We cannot say this enough: If you want to buy an individual health plan for your child or enroll them in your individual health plan, you have until April 30 to do it. Do not delay.
Individual coverage is typically bought by people who don't have access to employer-sponsored coverage, or whose employer doesn't cover dependents.
The next open-enrollment period for kids this year won't be until Sept. 15 through Oct. 31.
For more on this, please see our March 14 news release.
Seattle couple pleads guilty in storm-damage insurance scheme
The owners of a Seattle construction company have pleaded guilty to attempted theft for an insurance-billing scheme based on inflated storm-cleanup bills.
James and Cheryl-Lin Philo pleaded guilty March 25th in King County Superior Court to two counts of second-degree attempted theft. In addition, their company, Philo Construction Co., of Seattle, is guilty of one count of first-degree theft.
An investigation by Insurance Commissioner's Mike Kreidler's anti-fraud unit found dozens of cases of apparent fraudulent billing by the company.
Here's what happened: In December 2006, a major windstorm swept across Washington, knocking down trees and causing substantial damage to a numerous homes. The Philos hired subcontractors to remove many of those trees from customers’ homes.
In March 2007, a former employee contacted our office, saying that Philo was submitting inflated invoices to insurers. Other workers provided information as well.
An investigation by the agency’s Special Investigations Unit, working with more than 15 insurance companies, found that the Philos had been asking their subcontractors for two invoices for each job. The Philos paid the subcontractors the smaller amount, and then submitted the larger invoice to their customers’ insurance companies for reimbursement.
The markup averaged close to 30 percent, plus another 20 percent that insurers allow for profit and overhead. For example, a $2,150 bill from a tree service company was reported to the insurer as a $2,795 job. Once profit, overhead and sales tax were added, the Philos were paid a total of $3,649.
The Philos also created a fictitious company, Pro Line Construction Resources, to act as a subcontractor when they needed to support a particularly high estimate.
The Philos were each assessed a $500 victim penalty assessment. They'll also pay restitution totalling $19,849.15, and $220 in court costs.
James and Cheryl-Lin Philo pleaded guilty March 25th in King County Superior Court to two counts of second-degree attempted theft. In addition, their company, Philo Construction Co., of Seattle, is guilty of one count of first-degree theft.
An investigation by Insurance Commissioner's Mike Kreidler's anti-fraud unit found dozens of cases of apparent fraudulent billing by the company.
Here's what happened: In December 2006, a major windstorm swept across Washington, knocking down trees and causing substantial damage to a numerous homes. The Philos hired subcontractors to remove many of those trees from customers’ homes.
In March 2007, a former employee contacted our office, saying that Philo was submitting inflated invoices to insurers. Other workers provided information as well.
An investigation by the agency’s Special Investigations Unit, working with more than 15 insurance companies, found that the Philos had been asking their subcontractors for two invoices for each job. The Philos paid the subcontractors the smaller amount, and then submitted the larger invoice to their customers’ insurance companies for reimbursement.
The markup averaged close to 30 percent, plus another 20 percent that insurers allow for profit and overhead. For example, a $2,150 bill from a tree service company was reported to the insurer as a $2,795 job. Once profit, overhead and sales tax were added, the Philos were paid a total of $3,649.
The Philos also created a fictitious company, Pro Line Construction Resources, to act as a subcontractor when they needed to support a particularly high estimate.
The Philos were each assessed a $500 victim penalty assessment. They'll also pay restitution totalling $19,849.15, and $220 in court costs.
Samaritan Ministries ordered to stop offering unauthorized insurance in Washington state
This post has been updated. See below.
Washington state Insurance Commissioner Mike Kreidler on Friday ordered a health-care sharing ministry to stop offering unauthorized insurance in Washington.
Illinois-based Samaritan Ministries International, a nonprofit corporation, maintains that its member “need-sharing” program is not insurance. Under Washington state law, however, the program is considered insurance.
Insurers doing business in Washington must register with the state, submit their policies and rates for review, and meet state financial solvency requirements. Samaritan Ministries hasn’t done any of those things.
Kreidler on Friday issued a cease-and-desist order telling Samaritan to stop engaging in the unauthorized business of insurance in Washington state, which includes organizing the transfer of money between members.
“Our insurance laws exist to protect consumers and make sure that insurers live up to their promises,” said Kreidler. “Members of groups like this don’t have those protections.”
Samaritan Ministries members agree to pay monthly shares of $135 to $320 to other members who have medical costs, plus a $170-a-year administrative fee. A separate program is available to cover auto-accident injuries.
Members submit medical claims, and the group directs members to send their money to members with medical bills. The group says it has a total of 15,500 members in all 50 states, with shares totaling about $3.5 million per month.
The cease and desist order includes Samaritan Ministries International, its Christian Health Care Newsletter and 20 individuals.
Samaritan Ministries has the right to demand a hearing. The order takes effect immediately.
Update (5/31/2011) The order has been rescinded. On May 11, 2011, Washington Gov. Chris Gregoire signed Senate Bill 5122 into law, excluding health sharing ministries such as Samaritan from regulation under the Washington state insurance code.
Washington state Insurance Commissioner Mike Kreidler on Friday ordered a health-care sharing ministry to stop offering unauthorized insurance in Washington.
Illinois-based Samaritan Ministries International, a nonprofit corporation, maintains that its member “need-sharing” program is not insurance. Under Washington state law, however, the program is considered insurance.
Insurers doing business in Washington must register with the state, submit their policies and rates for review, and meet state financial solvency requirements. Samaritan Ministries hasn’t done any of those things.
Kreidler on Friday issued a cease-and-desist order telling Samaritan to stop engaging in the unauthorized business of insurance in Washington state, which includes organizing the transfer of money between members.
“Our insurance laws exist to protect consumers and make sure that insurers live up to their promises,” said Kreidler. “Members of groups like this don’t have those protections.”
Samaritan Ministries members agree to pay monthly shares of $135 to $320 to other members who have medical costs, plus a $170-a-year administrative fee. A separate program is available to cover auto-accident injuries.
Members submit medical claims, and the group directs members to send their money to members with medical bills. The group says it has a total of 15,500 members in all 50 states, with shares totaling about $3.5 million per month.
The cease and desist order includes Samaritan Ministries International, its Christian Health Care Newsletter and 20 individuals.
Samaritan Ministries has the right to demand a hearing. The order takes effect immediately.
Update (5/31/2011) The order has been rescinded. On May 11, 2011, Washington Gov. Chris Gregoire signed Senate Bill 5122 into law, excluding health sharing ministries such as Samaritan from regulation under the Washington state insurance code.
Kreidler: Premera doesn't want you to see what's behind your health rates
Insurance Commissioner Mike Kreidler called out Premera Blue Cross for attempting - again - to gut a bill that would give the public access to health insurance rate filings.
"I'm extremely disappointed in Premera," said Kreidler. "Their latest attempt to gut our legislation is very troubling. What don't they want the public to see?"
Kreidler's proposal (ESHB 1220) makes the information in a health insurance rate filing public shortly after his office receives it. This includes how much of the proposed rate will go to:
- Pay medical claims
- Cover administrative costs -- including salaries
- Profit
WA insurance commissioner issues more than $167,000 in fines against insurers
Insurance Commissioner Mike Kreidler has fined insurance companies more than $167,000 for violations including wrongly denying medical claims and overcharging customers.
“It’s important that companies follow the law, and when they don’t, we’ll hold them accountable,” said Kreidler. “Consumers, competitors and the marketplace all rely on insurers following the rules.”
In 2010, Kreidler’s office levied $583,750 in fines. Fines collected by the state insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.
Fines and disciplinary actions so far this year include:
■Aetna Life Insurance Co., of Hartford, Conn., was fined $65,000 for violations, including unreasonably denying 220 claims for acupuncture treatment. The company also refunded $16,427 to policyholders.
■Ace American Insurance Co., of Philadelphia, Penn., was fined $50,000 for violations, including using rates that it had not filed with the state.
■Progressive American Insurance Co., Progressive Northwestern Insurance Co, and Progressive Max Insurance Co, all of Mayfield Village, Ohio, were fined $30,000 for improperly deducting sales tax and fees from cash value calculations in more than 1,700 auto claims. The company also refunded $415,299 to customers.
■Homesite Insurance Company of the Midwest, of Mandan, N. Dakota, was fined $12,000 for overcharging more than 300 policyholders for renter’s insurance. The policyholders are receiving refunds.
■Austin Mutual Insurance Co., of Maple Grove, MN, was fined $10,000 for issuing insurance policies that weren’t in accordance with the rates it had filed with the state. As a result, 324 policyholders were overcharged a total of $26,200. The company also agreed to refund the overcharges to policyholders within 60 days.
■Doctors and Surgeons Benefit Association, of Charlestown, Nevis, West Indies; and several related entities were ordered to stop selling unauthorized insurance in Washington state.
In addition, Kreidler also took the following actions against agents or brokers:
■Mitchell A. Steitz, of Cashmere: License revoked, effective March 31, for misappropriating $12,500 from clients and spending it himself, rather than investing it.
■Allen D. James, of Sumner, agreed to pay a $1,000 fine for failing to promptly pay a premium refund to a client.
For details on cases, please see the agency's disciplinary orders site.
“It’s important that companies follow the law, and when they don’t, we’ll hold them accountable,” said Kreidler. “Consumers, competitors and the marketplace all rely on insurers following the rules.”
In 2010, Kreidler’s office levied $583,750 in fines. Fines collected by the state insurance commissioner’s office do not go to the agency. The money is deposited in the state’s general fund to pay for other state services.
Fines and disciplinary actions so far this year include:
■Aetna Life Insurance Co., of Hartford, Conn., was fined $65,000 for violations, including unreasonably denying 220 claims for acupuncture treatment. The company also refunded $16,427 to policyholders.
■Ace American Insurance Co., of Philadelphia, Penn., was fined $50,000 for violations, including using rates that it had not filed with the state.
■Progressive American Insurance Co., Progressive Northwestern Insurance Co, and Progressive Max Insurance Co, all of Mayfield Village, Ohio, were fined $30,000 for improperly deducting sales tax and fees from cash value calculations in more than 1,700 auto claims. The company also refunded $415,299 to customers.
■Homesite Insurance Company of the Midwest, of Mandan, N. Dakota, was fined $12,000 for overcharging more than 300 policyholders for renter’s insurance. The policyholders are receiving refunds.
■Austin Mutual Insurance Co., of Maple Grove, MN, was fined $10,000 for issuing insurance policies that weren’t in accordance with the rates it had filed with the state. As a result, 324 policyholders were overcharged a total of $26,200. The company also agreed to refund the overcharges to policyholders within 60 days.
■Doctors and Surgeons Benefit Association, of Charlestown, Nevis, West Indies; and several related entities were ordered to stop selling unauthorized insurance in Washington state.
In addition, Kreidler also took the following actions against agents or brokers:
■Mitchell A. Steitz, of Cashmere: License revoked, effective March 31, for misappropriating $12,500 from clients and spending it himself, rather than investing it.
■Allen D. James, of Sumner, agreed to pay a $1,000 fine for failing to promptly pay a premium refund to a client.
For details on cases, please see the agency's disciplinary orders site.
Tom Hanks sues his insurance broker
Actor Tom Hanks and his wife, Rita Wilson, are suing their former insurance brokers of 20 years, alleging that the brokers:
-falsely inflated and overcharged the couple, "misrepresenting the amounts of the premiums on insurance policies"
-"altering insurance documents and related records to conceal their fraudulent scheme"
-"and...taking other acts to engage in, and conceal, their embezzlement scheme through manipulation and deceit."
(All these quotes are from the Hanks' legal complaint.)
How much, you ask? The complaint says "hundreds of thousands, if not millions, of dollars."
How'd they find out? The couple last month got a new broker, who promptly told their business managers "that he was concerned that the insurance premiums from policies in the last year to two years appeared extraordinarily high for the coverage provided."
The complaint also alleges that the brokers illegally issued certificates of insurance without appointments, charged the Hanks for insurance that was never procured (or overcharged them), and bought "unecessarily duplicative insurance coverage," among other things.
-falsely inflated and overcharged the couple, "misrepresenting the amounts of the premiums on insurance policies"
-"altering insurance documents and related records to conceal their fraudulent scheme"
-"and...taking other acts to engage in, and conceal, their embezzlement scheme through manipulation and deceit."
(All these quotes are from the Hanks' legal complaint.)
How much, you ask? The complaint says "hundreds of thousands, if not millions, of dollars."
How'd they find out? The couple last month got a new broker, who promptly told their business managers "that he was concerned that the insurance premiums from policies in the last year to two years appeared extraordinarily high for the coverage provided."
The complaint also alleges that the brokers illegally issued certificates of insurance without appointments, charged the Hanks for insurance that was never procured (or overcharged them), and bought "unecessarily duplicative insurance coverage," among other things.
Free app helps you create a home inventory
If you're like most of us, you know you need to create a home inventory, but you haven't taken the first step.The National Association of Insurance Commissioners has just made it easier. They've developed a cool app for your iPhone - and it's free.
The myHOME app helps you capture photos, bar codes and serial numbers of your items. It also organizes the information for you, room by room, and creates a back-up file for e-mailing.
Subscribe to:
Posts (Atom)