Glass Company Owner Arrested for False Claims and Identity Theft

Phoenix – On November 30, 2016, the Arizona Department of Insurance Fraud Division arrested 20-year-old Gilbert Martinez, owner of Gilligan’s Auto Glass, on allegations of fraud schemes, insurance fraud, aggravated identity theft and theft.


The allegations involve Martinez’s unauthorized use of several insureds’ personal information, details of their auto insurance company and vehicle information, all taken from another glass company’s business where Martinez formerly worked. Gilbert Martinez is alleged to have started Gilligan’s Auto Glass in June 2016 and then allegedly reported false windshield-replacement claims to an insurance company posing as the insureds. So far, the investigation involves 33 known victims whose identities were used without their knowledge to make false claims. The insurance company paid out over $19,000 on the alleged false claims. The investigation is continuing with the hopes of locating other victims and insurance companies involved. The investigation will be submitted to the Arizona Attorney General’s Office for prosecution.

 

About the Fraud Unit

The Fraud Unit was established in the Arizona Department of Insurance in 1994 to deter, investigate and facilitate convictions of insurance fraud. By deterring fraud, the Fraud Unit reduces the inflationary impact of fraud that is passed on to consumers through higher costs of insurance products. If you believe you are a victim of insurance fraud or know of someone committing insurance fraud, please contact the Arizona Department of Insurance Fraud Unit at 602-364-2140.

About the Arizona Department of Insurance

The Arizona Department of Insurance, an agency of the State of Arizona, is responsible for the education and protection of insurance consumers and for oversight of the insurance industry in the state.  If you need assistance with your insurance, please contact the Arizona Department of Insurance Consumer Affairs Division at 602-364-2499 (metro Phoenix) or 800-325-2548 (outside Phoenix).

Extension of Major Medical Transitional Policies through Calendar Year 2018

Phoenix - The Arizona Department of Insurance (ADOI) announced today that insurers in the individual and small group[1] major medical health insurance markets can choose to renew transitional policies for a policy year beginning on or before October 1, 2018, provided all transitional coverage ends by December 31, 2018.    Transitional policies are non-Affordable-Care-Act-compliant policies that have been continuously in effect since by or before December 31, 2013.  At least 6 health insurers have individual or small group transitional policies still in effect in Arizona.

This extension is the maximum extension permitted under the Insurance Standards Bulletin issued on February 23, 2017 by the Center for Consumer Information and Insurance Oversight (CCIIO), and gives insurers the option to continue the pre-2014 individual and small group policies covering approximately 70,000 Arizonans through the end of 2018.  Insurers that offer this extension of transitional coverage are required to send each policyholder a renewal notice that explains the offer to continue the transitional policy through the end of 2018 and includes information regarding any related price increase.  Insurers must also send a 90-day notice for the final discontinuation of the transitional plans.

The extension does not affect grandfathered policies issued prior to March 23, 2010.  These policies can remain in effect as long as they maintain grandfathered status.

For additional information on the Affordable Care Act, please visit the Arizona Department of Insurance website or call Consumer Assistance at (602) 364-2499. 

 

[1] Small Group refers to a policy issued to an employer who employs at least two but not more than fifty eligible employees

(ARS § 20-2301(A)(21)).

 

Director's Message Regarding Health Insurance Premiums for 2018

Open enrollment will be available from November 1, 2017 through December 15, 2017 for health insurance coverage commencing January 1, 2018.  Here are a few things you can expect when purchasing or renewing health insurance this year.

In Arizona, the overall average Marketplace (“on-exchange”) Plan Year 2018 rates have stabilized with only slight changes from last year’s premium rates.  This is significant for our market after sustaining large premium increases in 2017.  This premium rate stabilization gives us hope that more insurers may consider entering our market for Plan Year 2019. Unfortunately, like last year, Arizonan’s health insurance plan choices are limited.  Only two insurance carriers will be issuing tax subsidized major medical policies on the exchange in 2018.  One insurer will be offering health plans in Maricopa and Pima counties, and the other insurer will be offering plans in the other 13 counties.  Additionally, we are down to a total of 4 health insurers offering individual plans off-exchange for 2018. Visit our Health insurance rate page to see a list of plans and premium averages by county. 

Additionally, you can view detailed information, compare plans, and complete the enrollment process at the federal Marketplace website at https://www.healthcare.gov.

As you may have read, the federal government announced that it will stop reimbursing insurers for Cost Share Reductions (CSR) associated with major medical policies issued to Marketplace customers that meet the federal poverty level criteria.  This announcement did not result in any changes to the 2018 Arizona Marketplace plan rates for Open Enrollment.

Families with children should be aware that the federal government made some changes to the “child” premium rate calculations which will result in higher premiums for children.  This will have the greatest impact on families that do not qualify for the premium tax credit.  For an explanation of how rates for children will be changing, please read our Frequently Asked Questions document.

Under Arizona state law, the Department of Insurance is not given the legal authority to approve or disapprove the major medical health insurance rates filed with us.  Instead, the Department’s role is to review the rate filings and confirm that valid, detailed financial and actuarial justification (as required by federal and state law) is provided and any change in the rate is found reasonable by these standards.  In order to perform that review, the Department engages independent actuaries to scrutinize the rate filings in depth to confirm compliance with the laws and regulations.  You can read the insurers’ justification of their rate increases and a narrative describing the data and assumptions that the insurer used to develop its rate (a consumer justification) by visiting https://filingaccess.serff.com/sfa/home/AZ.   Visitors can also see a list of all rate change filings (On and Off Marketplace, Individual and Small Group) on the Department’s Health Insurance Rate Information webpage.

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Introducing Keith Schraad

Governor Ducey appointed Keith Schraad to serve as Interim Director of the Arizona Department of Insurance (“ADOI”), starting Monday, February 12.