Regulatory Roundup: Delaware DOI By-the-Numbers, Florida Releases More P&C Changes, Washington Tackles Balance Billing

State by state variations of laws, compliance protocols, industry transparency, and general regulatory culture can lend one the impression that keeping up with industry changes is a little bit like herding cats. So, what better way to wrangle some of the more localized insurance news than in a Regulatory Roundup?

On an ongoing basis, in no particular order or rank, we’re wrestling the various regulatory changes, compliance actions, and commissioner decisions into our roundup. As a disclaimer: There’s a lot going on at any given time in these here United States, so this isn’t a comprehensive picture of state-level action by any means. Think of it as, instead, a sampler platter of regulation. 

Also important to note: If we’re recapping interpretations of legal decisions, this is some armchair insurance speculation and not at all legal advice. If you need legal advice, get a lawyer. 

Delaware DOI releases by-the-numbers report

Insurance Commissioner Trinidad Navarro’s office has released its annual data report. The data provides an interesting insight into the workings of the state.

A sample of the data:

• The department has 98 employees.
• The DOI office consulted on 20 bills during the legislative session.
• The staff providing Medicare assistance gave 5,123 sessions to help people understand Medicare coverage and saved consumers $1.5 million in unnecessary Medicare expenditures. 
• The department fielded 3,459 complaints.
• Officials negotiated 268 arbitration settlements with $690,000 in awards.
• The DOI issued 98,000 new licenses and maintained a state industry with 204,748 licenses, total.

“In the face of inflation, climate change, the pandemic, and other challenges, our priority remains the same: the residents of our great state. Sharing these statistics each year gives consumers a glimpse into the DOI’s broad array of work,” said Commissioner Navarro. “We’re expanding access to health insurance, fighting for affordable prescriptions, advocating for consumers in claims processing, and ensuring that carriers are complying with the law – and we’re not slowing down.”

Washington orders insurance carrier to reprocess ambulance service balance billing

Washington’s Office of the Insurance Commissioner has ordered a health insurance carrier and its subsidiaries to reprocess claims from more than 650 policyholders who were balance-billed by ambulance services for emergency ground transportation.

Washington has been debating whether to use the federal No Surprises Act as its main prevention of balance billing or to continue to rely on the state’s Balance Billing Protection Act. While both acts carve out exemptions for ambulance services, the Washington OIC news release noted the insurance carrier previously paid ambulance bills and only charged patients their typical deductible and cost-sharing. 

In these cases, however, the carrier paid its pre-determined rate to the ambulance companies, billed consumers their contractual cost-sharing amount, and then the ambulance services billed the difference to consumers. In some cases, the ambulance companies sent unpaid patient bills to collections.

“Unfortunately, the insurer’s approach to this issue was not consistent with the law or the documents they have filed with our office. More importantly, it left consumers unfairly caught between the insurer and the providers,” Kreidler said. He added that his office is in discussions with the insurer on how to best resolve the issue and make the impacted consumers whole.

Florida beefs up consumer protection, home hardening

Florida Gov. Ron DeSantis signed several pieces of legislation making further changes to the state’s property and casualty market – a market that, like many coastal states, has been struggling.

Among the changes are measures that drive additional funding to and expand the availability of the state’s home-hardening funds, as well as consumer protections such as:

• Requiring liability insurers to follow proper claims procedures and increasing penalties on insurers that don’t
• Stopping insurers or firms from amending an adjuster’s report unless the revision has a detailed explanation (likely in response to stories like this)
• Preventing carriers that are listed as impaired or insolvent from paying bonuses to officers and directors 
• Increasing the maximum OIR fine to carriers by 250 percent, and even 500 percent for carrier violations related to a state of emergency

Other changes include requirements that insurance carriers clearly communicate possible discounts to property owners for risk-mitigation.

Other state changes

Arkansas has issued a bulletin giving carriers more robust guidelines on what they must do to give state regulators relevant information in criminal investigations, and how to protect their business data both during the course of an investigation as well as in the aftermath.

California suffered a blow to insurance availability and affordability as State Farm and Allstate pulled P&C coverage from the market. 

Colorado has amended its standards for Affordable Care Act (ACA)-compliant benefit plans and ACA-compliant dental plans for the state. Commissioner Michael Conway has also adopted a new bulletin with guidelines for carriers to provide coverage for COVID-19 vaccines with the end of the federal public health emergency. The state has also announced fines for health insurance carriers that charged more than federal allowances for mental health services. Fines will range from $15,000 to $321,000.

Kansas’s Legislature has adjourned after passing a number of insurance laws, from changing fee structures for insurance agents, agencies, and public adjusters to changes to group-funded pools to setting up limited line travel insurance.

Maryland Insurance Administration officials determined a property and casualty insurer unfairly penalized its downstream distribution agency when that firm refused to discriminate against their policy-eligible clients in a wild ride of a report where race, economics, and insurance meet.

Montana has amended its continuing education law to eliminate its insurance advisory council, instead allowing CE contractors to provide coursework and instruction.

New Mexico has rescinded a bulletin regarding its surplus lines insurance regulation. In 2015, a bulletin allowed surplus lines brokers to forgo a diligent search requirement for the coverages on that bulletin’s list. By rescinding this 2015 bulletin, the state’s Department of Insurance is clarifying that surplus lines brokers must perform a due diligence search for coverage on the admitted market before pursuing surplus lines coverage.

Washington’s Office of the Insurance Commissioner alerted consumers to the law Gov. Jay Inslee signed in April 2023 to regulate pet insurance sales. The law is based on the NAIC pet insurance model regulation, which the OIC points will give increased uniformity and protections to consumers while establishing accountability for those who wish to become licensed to sell pet insurance in Washington.

Wyoming has issued a memorandum reminding the industry that new standards for annuity sales require four credits of training on sales practices, annuity replacements, and disclosures before Jan. 5, 2024.

While these points of interest aren’t comprehensive, our knowledge of insurance producer and variable lines broker license and compliance maintenance is. See how AgentSync can help make you look smarter today; head over to the Compliance Library and wrastle up some state-by-state regulation and more jurisdictional updates.