Q. Is there anything new or different that I should know this year about Open Enrollment for health insurance?
A. Great question. Yes, there are a few things.
Perhaps the biggest impacting change is the fixing of the so-called “family glitch” on the Individual Exchange. In previous years, the “glitch,” created by a federal IRS rule, prevented family members of an employee who had access to an affordable employer-sponsored health plan under the ACA from receiving subsidies to buy their own insurance coverage. This was due to the fact that the affordability question was based solely on the cost of health insurance for the covered employee, and didn’t include the cost of adding additional family members, which is more expensive.
This year, that “glitch” has been fixed through new federal rules allowing the family members of the employee to base the affordability of the employer’s plan on the total cost of covering both the employee and the additional family members under the plan, and not only the employee. If the plan is then not affordable based on this calculation, the family members will be eligible for premium subsides on the ACA Marketplace. The new federal rules will take place on December 12, but Exchange applications will be already completing this calculation during Open Enrollment.
It is also worth noting that Congress passed a bill over the summer which placed a cap on the monthly cost of insulin to Medicare Part D recipients to $35. Starting in 2023, Part D beneficiaries cannot pay more than that amount per month, regardless of whether or not they have met their deductible. The same bill also extended the granting of Advance Premium Tax Credits (APTC) to people over 400% of the Federal Poverty Level for another two years.
Finally, we have a new insurer on the Exchange in the dental market. Wyoming welcomes competition and hopes that the issuer will continue to write policies in our state for many years to come. So, take the time to compare insurers and policies and select the one which works best for you.
Jeff Rude, Wyoming Insurance Commissioner
I recently met with the Association of Wyoming Insurance Agents, where we had a great discussion and covered a wide range of topics. One thing I mentioned was the DOI’s increased attention to agent exams. I noted that over the past few years the number of exams had fallen off and that I wanted to focus on conducting more exams. Since there would be more exams, I wanted to be sure agents to know what we were looking for and what we have found in the past.
The purpose of producer and agency examinations is to assist the producer and/or agency in complying with the Wyoming Insurance Code and DOI regulations. If we identify any deficiencies, we will make corrective recommendations. If necessary, we will follow up to ensure changes are made.
In addition, we also want to acknowledge what is being done well. In the course of an examination, we will take note of best practices in place that go beyond mere compliance.
The Wyoming Insurance Code provides the statutory framework for producer and agency compliance, and is the basis under which examinations are designed. Some deficient findings from previous exams have referenced:
1. W.S. § 26-9-213; All producers must hold a current appointment with an insurer.
2. W.S. § 26-9-206(b); A business entity acting as a producer (i.e., an agency) is required to obtain a producer license.
3. W.S. § 26-9-206(b)(ii); Agencies shall specify a licensed producer responsible for compliance with the Code and DOI regulations.
4. W.S. § 26-9-207(f); Licensed producers shall inform the Commissioner of any change in name, address, phone number, or other contact information within 30 days of the change.
5. W.S. § 26-9-233; A producer doing business under any name other than the producer's legal name shall notify the Commissioner prior to using the assumed name. Note that this includes businesses/agencies.
6. W.S. § 26-9-229; All insurance financials must be accurately recorded and maintained.
7. W.S. § 26-9-228(c); Producers and agencies shall keep a record of all transactions for inspection at least three (3) years subsequent to the end of each transaction.
8. W.S. § 26-13-102; Unfair and/or deceptive trade practices prohibited.
9. W.S. § 26-13-110 & 26-13-112; Rebates and favors prohibited.
10. W.S. § 26-13-121; Illegal dealing in premiums and excess charges for insurance.
I hope this helps agents, brokers, and agencies understand the process and what we are looking for. If you have any questions about agent and agency exams that I may not have touched on, please feel free to call our office at (307) 777-7401.
Jeff Rude, Wyoming Insurance Commissioner
Jeffrey P. Rude
COMMISSIONER'S CORNER - PRODUCER QUESTION
Q. Can the Department of Insurance provide an opinion whether an insurer is engaging in rebating or improper promotional or marketing activities?
A. If you are an insurer or producer, you can submit a detailed written proposal to the department for review. Please allow reasonable time for a review to be completed before instituting a program that might be considered a violation of state law.
Below are the applicable Wyoming statutes:
W.S. § 26-13-102 ↗. Unfair methods and deceptive acts prohibited.
No person shall engage in this state in any trade practice which is defined in this article as or is determined pursuant to this article to be an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.
W.S. § 26-13-110 ↗. Rebates and favors as to life, disability and annuity contracts prohibited.
(a) Except as otherwise provided by law, no person shall:
(i) Knowingly permit or offer to make or make any contract of life insurance, life annuity or disability insurance, or agreement as to that contract other than as expressed in the contract issued thereon;
(ii) Pay, allow or give or offer to pay, allow or give in any manner as inducement to the insurance or annuity:
(A) Any rebate of premiums payable on the contract;
(B) Any special favor or advantage in the dividends or other benefits thereon;
(C) Any paid employment or contract for services of any kind; or
(D) Any valuable consideration or inducement not specified in the contract.
(iii) In any manner give, sell or purchase or offer or agree to give, sell, purchase or allow as inducement to the insurance or annuity or in connection therewith, and whether or not to be specified in the policy or contract, any agreement of any form or nature promising:
(A) Returns and profits;
(B) Any stocks, bonds or other securities, or interest present or contingent therein or as measured thereby, of any insurer or other corporation, association or partnership; or
(C) Any dividends or profits accrued or to accrue thereon.
W.S. § 26-13-112 ↗. Unfair discrimination, rebates and favors prohibited for property, casualty and surety insurers.
(a) No property, casualty or surety insurer or any employee or representative thereof, and no broker or agent shall pay, allow or give, or offer to pay, allow or give, in any manner, as an inducement to insurance, or after insurance has been effected, any valuable consideration or inducement of any kind not specified or provided for in the policy, except to the extent provided for in an applicable filing with the commissioner as provided by law.