Paul DuBois – Compliance Analyst

 Answers consumer inquiries about insurance and their legal rights  Investigates complaints filed against insurance companies  Educates citizens to allow them to make informed choices about their insurance needs and options

 9 Life & Health insurance analysts  7 Property & Casualty insurance analysts  7 Hotline specialists trained to triage and refer consumer calls for help to OIC’s Consumer Advocacy, SHIBA & the producer licensing program

 Recovered over $9.5 million for consumers  Responded to over 84,000 consumer calls  Mailed over 2,400 publications and consumer- related materials  Completed over 6,100 complaint investigations  Answered over 5,200 consumer requests for information

 General policy questions  Affordable Care Act  Shopping for ◦ health coverage ◦ life insurance ◦ annuities ◦ dental coverage ◦ small group coverage

 Fully insured health plans in Washington’s commercial individual, small, and large group market  Qualified Health Plans (QHPs) available through the Washington Healthplanfinder (our state’s Health Benefit Exchange)  Medicare Supplement plans

 Self-funded health plans through an employer or union trust  Health care providers  The Washington Healthplanfinder  Medicare A & B, D, or Medicare Advantage plans  Apple Health (Medicaid)  Federal employee benefit plans

If we don’t have the expertise or services a consumer needs, we refer them to others who do, including:  SHIBA  Washington Healthplanfinder  State and federal agencies  Private non-profit assistance  Insurance agents and brokers  Even insurance companies when needed

 Claim delays, denials, disputes  Coverage issues and appeals  Cancellations and renewals  Rate increases  Medical necessity issues  Company customer service issues

 Consumers ◦ Parents ◦ Children ◦ Attorneys ◦ Designated POA  Health care providers  Elected officials  Repair or service shop owners  Other state agencies  Producers (agents & brokers)

 s and online forms submitted via our website at  Filed online: Online Complaint Center ◦  Paper complaint form via mail, fax, We mail form to consumer or Consumer prints it from website

Complaint Received Does OIC have jurisdiction? Contact company and present complaint Refer to the correct agency or entity Review company response Provide you with an explanation of the company's response & our review Your complaint becomes part of the company’s record with our agency YES NO

The OIC’s insurance analysts:  Send complaints to insurance companies, who must respond within 15 business days  Review insurance company responses & evaluate according to RCW 48 and WAC 284  Advocate to reach resolutions  Communicate results and educate consumers  Refer insurer violations to OIC enforcement

Usually resolved within 30 days

 An L&D analyst helped a consumer who received a quote for a 50% coinsurance rate for a drug his wife needed for her cancer treatment. As a result of his work, the company learned the consumer was only responsible for paying 20% coinsurance charges. This saved the consumer $18,000.  A P&C analyst helped a consumer who was told by their insurer that their vehicle was a total loss. But after buying a new car, the consumer was told their totaled vehicle was repairable after all. Following receipt of the OIC complaint, the company decided to allow the total loss and paid $3,916 to the consumer.

Contact the OIC’s Consumer Advocacy Program We have insurance experts available to discuss your insurance options and concerns over the phone or via from 8 a.m. – 5 p.m. weekdays.