This cuttingedge mechanism focuses on the protection of consumers while allowing insurance companies to strategically deploy assets to their areas of focus.

If you have questions about IBT’s or other insurance issues, contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov 

Commissioner Mulready Approves Filing to Lower Workers’ Comp Premiums for Oklahoma Employers

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For Immediate Release:
October 14, 2020

Commissioner Mulready Approves Filing to Lower Workers’ Comp Premiums for Oklahoma Employers

 

OKLAHOMA CITYCommissioner Glen Mulready and the Oklahoma Insurance Department has approved a 9.6 percent decrease in workers’ compensation insurance loss costs for 2021.

This will mark the 10th year in a row that average workers’ compensation loss costs have decreased. Since 2011, there has been a 54 percent decrease in loss costs. Loss costs are the average cost of lost wages and medical payments of workers injured during their employment.

“The biggest driver in bringing down the loss costs portion of premiums is what is actually paid out in claims and the reduction in the number of claims being filed,” said Commissioner Mulready.

He also notes that Oklahoma lost-time claim frequency has come down significantly over the last 15 years (by almost 50%), and is projected to continue to decline into 2021.

“This is excellent news for Oklahoma businesses,” Mulready said. “The decline in workers’ compensation loss costs will aid in lowering the cost of doing business in our state. I will continue to focus on creating a more business-friendly environment for all sectors.”

The National Council on Compensation Insurance (NCCI), a licensed rating and advisory organization, collects annual data on workers compensation claims for the insurance industry. NCCI is authorized to make recommended lost cost filings on behalf of workers compensation insurance companies in Oklahoma.

The new loss costs will go into effect for new and renewing policies effective January 1, 2021.

If you have questions about other insurance issues, contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov.

 

For more information, contact:

Liz Heigle
405-522-0683
Liz.Heigle@oid.ok.gov

Free Medicare Counseling and Information Available for Oklahomans

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For Immediate Release:
October 13, 2020

 

Free Medicare Counseling and Information Available for Oklahomans

 

OKLAHOMA CITY – With the Medicare Open Enrollment Period fast approaching, the Oklahoma Insurance Department (OID) offers free counseling to assist Oklahomans eligible for Medicare. In past years, OID’s Medicare Assistance Program (MAP) hosted annual Medicare Open Enrollment events across the state, educating Medicare beneficiaries on their options, enrollment eligibility and changes for the upcoming year. Despite the inability to host in-person events due to COVID-19, MAP has found new ways to continue consumer education and services. 

“The Medicare Assistance Program is an important and valuable service we provide Oklahomans. We’re making their services more accessible by offering free, one-on-one Medicare counseling remotely and hosting free educational webinars,” said Insurance Commissioner Glen Mulready. 

Medicare Open Enrollment Period runs from October 15 through December 7. During this time, beneficiaries can make changes to their health insurance coverage and review current coverage options. OID also kicked off the first two sessions of its six-week Medicare Open Enrollment webinar series on October 6 and October 13. Participants can still sign up for the remaining four webinars and watch the webinar recording at www.youtube.com/okinsurance411. Each webinar is free, but registration is required. To register, visit www.oid.ok.gov/MOEP.

“We are committed to making Medicare Open Enrollment less confusing and frustrating,” said MAP Director, Ray Walker. “We are more accessible than ever through our virtual programs, and we’re working diligently to provide the same, high-quality customer service while keeping everyone safe. A group educational session is also available through our virtual programs.”

MAP provides one-on-one counseling and information for people eligible for Medicare. All services are free, unbiased and confidential. To schedule an appointment, call 1-800-763-2828. To schedule a group session, visit https://www.map.oid.ok.gov

LH BULLETIN NO. 2020-04

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LH BULLETIN NO. 2020-04


To: All Health Insurance Companies, Health Maintenance Organizations and Other Interested Parties

Re: Mental Health Parity

From: Glen Mulready, Oklahoma Insurance Commissioner

Date: October 9, 2020


The purpose of this bulletin is to provide guidance regarding 36 O.S. 6060.11 as it relates to amendments passed by the Oklahoma Legislature under SB1718 and effective November 1, 2020.

Oklahoma law requires all health insurance companies to cover benefits for mental health and substance use disorders that are equal to benefits for treatment for all other physical diseases and disorders.  Treatment limitations applicable to mental health or substance use disorder benefits shall be no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by a plan.

All health benefit plans must meet the requirements of the federal Paul Wellston and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended, and federal guidance or regulations issued under these acts including 45 CFR 146.136, 45 CFR 147.160 and 45 CFR 156.115 (a)(3).

Carriers must demonstrate compliance to MHPAEA through the submission of an annual report to the Insurance Commissioner on or before April 1 of each year that details their compliance to the requirements as set forth in 36 O.S. 6060.11(E). The report shall include a comprehensive review of all elements outlined in the act that demonstrates benefits are comparable to and are applied no more stringently than to medical and surgical benefits in the same classifications of benefits. The Department will issue subsequent guidance on the format of this annual report later this month.

Implementation of the requirements as set out in the act shall be included at the time a health benefit plan is offered, issued or upon renewal of a policy on or after the effective date of the act.

Questions or comments regarding this bulletin should be directed to the Legal Division at the Oklahoma Insurance Department, 400 NE 50th Street, Oklahoma City, OK 73105.

AFFORDABLE CARE ACT HEALTH RATE FILINGS

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AFFORDABLE CARE ACT HEALTH INSURANCE RATE FILINGS

Health Insurance rate filings are available for the companies listed below. Additional companies will be listed as their filings are received. Any insurance filings already approved are available to the public through the NAIC’s System for Electronic Rate and Form Filing (SERFF) interface. There is no fee for using SERFF. Rate info can also be accessed at the Rate Review page at Healthcare.gov.

If you have a specific complaint about an insurer, please contact our Consumer Assistance at 800-522-0071 or visit our Contact Us page.

2024 Affordable Care Act (ACA) Carriers

ACA Carrier Code ACA Carrier Name
CMMC-133691246 CommunityCare HMO Inc
UHLC-133657018 UnitedHealthcare of Oklahoma, Inc.
CELT-133643409 Celtic Insurance Company
OKAC-133653175 Blue Cross Blue Shield of Oklahoma
OKAC-133653130 Blue Cross Blue Shield of Oklahoma
OHIN-133673903 Oscar Insurance Company
MEDI-133693431 Medica Insurance Company
THPO-133692170 Taro Health Plan of Oklahoma Inc.

Note: HMO rates are protected by Statute and will not be accessible.

To view rate filings for previous years, please contact the Rate and Form Division at kurt.cagle@oid.ok.gov.

To View Rate Filings at the Oklahoma Insurance Department Office

  • Filings can be viewed by walk-in or through appointment using the computer terminal for public access data on SERFF (System for Electronic Forms Filing) located at the Insurance Department. Individuals making appointments will be given priority access to the SERFF computer. You may call 405-521-3681 to schedule an appointment.
  • If you need to review a paper rate and form filing, please follow the Oklahoma Insurance Department’s Procedure for Requesting Records.
Need Help?

If you are experiencing technical difficulties or problems accessing the site, please direct your questions to the SERFF Help Desk at 816-783-8990 or email sfahelp@naic.org. The SERFF Help Desk is staffed Monday through Friday from 8:00 am to 5:00 pm CST. If a Customer Support Analyst is not available, please leave a message with the SERFF Help Desk. Your call or email will be returned the next business day.

Life Insurance Awareness Month 2020: Get Ready for Uncertainties

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September 22, 2020

Life Insurance Awareness Month 2020:
Get Ready for Uncertainties

By Oklahoma Insurance Commissioner Glen Mulready

The pandemic has caused anxiety, depression and a feeling of restlessness for most of us. We worry about our health, family, jobs, and finances. No one knows what the future holds and most of us feel powerless during these unique times. However, there is still something you can have control over: taking care of your loved ones. One of the best and easiest ways to do this is purchasing life insurance. Life insurance is not for the people who die—it is for the people who live. Life insurance would ensure your loved ones would be in a good financial place when you’re gone.

Yet, most people still either have no life insurance or don’t have enough. They worry it’s too expensive, too complicated, or don’t want to think about their death. The pandemic has also brought us back to familial values, reminded us what really matters and how quickly something can be taken away. It doesn’t need to be a difficult conversation to talk about death. If someone depends on you financially, they would most likely struggle if you were to pass away. Let them know how much you love them by getting the protection they need.

September is Life Insurance Awareness Month, making it the perfect time to evaluate your life insurance needs. I encourage Oklahomans to take a few minutes this month to help their families get ready for uncertainties, protect their futures and ease financial burdens. Here are three reasons why you should consider life insurance today: 

  1. LOWER PREMIUM
    You will never be younger than you are today. While that may sound obvious, your age is key when it comes to life insurance. In general, you’ll pay less the younger and healthier you are as premiums are based on age, health and the type of policy you buy. For most policies, premiums will be locked in at that rate over the policy’s life and cannot be raised due to a change in health status.
  2. CHEAPER THAN YOU THINK
    People overestimate the cost of life insurance. According to the Insurance Barometer Study, people think life insurance costs three times more than it does. The average price of a term life insurance policy for someone in their 30’s is $16 per month. If you get a policy in your 40’s, you can expect to pay $22 per month according to S&P Global.
  3. PEACE OF MIND FOR YOUR LOVED ONES
    According to the Life Happens’ recent survey “Tough Talks During COVID-19”, half (49%) of respondents agreed that it is essential to have open conversations with their partners and families about their financial future. Additionally, it’s helped two thirds (66%) of Americans better understand life insurance’s value, with another quarter (25%) buying coverage for the first time.

For more information about life insurance: https://www.oid.ok.gov/consumers/insurance-basics/life-insurance/ 

Commissioner Mulready Elected Vice Chair of NAIC Midwest Zone

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For Immediate Release:
September 17, 2020 

Commissioner Mulready Elected Vice Chair of NAIC Midwest Zone

 

OKLAHOMA CITY – On September 11, 2020, Oklahoma Insurance Commissioner Glen Mulreadwas elected Vice Chair of the National Association of Insurance Commissioners’ (NAIC) Midwest Zone. The zone groups are part of the NAIC Executive Committee. They help carry out the authority and responsibilities of the NAIC’s goals. The Midwest Zone represents 13 states, including Oklahoma. 

I’m honored to serve as Vice Chair of this groupThe position allows me to continue collaborating with neighboring states and others in our region to track best practices and new challenges thamay come to Oklahoma in the future,” said Mulready. “NAIC is an excellent source of support and expertise for insurance departments as we fulfill our mission of protecting consumers while ensuring healthy, competitive insurance markets. I look forward to working with my fellow commissioners in this capacity.” 

The NAIC is the U.S. standard-setting and regulatory support organization created and governed by insurance regulators from all 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review and coordinate regulatory oversight. 

If you have questions about other insurance issues, contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov