Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts

Not a scam: SSA letters alert qualified Medicare clients about missed benefits

Wednesday, May 18, 2016


Starting this week, many Medicare clients will receive a letter from the Social Security Administration (SSA) telling them they may qualify for help with their out-of-pocket medical and drug expenses.

The Statewide Health Insurance Benefits Advisors (SHIBA) program encourages clients who receive these letters to take action to learn more about the Medicare Savings Program (MSP) and Extra Help. SHIBA is a free, unbiased program of the Washington State Office of the Insurance Commissioner.

SSA sends the letters annually to people on Medicare with limited Social Security incomes who could be eligible for — but are not enrolled in an MSP, which helps with Medicare out-of-pocket costs, or Extra Help, which helps with the costs of prescription drugs.

“These letters are not a scam,” said Todd Dixon, SHIBA program manager. “They are an important notification that Medicare clients should review and consider. We can help determine if they’re eligible, apply, enroll and even understand how to use their new benefits once they’ve been approved.”

Anyone who receives a letter—or who believes they or a loved one may be able to get help from these programs—should contact SHIBA for help at 1-800-562-6900.



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Medical insurance rates to go up

Monday, May 16, 2016

From the office of the Insurance Commissioner

Thirteen health insurers have filed 154 individual health plans for 2017 both inside and outside of the Exchange, Washington Healthplanfinder, with an average requested rate change of 13.5 percent.

Nine of the 13 insurers intend to sell individual plans inside the Exchange and four will only sell plans outside of the Exchange.

“The requested rate changes are not a surprise, as we expected insurers to make adjustments based on their earlier predictions compared to who actually signed up and what services they used,” said Insurance Commissioner Mike Kreidler. “Clearly, some of the insurers guessed better than others. We know that no one wants to see their rates go up. We will review each plan carefully over the next several months to see that rate changes are justified.”


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How to get health insurance if you missed open enrollment

Monday, February 29, 2016

From the office of the Insurance Commissioner

If you missed open enrollment and didn't sign up for health insurance by Jan. 31, 2016, you may have to wait until next year's open enrollment period, unless you have a life event that makes you eligible for a special enrollment or you qualify for Apple Health (Medicaid).

Such events include, but are not limited to:

  • Losing health insurance, including an employer plan or individual health plan 
  • Losing Apple Health (Medicaid) because you no longer qualify 
  • Giving birth to or adopting a child 
  • Permanently moving to a new area where your current plan doesn't provide coverage 
  • Your employer not paying your COBRA premiums on time 
  • Your COBRA coverage ending or reaching the lifetime limit 
  • Your dependent turning age 26 and losing their coverage on your employer plan 
  • Getting married or entering into a domestic partnership 
  • Getting divorced or ending a domestic partnership 
  • Cancelling your Washington State Health Insurance Pool (WSHIP) coverage 
  • Your health plan no longer being offered for sale in Washington state 
  • Most special enrollment periods are limited to 60 days from the qualifying event. 

Keep in mind that you do won't qualify for special enrollment if you voluntarily cancel your health insurance or if your insurer cancels you because you didn't pay your premium.

Next year's open enrollment for individual and family coverage starts Nov. 1, 2016.



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Insurers should be current on emerging treatments for consumers

Saturday, February 6, 2016

Insurance Commissioner
Mike Kreidler
Washington state Insurance Commissioner Mike Kreidler, Blog Post

A growing concern for consumers and health insurers is the cost of prescription drugs and specifically, treatment for debilitating and life-threatening diseases.

Hepatitis C is a good example. New drugs are now used to cure this life-threatening liver ailment with proven success. But the pills are costly, ranging from $55,000 to almost $95,000 per patient for a standard 12-week treatment period.

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, now recommend that most patients receive treatment even if they are in the early stage of the disease versus waiting until it has progressed.

Last November, the federal government encouraged states to ensure that health coverage policies are “informed” by the treatment guidelines noted above.

Unfortunately we do not have the authority to mandate that insurance companies abide by the guidelines. However, we do expect insurers to be current on all appropriate guidelines that best serve consumers. That is true for all types of treatments.

We recently asked health insurers in Washington if they were aware of the new guidelines and if they were making any changes to how they were treating patients with this disease. The responses were varied, but there were common themes:
  • No company excludes treatment.
  • All allow testing to detect the disease.
  • All recommend that patients consult their doctors on the best course of action. 

What’s also evident is that insurers are trying to manage their claims costs. That’s not unexpected. Future prescription drugs for ailments such as multiple sclerosis and high cholesterol are expected to cost even more than the hepatitis C treatment.

The emphasis for insurers, though, should be on ready access to appropriate treatment that leads to a healthier state and nation overall.

If you believe you’ve not getting access to prescription drugs or other necessary treatment, we can help you understand your rights to appeal and even contact your insurer on your behalf.



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My insurance premium went up. How can I find out the reason for the increase?

Friday, January 29, 2016

From the Office of the Insurance Commissioner

Consumers frequently ask us this question. Your agent or insurer should be able to provide you with an explanation other than “there was a general rate increase.” We recommend that you obtain a policy-specific premium breakdown directly from your agent, and that you ask for a rate worksheet comparison between your old premium and your new premium. 

Every policy is priced differently, depending upon the type of coverage you want and what are called underwriting factors.

Underwriting factors for auto insurance may include:


  • Household/family driver records.
  • Driver(s) age(s).
  • Type of vehicle(s).
  • The number of miles you drive per year.
  • Where you live and/or drive your car.
  • Level of coverage being purchased
  • There may be surcharges or discounts unique to your situation.
Underwriting factors for homeowner’s insurance may include:
  • The age of your home.
  • The materials used to build your home.
  • Your home’s value, as based upon its size and features.
  • Your home’s location.
  • Prior claims or losses for the home.
Read more about understanding auto insurance and understanding home insurance.

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



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Homeowners, insurers have responsibilities in repair claims

Monday, January 11, 2016

Photo by Steve Franco-Ross

From the Office of the Insurance Commissioner

We often hear from consumers who are concerned about their home repair or rebuild insurance claims and have questions about their insurer's role in overseeing the contractors' work.

Your insurance company is responsible for paying the claim, as laid out in your homeowner policy.

Typically, it is your responsibility to oversee the project with your contractor, and when applicable, your lender. The exception would be if your insurance company has given you assurances or if your policy contains a provision that obligates the insurer to manage a covered home repair or rebuild.

However, if you are using an insurer’s recommended (sometimes called “preferred”) contractor, you should expect assistance from the insurer in answering your questions about the contractor’s actions and performance.
Many insurers also require the homeowner to stop the damage from getting worse -- this is called loss mitigation in your policy. If you don’t mitigate the loss, you could be on the hook for paying for any resulting additional damage.

For example, if you have water damage in your home, you must control it as soon as you discover it. If you let it go until you get around to calling your insurance company, you will be responsible for any resulting damage, including rot, mildew or mold. Even if you use an insurer's preferred contractor, you are still responsible for mitigating the loss prior to the contractor showing up and starting the repairs. 
More information:
Questions? You can contact consumer advocates online or at 1-800-562-6900.



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Is there a drone on your shopping list? You might want to talk to your agent or broker

Friday, December 18, 2015


From the Office of the Insurance Commissioner

The Federal Aviation Administration (FAA) estimates more than one million drones will be sold this holiday season. Everyone from photographers and farmers to law enforcement and hobbyists are using drones. Whether for personal or commercial use, there are a number of insurance issues to consider ranging from personal injury and property damage to privacy concerns.

Drones present a significant risk to property and life on the ground in the event of an accident. Drones can crash due to faulty and inappropriate operation, mechanical defects and component failure. Losses and damages could involve bodily injury to humans and animals as well as buildings and structures.

Using a private drone as a hobby is generally covered under a homeowner’s insurance policy —and subject to a deductible -- which typically covers radio-controlled model aircraft. This also applies to a renter's insurance policy. Look at the contents section of your policy, or talk to your agent to see if your drone will be covered if it is lost, stolen or damaged. If your drone falls onto your car, damage to your car may be covered if you have a comprehensive coverage auto policy.

A larger concern is liability for an accident caused by your drone if your drone crashes into someone else's vehicle or a person. If you have a homeowner’s or renter's policy, generally the policy will cover liability for an accident caused by your drone if it is determined that you were negligent and at fault. Check with your agent or insurer to verify your policy contains this important coverage. You can also read a story about drone insurance that was recently posted on the Insurance Journal’s website.

Drones are defined as remotely piloted aircraft systems and the FAA says pilots of unmanned aircraft have the same responsibility to fly safely as manned aircraft pilots. In addition to FAA regulations, state and municipalities may have their own laws regarding drone use.

The FAA has issued these guidelines for drone hobbyists:
  • Don't fly higher than 400 feet and stay clear of surrounding obstacles. 
  • Keep the aircraft in sight at all times. 
  • Stay away from manned aircraft operations. 
  • Don't fly within five miles of an airport unless you contact the airport and control tower before flying. 
  • Avoid flying near people or stadiums. 
  • Don't fly an aircraft that weighs more than 55 pounds. 
  • Use caution when flying your unmanned aircraft. 
  • With some drones weighing up to 55 pounds, a fall from the sky can cause significant damage to property or bystanders. 

Recently, federal regulators announced that recreational drone operators will soon need to register their aircraft. This will allow authorities to trace a drone back to the owner, which means it is vital that you are in compliance with laws and regulations and have the appropriate insurance coverage.



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No health insurance for 2015 or 2016? You may be facing a tax penalty

Saturday, December 12, 2015

From the Office of the Insurance Commissioner

If you can afford health insurance but you choose to not enroll in coverage for 2016, you may be required to pay a fee when you file your 2016 federal income taxes. The fee is also called a penalty, fine, or the individual mandate.

A few facts about the individual mandate:

The fee is calculated one of two ways. The fee for not having health insurance if you can afford it is $695 per person in your household who doesn’t have health insurance or 2.5 percent of your income – whichever is higher. HealthCare.gov has a guide to estimate the fee you’ll have to pay if you don’t have health insurance.

The fee for 2015 is lower than for 2016. For 2015, the fee for not having health insurance if affordable insurance is available to you is $325 per person or 2 percent of your annual household income – whichever is higher. The fee is calculated based on the number of months you, your spouse, or your tax dependents went without qualifying coverage, such as an employer-sponsored health plan, Medicare, Medicaid or coverage through Washington Healthplanfinder.

In some cases, the fee may be higher than buying health insurance through Washington Healthplanfinder. You can look at plans and find out if you qualify for help here.

For some people, exemptions from the fee are available. People with very low incomes and individuals who meet other specific conditions can receive an exemption from the requirement to have health insurance and will not have to pay the fee. Additional information about exemptions and a tool that helps you determine if you qualify for an exemption is available on HealthCare.gov.

If you need health coverage and want to avoid the fee for 2016, the deadline to enroll in a plan is January 31. If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes. If you want coverage that starts on Jan. 1, you need to enroll by December 23.

More information about the individual mandate on the Internal Revenue Service's (IRS) website.



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Insurance Commission to review proposed Group Health acquisition by Kaiser Permanente

Friday, December 4, 2015

From Washington State Insurance Commissioner Mike Kreidler

Group Health Cooperative, a health insurer based in Washington, notified the Office of the Insurance Commissioner (OIC) on December 3 that it will be acquired by Kaiser Permanente. The proposal requires approval of the insurance commissioner. That review, which is expected to be lengthy, will begin once the insurance commissioner receives a formal filing from the companies.

Kaiser Permanente is based in California and operates in several other states. It has more than 10 million policyholders nationwide.

This proposed deal is one that my office will examine closely when we see the formal filing. Our examination process will look closely at how this proposal could affect the overall stability of the health insurance market in Washington, including competition and consumer choice.

My chief concern is protecting consumers in Washington, including policyholders at Group Health and all consumers buying health insurance in Washington. I want to ensure that we maintain the healthy competition and wide selection of plans we currently have in our state.

At this time, I expect no changes in policies for current enrollees in Group Health plans or those considering enrolling in plans for 2016.



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Mold, mildew, rot typically not covered by homeowner’s insurance

Sunday, November 15, 2015

From the Office of the State Insurance Commissioner

Living in the Northwest, it is not unusual for homeowners to discover mold, mildew or rot damage to their homes as a result of things like a leaking pipe, a hole in the roof, a failing window seal or improper venting.


Such damage is considered wear and tear and is typically not covered by homeowner's insurance.

Insurance is designed to cover sudden and accidental damage caused by specific perils, such as a windstorm, fire or explosion. Some policies may cover mold or mildew damage discovered and reported within two weeks of the leak that caused the damage and some insurers offer limited mold coverage.

Consumers should check their policies to find out what is covered.  

We do hear from consumers who are unhappy to find out this type of damage is not covered by their insurance. If the policy specifically excludes such damage, we can't compel the company to pay for the repairs.
Here are some perils that homeowner's insurance policies typically do not cover:
  • Earthquakes
  • Floods
  • Mold damage
  • Damage due to animals or rodents
  • Foundation settling 

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



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What to consider before picking a health plan

Wednesday, November 4, 2015

Most people shopping for health insurance look at the monthly premium first, but there other factors to consider if you want to get the best cost and coverage deal.

Fifteen health insurers are selling 210 health plans for the 2016 individual market and, while all plans must include the same essential health benefits, the plans differ greatly in deductible amounts and which medical providers are included in their networks.

“Most people are motivated to keep their premium monthly costs down when shopping for health insurance, and that’s understandable,” said Insurance Commissioner Mike Kreidler. “But paying attention to how the health plan’s deductible works and what you will have to pay to see certain providers can be just as important in keeping your costs down over the long run.”

What to consider before picking a health plan: 

  • 2016 health plans have deductibles ranging from $500 to $6,850. 
  • Some plans have a separate deductible for prescription drugs. 
  • Know what services are subject to the deductible. Most plans must cover preventive services at no cost to you. Also, some plans allow you to see your doctor, obtain generic drugs, and even receive some specialty care and lab tests before you’ve met your deductible. 
Provider networks
  • Find out if your medical providers are part of the plan’s provider network. 
  • Understand what you will pay if you use out-of-network providers. 
  • Prescription drug coverage 
  • Review the plan’s drug coverage and understand the difference in costs to you between any drug tiers the insurer uses. 
  • Learn about any restrictions in coverage for preventive care. For example, most plans will not cover preventive care if you receive it from an out-of-network provider. 
  • Review coverage for emergency room services. 
See 2016 health plans and their rates by county.



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Do you need flood insurance? Now is the time to do your research

Thursday, October 29, 2015

From the Office of the Insurance Commissioner

Flood damage is not covered by homeowner’s insurance. Consumers who want to protect their property must purchase a policy through the National Flood Insurance Program (NFIP). Most properties qualify for NFIP, as long as it is located in a community that participates in the NFIP.

Typically, there is a 30-day waiting period before your flood insurance policy takes effect.

Read more about flood insurance: Are you protected against flood damage?

Local agent:

Ryan Woodward
Email Ryan Woodward

Woodward-Scott Agency


PO Box 55337
18336 Aurora Ave N Ste. 101C
Shoreline, WA 98133
Phone Numbers:
Direct (206) 367-2244
Fax (206) 367-2662
Specialties:
Residential, Rental, Commercial



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Nationwide health insurance nudged into compliance with state regulations

Tuesday, September 22, 2015

Nationwide Life Insurance Co.,  of Columbus, Ohio filed health insurance rates and plans to sell to students at six Washington state universities and all state community colleges for the 2015-16 school year that did not comply with state requirements.

Rather than disapprove the plans and leave thousands of students without health insurance just before the start of the school year, the Washington State Insurance Commissioner agreed to temporarily approve the plans and refrain from issuing an enforcement action against the company.

Nationwide agreed to bring the plans in line with state insurance requirements by September 30 and refile them with the Insurance Commissioner, communicate to students that their plans are changing with agreed-upon language, adjust the rates appropriately, distribute updated policies to all students by October 30 and file its rates and forms properly for the following school year by January 1, 2016. 



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Life insurance mail scam

Sunday, August 9, 2015

From the Office of the Insurance Commissioner

Some Washington residents are receiving mailers from National Processing Center advertising a “state-regulated life insurance program to pay Final Expenses for just pennies a day… Return this card today and you will receive the latest information on how this Special Program will pay 100% of all funeral expenses not paid by government funds, up to $25,000 (TAX FREE), for each Washington citizen covered.”

This is a mail phishing scam and we are alerting consumers to not return the card or provide any personal information.

Here’s what the mailer looks like:


Here are some red flags we identified in this mailer that consumers should be aware of:
  • The mailer doesn’t identify the name of the insurance company.
  • The mailer doesn’t give an agent or broker to contact. 
  • The card gets returned to “National Processing Center,” which is not an insurance company. 
  • The mailer gives no information about the policy. 
  • The Virginia Better Business Bureau issued a consumer alert about the mailings in 2013.
A handful of companies are authorized to sell final-expense life insurance policies in Washington, which typically are purchased to cover funeral expenses.

Before you buy any insurance, you should make sure the person or company selling the policy is licensed to do business in this state. If you are interested in finding one of the companies that sells final-expense life insurance, you can contact our consumer advocates at 1-800-562-6900 for a list.




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Car insurance scam

Tuesday, August 4, 2015

Don’t fall for Pay My Deductible offer for auto accidents 

Insurance Commissioner Mike Kreidler is alerting Washington consumers to be wary of any solicitation from the Pay My Deductible Club, which offers to pay your auto insurance deductible if you are involved in an accident. 

Several payment options, including a lifetime membership, are offered to join the club and become eligible for the deductible payments.

The company claims to be based in Beverly Hills, CA. However, the firm is not licensed in Washington and is not authorized to do business here. 

Although the company claims its deductible benefit is not insurance, the commissioner sees otherwise. To offer this product in Washington, the firm would need to apply for and receive approval to operate as a property and casualty company. 

Other states have also alerted consumers about Pay My Deductible.

Some tips to consider if you do receive a solicitation from Pay My Deductible or any other company seeking to sell you an insurance product or one that sounds like it could be insurance:

  • Check the Washington Secretary of State’s website to see if the company is registered. 
  • Search the OIC website to determine if the company is authorized to sell insurance in Washington. 
  • Check the company’s website. If you get an error message such as “under construction” or that the security certificate is registered to another entity, consider those red flags. 
  • Don’t give out any bank account information if you are suspicious about a company. If you've received an offer for this product, contact the OIC office and they will investigate.


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Are insurers allowed to cancel homeowner's policies?

Tuesday, July 28, 2015

Fire hazard?
From the Office of the Insurance Commissioner

Unfortunately, yes, an insurer can cancel or choose not to renew your homeowner policy at any time. 

Insurers are required to send you a written notice 45 days in advance, clearly listing the reason(s) for their actions. They are only required to give 10 days’ notice if the reason is nonpayment.

Insurers are not prohibited from making a decision to cancel or not renew a homeowner policy due to claims history, the condition of your property, or failure to respond to their requests for underwriting data from you.

Last summer, a few homeowners reported their insurers wanted to cancel their policies for homes located in the wildfire region in Eastern Washington. Insurers can also ask you to make changes to your property to remain insured, such as removing vegetation to create a fire break around your house, cleaning or repairing your roof, or making repairs to worn siding, etc. 

Your insurance agent may be able to work with the insurer to retain coverage, possibly with a higher deductible or some other provision, such as a home inspection report that would provide the insurer with more information about the overall condition and care of the home and property. There’s no guarantee the insurer will continue the coverage, but it’s worth asking the question.

If you are unable to find coverage, you can get a quote from Washington Fair Access to Insurance Requirements (FAIR) Plan. It provides basic property insurance up to $1.5 million to people who can't get coverage. All Washington property insurers must participate and consumers must get a quote from a licensed insurance agent. Find a licensed insurance agent or broker

Read more about what to do if your policy is canceled. Questions? You can contact our consumer advocates online or at 1-800-562-6900.



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Insurance Commissioner's Office needs your help with its Medicare webpages

Saturday, April 25, 2015

The Insurance Commissioner's Office is in the process of conducting a usability study on the agency's Medicare webpages. To help them organize the pages and content more efficiently for consumers, they would like the help of those on or approaching Medicare.

All it takes is 10-15 minutes to take a simple online survey. The survey is open through May 1. Your feedback is very important, so please help us out!


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Insurance Commissioner: Warranties - know what you are paying for

Tuesday, March 10, 2015

From the Office of the Insurance Commissioner

Consumers can buy warranties on any number of products these days, ranging from a new vehicle to a small gadget or appliance. Before you lay down more money for a warranty, here are a few things you should know: 

  • Be sure you fully read any warranties before you buy them and don't be afraid to ask questions if something you read needs clarification. 
  • Warranties do not cover all damage. For example: Vehicle warranties may exclude damage related to after-market modifications to engines, power trains or suspension systems. If you buy a used vehicle that comes with these types of modifications, the warranty may not cover damage to or in the event that those modifications fail. Be sure you understand the limitations of any warranty you are thinking about buying. 
  • Some warranties require you to pay a fee or copayment if you need to use the warranty. For example, smartphone warranties often require you to pay a fee each time you use them. 
  • Do the math. Weigh the cost of the warranty over the time period it covers. Would it cost you the same or less money to replace the item if it broke during the warranty period? 
  • Does your homeowner or renter's insurance cover the item? Your policy may cover you if the item is stolen or destroyed in a fire or other incident. Check your policies and deductibles first, and remember that insurance policies typically don't cover damage to items that you break. 

Read more about warranties and service contracts on the OIC website. Questions? You can contact consumer advocates online or at 1-800-562-6900.



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State fraud unit saves $3.3 million in fake claim payouts including one to Lake Forest Park resident

Friday, February 27, 2015

Insurance Commissioner Mike Kreidler’s Special Investigations Unit (SIU) saved insurance companies $3.3 million in fraudulent insurance claim payouts from Jan. 1, 2012 through Dec. 31, 2014.

In its periodic report to the Washington Legislature, Kreidler’s insurance fraud unit lays out the results of its work during calendar years 2012 through 2014:
  • Received 5,745 referrals from the public, the National Association of Insurance Commissioners and the National Insurance Crime Bureau.
  • Investigated 141 criminal cases across Washington, resulting in 54 convictions.
  • Convictions resulted in more than $2 million in restitution ordered to be repaid to victims.
  • The bulk of cases originated in King and Pierce counties.  
“My Special Investigations Unit is a key part of protecting Washington consumers,” said Kreidler. “Industry estimates peg 10 percent of insurance claims as fraudulent, and those costs get passed on to consumers in the form of increased premiums. My message to people who would defraud insurance companies is this: We will come after you if try to get away with it in Washington state.”

Some of the cases that drew media attention included:
  • Kenneth Welling, a registered surgical technologist from Lake Forest Park who billed insurers as a physician’s assistant or surgeon, which is a higher billing rate. He billed $7.4 million in claims between 2004 and 2012.
  • Yevgentiy Samsonov, who made a false claim of $20,000 to PEMCO for the death of his fictitious cat in a car accident in Tacoma.
  • Kevin Kolenda, an unlicensed insurance producer from Connecticut who sold hole-in-one policies to golf tournaments over several decades in numerous states. Many of his victims were charities that lost money when he failed to pay prizes for holes-in-one. He was charged for failing to pay the prizes for two Western Washington tournaments and served 89 days in King County jail and was ordered to pay $35,000 in restitution.
  • Attorney Edward Joseph Callow and insurance adjuster Fariborz Rahrovi, both of Seattle, defrauded an accident victim out of more than half of a $500,000 insurance settlement.

Kreidler’s Special Investigations Unit investigates insurance fraud and works with the Attorney General’s Office and local prosecutors to prosecute criminal cases. Consumers can report suspected insurance fraud on the Insurance Commissioner’s website.

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Less than two weeks left to enroll in health plan for 2015

Tuesday, February 10, 2015

The last day to enroll in a health plan for 2015 is Feb. 15. Coverage takes effect March 1 if you enroll before 11:59 p.m.

If you qualify for a subsidy or Medicaid, you should obtain health insurance through the Washington Healthplanfinder, our state’s health benefit exchange. If you do not qualify for a subsidy, you can buy a health plan directly from an insurance company. Here’s a list of the plans that are available in Washington.

There are ways to qualify for a special enrollment after Feb. 15, including losing health coverage provided by an employer, adding dependents and consumers who had trouble enrolling through Washington Healthplanfinder. Read more about special enrollments.

Need more information?

    Get application quick tips from Washington Healthplanfinder.



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