2020 is an unusual election year, with many high-level outcomes still undetermined weeks after the polls closed. Despite this uncertainty, insurance industry stakeholders need to look ahead to the future. Thought leaders from Faegre Drinker’s insurance team participated in a post-election roundtable — and have helpful insights to share as we head into 2021.
The Alaska Division of Insurance recently ordered long-term care insurers to suspend enforcement of family member exclusions until December 15, 2020, or until such time that Governor Mike Dunleavy determines that the declared public health disaster emergency resulting from COVID-19 no longer exists. See Order R20-10 (November 16, 2020). In the Order, the Division expresses its determination that insureds be able to access their benefits notwithstanding family member policy exclusions due to the increased risk of exposure attendant to home health care providers traveling between households. The Division has extended similar orders during the pandemic, so this Order may be extended beyond December 15. Although the industry has become accustomed to COVID-19-related accommodations pursuant to orders from state regulators, the Division’s decision to suspend family member exclusions is a first during the COVID-19 pandemic and may present administrative and compliance challenges.
The NAIC Innovation and Technology (EX) Task Force met on November 4 to discuss proposed changes to the anti-rebating language in the NAIC’s Model Unfair Trade Practices Act (MDL-880). Drafting leaders used the meeting as an opportunity to address comments received in response to the August 10 draft, including comments from the American Council of Life Insurers (ACLI). The final comment period is open now through Wednesday, November 18, after which a final version of the amendment will be made available. The Task Force hopes to vote to adopt the final draft at the December 4 meeting.
Senior Health Insurance Company of Pennsylvania (“SHIP”) was placed in rehabilitation in Pennsylvania in January. As required by the Order of Rehabilitation, the Rehabilitator filed a Proposed Plan of Rehabilitation (the “Plan”) in April.1 Several interested parties, including three state insurance regulators, intervened in the rehabilitation proceedings in the Commonwealth Court of Pennsylvania (the “Court”). Other interested parties filed formal comments with the Court, generally expressing concerns about or opposition to the Plan. On October 21, the Rehabilitator filed an Amended Plan of Rehabilitation (the “Amended Plan”). When filing the Amended Plan, the Rehabilitator stated that it “addresses most or all of the material and substantial concerns raised in response to the initial Proposed Plan.”
The core of the Plan is charging policyholders the “If Knew Premium” for the benefits under their policies. The If Knew Premium is the rate that, if charged since inception, would have produced the greater of the initial target loss ratio or the minimum loss ratio applicable to the policy form. Policyholders would be offered options to increase premiums or reduce benefits so that they are paying the If Knew Premium for the benefits provided. Many objections to the Plan asserted that the Rehabilitator does not have the authority to implement rate increases without seeking approval from state insurance regulators. Under the Plan as originally filed, no such approval was contemplated.
We are less than a week from a presidential election, with control of Congress in play. Meanwhile, shifts in state legislatures have the potential to change the direction of policymaking and impact the redistricting process. And, 11 gubernatorial elections are on 2020 ballots. Plenty to watch.
That said, for insurance regulatory stakeholders, the top of the ticket in some respects is those insurance commissioners independently elected statewide. Here’s a rundown on that field.
Continue reading “Election Night for Insurance Geeks: 2020 Edition”
Overpayments in the long-term care insurance industry become more prevalent with each passing year, in concert with the increase of claims paid. Each year, insurers pay out hundreds of thousands of dollars on LTCi policies that are not owed. This not only results in financial loss, but also leads to over-inflated reserves. The problem persists because it is increasingly difficult for companies making the payments to obtain timely information and to identify issues. Many recipients of overpayments spend what they have been paid and have little else to recoup, while others have since died, and their estates/heirs/next of kin can be impossible to locate or deal with. If companies do not recognize this quickly, the recoupment process can be more complex.
Overpayments occur for a variety of reasons. The most common is simple mistake, miscalculation or clerical error. More complicated scenarios occur when evidence shows that an insured who has been receiving benefits should not have, for a variety of reasons. This latter occurrence, which may or may not include implications of wrongdoing or fraud, creates a complicating factor that may require a remedy at law if the recipient(s) is unwilling to re-pay the company when asked. We have recently seen a trend in overpayments where insureds have passed away, and their spouse/next of kin (or even caregiver) will request/receive benefits not owed.
There is a possibility that the structural and financial costs of caring for elderly Americans will become the issue that overwhelms all others in importance in the coming decades. Among the myriad issues and problems facing the United States at present, many politicians and policymakers have focused on issues that appear more immediate. As they do, however, the United States grows older and more infirm, all while birth rates fell to 1.73 births per female in 2018 and net immigration has fallen to the lowest levels this decade. Given the aging baby boomer generation, the current scenario has all of the makings of a serious demographic crisis. Among an aging population, dementia has become a very prevalent, very difficult, and very expensive illness that many confront, and so far little progress has been made on a cure. Indeed, The Economist, in its August 27, 2020 edition, published a special report on dementia that included the following statistics:
In this hectic year, insurers shouldn’t lose track of the National Association of Insurance Commissioners’ standards for data security. Which states have adopted the NAIC Model Law, and what approach has each state taken? Insurers should give careful consideration to the complex differences from state to state when it comes to data protection and reporting cybersecurity events.