What is the insurance company's role in home repairs?


It�s common for consumers to call us with their concerns about their home repair or home rebuild claims and the insurer's involvement in oversight of the work. The insurer�s duty is to pay according to the terms laid out in the policy. Unless your insurance policy contains a provision, or unless your insurer has given you assurances, that obligates them to manage a covered home repair or rebuild, it is your responsibility to oversee the project with your contractor, and when applicable, your lender.


However, if you using an insurer�s recommended (sometimes called �preferred�) contractor, then you should expect assistance from the insurer in answering your questions about the contractor�s actions and performance.

Read more about homeowner insurance.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.


Important change may affect business owners� insurance

Business owners carry commercial insurance policies to protect their financial interests in their property and to cover their liability arising out their business operations. One of the important liabilities that is covered is in the event that a business is sued. The typical commercial insurance policy includes a clause called �duty to defend,� which means the insurance company is required to defend the business if it is sued and it will pay the associated legal costs. However, some commercial policies are being changed to require businesses to repay legal defense costs if the insurer later determines a claim is not covered.


How will you know if your insurance company will require you to repay legal costs? Read your policy or talk to your agent , broker, or with the insurer. Insurers may be adding the clause to new policies or to renewing policies, so it�s important to know what your policy says.

It�s also important that you promptly report lawsuits to your insurance company. Reporting this information to the insurer too late can impede the insurer�s ability to defend your business against the lawsuit. 

More information:
Questions? Contact our consumer advocates online or at 1-800-562-6900.

Consumers who had trouble with Washington Healthplanfinder have a second chance to enroll

The Washington State Health Benefits Exchange has announced a special enrollment through Feb. 23, 2015 for people who have experienced trouble enrolling in a health plan for 2015 through the state�s exchange, Washington Healthplanfinder.

�I am pleased that Washington consumers who have had trouble with Washington Healthplanfinder have an option for getting coverage effective Jan. 1,� said Insurance Commissioner Mike Kreidler. �I encourage affected consumers to act sooner rather than later.�

The special enrollment applies to people who made an effort to receive health coverage through http://www.wahealthplanfinder.org/ before the Dec. 23 deadline, but who were unable to complete their applications due to a technical error associated with the Washington Healthplanfinder system.

Starting at noon today, affected consumers should fill out an online request form for coverage retroactive to Jan. 1 at: https://petition.wahealthplanfinder.org/. If customers need assistance or do not have Internet access, they can call the Exchange�s Customer Support Center at 1-855-923-4633. Each request will be reviewed and customers will receive a notification of their special enrollment through email or mail.

The Exchange also posted a list of frequently asked questions about the special enrollment period.

Does insurance have to replace my entire roof?

Here's a consumer question related to winter weather: My insurer will repair a portion of my roof that was damaged, but won�t replace the entire roof to match. Can they do this?

This is a common question and it's a frustrating issue for consumers. The short answer is yes, insurers can do that. Home insurance policies cover direct physical damage to the roof, like a tree branch falling in a wind storm and poking a hole in the roof, or blowing a section of your shingles off and allowing water to enter. The insurer will repair the damaged portion of the roof and any resulting water damage. The insurer would not pay to repair any sections of your roof that are not damaged. 

If you decide you want the entire roof replaced, you would have to pay for replacing all non-damaged areas of the roof.

Read more about homeowner insurance on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Covered CA Cancels 4,100 Health Net Subscribers!

We have received a communication from Health Net CA regarding plan terminations from Covered California.

According to the e-mail, Covered CA has cancelled over 4,100 current Health Net subscribers effective 12/31/14.  No one knows how or why this has happened and I have not heard of this issue with any other carriers at this time.  Since Health Net has no agent/broker information for the 4,100 plans, they will be calling and e-mail those who are being terminated.




According to Health Net, cancelled members must re-enroll in health insurance via Covered CA as a new user through Covered CA (www.coveredca.com) and select a new health plan for 2015.  Cutoff to enroll is Sunday, 12/21/14 for coverage beginning January 1, 2015. 

If you are a Health Net member via Covered CA, I would suggest you check with Covered CA and/or Health Net to verify whether or not you are one of the cancelled subscribers.  

Dave

Oregon Insurance Commissioner extends comment period on Mutual of Enumclaw holding company conversion

The Oregon Insurance Commissioner has extended the open comment period following the Dec. 15 public hearing of the proposed mutual holding company conversion of Mutual of Enumclaw Insurance Co. Comments must be delivered to the Oregon Insurance Commissioner by 5 p.m. on Dec. 29. Comments should be sent to Russell Latham, Financial Regulation Section, Oregon Insurance Division, P. O. Box 14480, Salem, OR 97309-0405.

Mutual of Enumclaw Insurance Co. and its subsidiary, Enumclaw Property and Casualty Insurance Co., have requested permission from the Oregon Insurance Commissioner to reorganize into a holding company structure. Holding companies are corporations that own and control other companies. The new holding company would be the direct owner of Mutual of Enumclaw and the indirect owner of Enumclaw Property and Casualty Insurance Co. Read more about the request in our Dec. 9 blog post.

To find information about viewing the plan of reorganization, view the Dec. 15 public hearing notice from the Oregon Insurance Division.

Insurance Commissioner fines health insurer $50,000

LifeWise Health Plan of Washington has agreed to pay a $50,000 fine for overcharging 5,700 consumers $6 to $38 per month for the first six months of 2014. 

The health plans were WiseEssentials 25 and WiseSavings 20, which are catastrophic plans that trade a high deductible for a lower monthly premium. They are usually purchased by young, healthy people who want coverage in case of an injury, accident or serious illness. Each year, health insurers are required to file with the OIC their health plans--called "forms" in insurance vernacular--and the rates they will charge for each plan. The OIC then reviews and ultimately approves the plans and rates, working with the insurers when they need to. 

In this case, the 2014 rates that LifeWise filed for those catastrophic plans had decreased slightly, depending on the enrollee�s age, because the deductible increased. From January through June 2014, LifeWise charged those consumers rates that were based on the 2013 plans, which had higher deductibles.

As part of the agreement, called a consent order, LifeWise will repay the affected consumers the amounts they overpaid plus 8 percent annual interest. View the consent order here

You can search our disciplinary orders or file a complaint against an insurance company, agent or broker on our website.

Health Care and School Lunches

Do you remember those school days in the cafeteria when you were going through the lunch line? How about the lunch ladies with their hair nets, and big metal spoons they used to slop the slop? And what about �Mystery Meat Thursday�? Do you have flashbacks when you go into a restaurant that has self serve buffet lines?

These kinds of memories are shared by millions of people who at one time or another experienced eating lunch in a school lunch room, and only the lucky kids who brought their sack lunches were fortunate enough to avoid seeing chicken spaghetti with sauce as heavy as silicon morter thrown onto their tray at least once a week.

The school lunch program in schools across the country has long been a joke that keeps on giving. However, it has suffered some changes, and is still a source of contention with school districts, parents and kids, and the federal government. This month, according to Farm Futures Magazine, the USDA has renewed efforts to connect school cafeterias with local farmers and ranchers through its Farm to School Program. The program helps schools buy more food from local farmers and ranchers in their communities, expanding access to healthy local food for school children and supporting local economies.

The Secretary of Agriculture stated: "These inspiring collaborations provide students with healthy, fresh food, while supporting healthy local economies. Through farm to school projects, community partners are coming together to ensure a bright future for students, and for local farmers and ranchers." Much more information about this initiative can be found at this website: http://farmfutures.com/story-usda-pushes-more-local-food-school-lunches-0-121067. 

Since the 1940�s schools have been providing federally assisted school meal programs. The National School Lunch Program (NSLP) is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day. The program was established under the National School Lunch Act, signed by President Harry Truman in 1946, according to the USDA. More feedback about this aspect of school nutrition can be found at this site: http://www.fns.usda.gov/nslp/national-school-lunch-program-nslp.

According to FRAC, the Food Research and Action Center, the NSLP provides per meal cash reimbursements to schools as an entitlement to provide nutritious meals to children. This means that all eligible schools can participate and all children attending those schools can participate. Schools participating in NSLP also receive agricultural commodities (unprocessed or partially processed foods) as a supplement to the per-meal cash reimbursements, in amounts based on the number of lunches they serve. USDA research indicates that children who participate in the NSLP have superior nutritional intakes compared to those who do not participate. 

The National School Lunch Program provides school children with one-third or more of their Recommended Dietary Allowance (RDA) for key nutrients. These lunches are required to provide no more than 30 percent of calories from fat and less than 10 percent from saturated fat. Every school district that participates in the National School Lunch Program was required to enact a local school wellness policy, an opportunity to address obesity and promote healthy eating and physical activity through changes in school environments. More details are available at this site: http://frac.org/federal-foodnutrition-programs/national-school-lunch-program/. 

Additionally, the Food and Nutrition Service administers several programs that provide healthy food to children including the National School Lunch Program, the School Breakfast Program, the Child and Adult Care Food Program, the Summer Food Service Program, the Fresh Fruit and Vegetable Program, and the Special Milk Program. Administered by State agencies, each of these programs helps fight hunger and obesity by reimbursing organizations such as schools, child care centers, and after-school programs for providing healthy meals to children.

Details about this expanded food program is available at this website: http://www.fns.usda.gov/school-meals/child-nutrition-programs. And, for a more exhaustive amount of background material on all school food programs administered by the government, you can see that at this site: http://www.nutrition.gov/food-assistance-programs/school-lunch-and-breakfast-programs.

According to the New America Foundation, the National School Lunch Program supports student nutrition in over 101,000 schools and residential facilities. It provides free and reduced priced meals to low-income children before school, during school, after school, and over the summer. In fiscal year 2013, federal school nutrition programs underwrote more than five billion lunches served. Total funding for all nutrition programs sums to $16.3 billion in both cash and commodity payments in fiscal year 2014. To find more detailed info on this topic, visit this website: http://febp.newamerica.net/background-analysis/federal-school-nutrition-programs.

However, according to Breitbart, the National School Lunch Program feeds upwards to 31 million American students a day, spending nearly $12 billion annually; but many of those children are throwing away the vegetables, fruits, and snacks forced on them by the new federal nutrition standards. The government's new school lunch requirements championed by First Lady Michelle Obama are wasting $4 million a day in discarded food that children won't eat.

A new Harvard study of the program, "shows that 60 percent of fresh vegetables and 40 percent of fresh fruit are being thrown away." And a recent study released by the National School Nutrition Association found 81.2 percent of schools surveyed indicated an increase in the amount of food being thrown away by students since the new nutrition standards went into effect two years ago.
Nearly 600 school districts have already dropped out of the First Lady's lunch program. That�s a lot of food and tax dollars being wasted. More details on this issue can be found at this site: http://www.breitbart.com/Big-Government/2014/09/18/Michelle-Obama-s-School-Lunch-Program-Wastes-Millions.

Is there light at the end of the checkout line? Perhaps, but innovation is slow to be adopted, unless the government mandates it. There are other options, though. One company is already making a difference�OrderLunches.com. The company was created in 2006 to replace the complicated task of organizing and managing school lunch programs. Schools can now eliminate the endless hours spent managing paper processes or using other online systems that simply just don�t work. Busy parents get to pre-order their kids meals, know what they�re eating at school and get rid of the morning chaos.

Helping schools nationwide connect with local restaurants, caterers or on-site cooks to build strong partnerships that keep kids healthy & parents happy is the mission of this company. More details about this resource is available at this website: http://www.orderlunches.com/how-it-works/.

Do school lunch programs work? Yes, for the most part. However, figuring out the secret sauce to avoid waste and still provide nutritious food at an affordable price is a huge challenge. Kids will be kids, though. If they don�t like it, they won�t eat it. The best option is to continue to find ways to help children and teens eat healthy food. That is a big part of the education process. Perhaps schools can sneak that curriculum in somewhere between home economics and gym class. 

Until next time.

New Medicare cards are coming starting in April

The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state aft...