Press Release 2000-10 Director of State Insurance Department Advises Medicare + Choice Members to Understand Rights Before Making Changes

NEW AGENCY


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630


Starting July 1, 2020, we became the
Department of Insurance and Financial Institutions (DIFI).


Media Contact: Don Harris, Public Information Officer, (602) 912-8402

For Immediate Release June 23, 2000 

Arizona Insurance Director Charles R. Cohen advised Medicare beneficiaries that although some of them are receiving notice that they will be losing their Medicare HMO coverage after Dec. 31, 2000, they will have full coverage until the end of the year and do not need to take any immediate action.

At least one Medicare + Choice HMO recently announced that it plans to withdraw from certain Arizona counties at the end of this year. Similar announcements from other Medicare + Choice HMOs may follow in the next two weeks. However, Cohen advises Medicare beneficiaries enrolled in these plans to understand the options before making any changes in their Medicare coverage.

Some Medicare beneficiaries who lose their Medicare HMO coverage on Dec. 31, 2000, have the option of switching to a different Medicare HMO. All Medicare beneficiaries always have access to original fee-for-service Medicare. In addition, many will have the right to purchase a “guaranteed- issue” Medicare Supplement policy for a certain time. A Medicare Supplement policy is designed to supplement original fee-for-service Medicare. While some Medicare Supplement plans provide prescription drug coverage, the plans that are available under the guaranteed issue rules do not provide drug coverage. “Guaranteed issue” means the insurance company can’t turn you away, Cohen explained.

Although Medicare + Choice HMOs are announcing their plans for 2001 now, official notice to affected members will not be mailed until fall. In late September or early October, affected members will receive an official termination notice from their plan. This letter will provide more information to consumers about their options. Consumers should save these termination letters, because if they decide to buy a guaranteed-issue, Medicare Supplement policy they will need to send a copy of the letter with the application to the Medicare Supplement insurance company. Some plans may send a letter this summer to members, announcing the changes, but the official termination letter will arrive in the fall. It is this official termination letter that triggers the “guaranteed issue” time period.

Here are the options:

  • When consumers receive an official notice of termination from the Medicare + Choice HMO, they will have a 63-day window to purchase a guaranteed-issue Medicare Supplement Plan A, B, C, or F without any exclusions for preexisting conditions or a waiting period. The 63-day open enrollment period begins on the date of the termination letter.
  • Or, if they wait until the end of the year when their coverage expires, they can purchase a Medicare Supplement policy during the first 63 days of 2001. This supplement insurance is available from any insurer that markets the four plans listed above, as long as the beneficiary applies for the plan before March 4, 2001.
  • Or, the consumer can join another Medicare HMO plan that still accepts new enrollees, if there are other HMOs in the county where that consumer lives.

Arizonans who already have original fee-for-service Medicare will not be affected by the HMO changes. The recent notices affect only those individuals who receive their coverage through a Medicare HMO.

To help Medicare beneficiaries sort through the confusion, Arizona has a State Health Insurance Assistance Program, (SHIP). Medicare beneficiaries and any consumer can dial 1-800-432-4040, a statewide toll-free number, to obtain free counseling on available options. The SHIP program has trained counselors who can give callers facts and information regarding Medicare, Medicare + Choice plans, and Medicare Supplement (also known as Medigap) insurance plans. The SHIP program is administered through the Aging and Adult Administration at the Arizona Department of Economic Security.

“The best advice we can give Medicare Beneficiaries is to stay put for right now and wait until they receive their official Medicare + Choice termination letters in the fall before taking any action,” Director Cohen said. “Medicare + Choice HMO enrollees can continue to use their same doctors and hospitals until the end of the year, even if their coverage will end Dec. 31, 2000. We recommend that consumers get all the facts before making any decisions. The staff at the State Health Insurance Assistance Program can be very helpful and we strongly recommend consulting them.”

Consumers can also obtain information by calling 1-800-MEDICARE (1-800-633-4227) or on the Internet at www.medicare.gov which is the federal government’s web site. A list of insurers who have approved Medicare Supplement policies or who are authorized to offer Medicare HMO coverage in Arizona is available from the SHIP program at 1-800-432-4040.

In addition, Medicare beneficiaries can learn more from The 2000 Guide to Health Insurance for People with Medicare, available from the SHIP program or from the Arizona Department of Insurance Consumer Affairs Division at (602) 912-8444 or statewide at 1-800-325-2548.

-30-



Period: 
2000
Priority: 
10
Insurers Offering Individual Health Insurance in Arizona

Lists insurance companies that are offering health insurance to individuals and families in Arizona in 2020.  Open enrollment starts November 1st and now runs through December 17th, 2019.  Individuals can start shopping for coverage now at healthcare.gov or cuidadodesalud.gov (Spanish)

Notice of Proposed Rulemaking - Corporate Governance Annual Disclosure Model Regulation In 2019, the Arizona Legislature adopted the NAIC Corporate Governance Annual Disclosure Model Act at Arizona Revised Statutes (“ARS”) by enacting the Corporate Governance Act at Title 20, Chapter 2, Article 16 (Laws 2019, 1st Reg. Sess., Ch. 180, § 1).   The Department of Insurance (“Department”) seeks to adopt the correlate Corporate Governance Annual Disclosure Model Regulation.  ARS § 20-492.02 allows the Department to adopt rules to carry out the Act upon notice and an opportunity to be heard.  The Legislature has exempted the Department from Title 41, Chapter 6 for one year after the effective date of the Act.  (Laws 2019, 1st Reg. Sess., Ch. 180, § 2.)
Arizona's Surprise Bill Resolution Report for 2019

As shown in the attached report prepared pursuant to A.R.S. § 20-3118(A), the Department of Insurance received 91 requests for dispute resolution in Calendar Year 2019.  Of those, 53 have been resolved or closed, and health plan enrollees saved $41,538 by submitting their surprise bills for resolution.  

Not all health care bills qualify for the surprise bill resolution process.  The Department's Suprise Out-of-network Billing Dispute Resolution website (https://insurance.az.gov/soonbdr, and especially the section entitled, "I got a surprise bill. Can I submit a request for arbitration?") lists conditions when a health care bill may not qualify under Arizona law for the dispute resolution process.  But for those that do, the enrollee will only be responsible for paying the enrollee's cost-sharing amounts (copay, coinsurance and deductible) if the enrollee provides information the Department needs, and participates in an informal settlement teleconference with the health care insurer and the health care provider.

Fire Readiness and Your Insurance Coverage

Complete three steps to be prepared

STEP ONE: Inventory your contents. 
Making a record of what you have provides two major benefits.  First, it could help you estimate the cost of replacing your contents, which you could use to make sure you have enough insurance coverage.  Second, it will help you identify missing or destroyed items if you need to file an insurance claim. Keep your inventory records in a safe place outside your home, such as a safe deposit box at a bank, or in a secure online location. 

  • The National Association of Insurance Commissioners (NAIC) has a free app called, “MyHome Scr.APP.book,” available from Google Play and from the Apple App Store, which can help you keep track of your personal property. 
  • The Insurance Information Institute provides advice that can make creating a home inventory easier (https://www.iii.org/article/how-create-home-inventory).

STEP TWO: Understand what your homeowners’ insurance policy covers.
If you do not have your policy on hand, get a copy from your insurance company or insurance agent. Then, make sure your policy provides enough coverage for your dwelling, contents and additional living expenses.

  • Dwelling Coverage:  This pays to reconstruct your home, from ground up if necessary.  It does not include the cost of the land on which your home sits because you will still have that, but it should include the cost to remove a destroyed structure and replace it a home that is similar to what you had prior to the fire.
  • Contents Coverage:  This pays to repair or replace your personal belongings. Your policy may provide contents coverage based on a set percentage of your dwelling coverage, but you can pay for more contents coverage if you think you need it. 
    • Check to see if your coverage will pay “actual cash value” or “replacement cost.”  Actual cash value (ACV) means what an item was worth when it was destroyed based on its initial cost minus depreciation or loss in value due to its age, condition and wear-and-tear.  Replacement cost (RC) means the cost to replace or repair damaged or destroyed property with materials of “like kind and quality”. Claims for damaged or destroyed items will initially be paid based on the ACV of the item.  When the item is replaced, a copy of the receipt must be provided to the insurance company to obtain payment of the balance owed.  Many policies require the damaged items to be replaced within six (6) months.
    • If you have expensive items, such as artwork, jewelry or computers, you can purchase or increase “scheduled” property coverage to make sure you have sufficient coverage for those items.
  • Additional Living Expense (a.k.a. Loss of Use) Coverage. This pays additional costs you may resulting from the property damage.  For example, if you are not able to live in your home, your policy may cover the costs of lodging and food, boarding your pets, etc.

Importantly, insurance policies are often lengthy, detailed documents.  Do not hesitate to contact your agent or insurance company representative if you have any questions. 

STEP THREE: Minimize your fire risk.
Periodically inspect your home for overloaded power strips, damaged electrical cords or other potential fire hazards.  Keep vegetation and combustible materials away from your home.  If you are in an area that is at higher risk for wildfire, follow “Avoiding Wildfire Damage” guidelines published by the Federal Emergency Management Agency (https://www.fema.gov/pdf/hazard/wildfire/wdfrdam.pdf). 

Remain organized and keep good records

If you are the victim of a fire, remaining organized after an event can be difficult, but it is essential so that you can receive the benefits that your insurance coverage provides.

  • Keep all receipts for living expenses (housing, food, etc.) and for all items that you replace or repair.  Insurance companies may require that you submit original receipts. You should either copy, scan or take clear photos of receipts to provide yourself a backup. 
  • Take photos of your property and the damage.
  • Keep records of all your conversations, emails and letters about your claim with your insurance company and agent.  Take notes of conversations, documenting who you talked to, when you talked to them and what you were told. When possible, send an e-mail message to the person with whom you had the conversation to confirm your understanding of what you were told.
  • Do not throw away or destroy damaged property until your insurer inspects the property and tells you in writing/e-mail that you can do so.
  • Take an inventory of the damaged contents.  If you have an inventory from before the fire, use it to help identify items that were damaged/destroyed. 
  • When the insurer inspects the damage, do a complete walkthrough of your property and point out any issues or concerns you have.
  • When beginning the repair process, get multiple repair estimates from licensed contractors (look up records on the Arizona Registrar of Contractors “Contractor Search” page at https://roc.az.gov/contractor-search) with good reputations (look up records on the Better Business Bureau website at https://www.bbb.org).
  • Don’t delay.  Insurance policies generally have restrictions on how long after a fire you can file claims.

Persons with disabilities may request materials in an alternative format by contacting our Americans with Disabilities Act Coordinator at (602) 364-0108. 

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