Sun Life Agrees to Change Its Use Of The Death Master File


Sun Life Agrees to Change Its Use Of The Death Master File

Insurance Commissioner Dave Jones announced a $3.2 million multi-state settlement with Sun Life. Sun Life joins 13 other life insurers that agreed to reform business practices to use the Death Master File database to search for deceased policyholders and make benefit payments. Sun Life will now compare all company records against the Death Master File to determine whether there are unclaimed death benefits, and has agreed to conduct a thorough search for beneficiaries to whom unclaimed benefits may be owed. Sun Life also agreed to make a payment, which will be disbursed among the states that participated in the examination. California will receive $325,000 for the general fund, as well as $150,000 for the state insurance fund. Calif., Fla., and a handful of other states are leading a national investigation of life insurers to ensure that life insurance companies are complying with the Unfair Claims Settlement Practices Act. Florida was the lead state on this examination.

Scammers Targeted Seniors 

Gregory Alan Steen, 53, was arrested in Clovis on 13 felony counts of grand theft, 13 felony counts of embezzlement and 12 felony counts of identity theft. Steen, a licensed insurance agent, was allegedly using clients’ funds for his own benefit. This scheme involved co-conspirators Sara Vann, 37, of Studio City, Patricia Ramirez, 40, of Clovis, and Lisa Bennett, 44, of Fresno. Steen, a partner in Soutas and Associates Insurance Services, LLC, allegedly charged one of his clients $1,500 to oversee her elderly father’s Veteran Affairs benefits and annuity funds, but failed to do so. Steen convinced his senior victims to make him the trustee on their trusts or executor of their wills, which gave him full access and control of their finances. Steen disregarded his customers’ wishes, and neglected to disperse estates to the intended beneficiaries. Investigators believe Steen targeted dozens of seniors and misappropriated more than $56,000 for his personal benefit. Steen and his co-conspirators also committed identity theft to get various annuities and coached their senior clients to hide assets in attempts to circumvent Medi-Cal eligibility rules to qualify or lower the senior’s share of cost of coverage. Steen was arrested January 30, and his license was suspended. But he continued swindling more seniors after his arrest and release from jail. Steen, Vann, Ramirez and Bennett will appear in Fresno County Superior Court, Department 33, on Tuesday, November 18, 2014 at 8:30 a.m. for a preliminary hearing. This case is being prosecuted by the Fresno County District Attorney’s Office.

Private Marketplace

PlanSource launched the True Choice Private Marketplace, a healthcare exchange for California employers formed through a partnership with leading brokers: The Centennial, Bolton & Company, and Sequoia. True Choice is the first multi-carrier exchange with online enrollment and decision support in the under-100 market in California. The PlanSource OneMarket Exchange provides one source for brokers, employers, and carriers to participate in the exchange type of their choice, ranging from a white-label exchange for those who want to build their own branded marketplace to a national proprietary exchange. For information, visit

Covered California Improves Open Enrollment

Open enrollment in Covered California began Saturday, Nov. 15. This round features the following improvements over last year according to executive director, Peter Lee:

  • A stronger outreach to African-Americans, Latinos, and Asian-Americans through targeted advertising in ethnic media.
  • New grants supporting outreach and enrollment activities in African-American, Latino, and Asian American communities as well as new community activities throughout the state.
  • Expanded Service Center hours. It is now open from 8:00 a.m. to 8:00 p.m. Monday through Friday and from 8:00 a.m. to 6:00 p.m. on Saturday. In addition, the Service Center will be open every Sunday from November 16 through December 15.
  • The addition of more than 200 storefronts across the state, operated by community groups partnering with Covered California. These storefronts are located in easy-to-find locations, such as shopping malls. This is in addition to the thousands of offices of insurance agents and partner enrollment organizations.

Covered California executive director, Peter Lee said, “We have more than 12,000 certified insurance agents, 10,000 county eligibility workers and 6,490 certified enrollment counselors ready to help educate and enroll consumers.” For more information, visit


What Doctors Want You to Consider Before Choosing a Health Plan

As open enrollment for 2015 exchange plans gets underway, the American Medical Association (AMA) urges patients to review the plans they are considering in order to prevent interruptions in care and higher out-of-pocket costs. Whether it’s a new plan or a renewal, patients should consider deductibles, co-pays, drug costs, which physicians and facilities are covered, and the cost of out-of-network treatment. Patients should ask whether their physicians are participating in plans they are considering. AMA President Robert Wah, MD said, “It is very important that patients look beyond the big print, color-coded plan designations and price of insurance plans and check the small print details before making their selection.” AMA asks patients to consider the following:

1) Are your family’s doctors in the plan? If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes? Is the plan’s directory of participating physicians up-to-date and accurate? Are there physicians on the list who are still accepting new patients?

2) What does the plan cover? What percentage of your health care costs will you have to cover? If so, how much and can you afford it? How much will you have to pay out of pocket for the medicines your family needs? Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work? Does the plan provide access to a sufficient number of specialists that you need?

3) Does your primary care physician have to get permission from the insurance company to refer you to a specialist? Does that rule include specialists you see regularly for a chronic condition? Does the insurer use penalties or incentives to induce physicians in the plan to limit referrals in any way?

For more information, visit

The Pitfalls of Enrolling in Medicare Part B

The Medicare Rights Center released a report detailing common enrollment challenges for people who are new to Medicare. The report, “Medicare Part B Enrollment: Pitfalls, Problems and Penalties,” includes a compelling story of a caller to the Medicare Rights Center helpline. He chose to delay enrolling in Medicare Part B, believing that he had adequate health coverage when he turned 65. Based on confusing information received from his health plan, he made a choice that caused him to be without adequate health coverage and will require him to pay a lifetime premium penalty for Medicare Part B. Unfortunately, this caller is not alone, in 2012, 740,000 beneficiaries were paying Part B late enrollment penalties.

“Simple, streamlined and standardized information and tools are needed to adequately educate the thousands of individuals who become eligible for Medicare each day,” said Jonathan Blum, former principal deputy administrator of CMS and Medicare Rights board member. Joe Baker, President of the Medicare Rights Center said, “Stories of Medicare enrollment woes are all too common, and will likely become increasingly so as the Baby Boom generation ages into the Medicare program.”

The report recommends that Congress, the Social Security Administration, and CMS do the following:

  • Enhance notification and education for those who are new to Medicare.
  • Reform the Medicare enrollment periods to eliminate needless gaps in the start of health coverage.
  • Strengthen avenues for relief, giving greater opportunity for retroactive enrollment and the elimination of premium penalties.
  • Conduct more research on how many people face Medicare enrollment challenges and how many could be affected in the future. 

The report is available at:

The Future of SHOP Plans

As of June 2014, all of the Small Business Health Options Programs (SHOPs) required by the ACA, were operational, but many features were not yet available, and enrollment was low, according to a report by the Government Accountability Office (GAO). According to CMS, all 33 of the federally facilitated SHOPs and 14 of the 18 state-run SHOPs were accepting enrollment applications as of the October 1, 2013, deadline. The remaining four state-based SHOPs became operational by the following May.

Websites, where employers could review premiums and benefits, were available on October 1, 2013 for all federally facilitated SHOPs and most state-based SHOPs. Other key features were delayed for all federally facilitated SHOPs, but available for most state-based SHOPs, such as online enrollment and the employees’ ability to choose among multiple plans.

CMS is gearing up for online enrollment for all federally facilitated SHOPs for 2015. Enrollment for the state-based SHOPs has been significantly lower than expected. As of June 1, 2014, the 18 state-based SHOPs had enrolled about 76,000 people including employees, their spouses, and dependent children in plans purchased through nearly 12,000 small employers. CMS is expected to have complete enrollment data for the federally facilitated SHOPs by early 2015. CMS officials don’t expect major differences in enrollment trends for 2014 among state-based and federally facilitated SHOPs. Most SHOPs had multiple plans  in each county, although a small number of states had counties with no plans available.

Premiums for SHOP plans are generally comparable to premiums for other non-SHOP small group plans. Many stakeholders say that getting the small business tax credit is the primary incentive for employers to use the SHOPs. However, many employers are not motivated to enroll because the credit is too small and too complex to administer. Also, employers can still renew plans that existed before the SHOPs until October 1, 2016, depending on state requirements. Also, employers have misconceptions about SHOP availability. Other factors that may hinder enrollment growth are the two-year limit on the small business tax credit and the likelihood that SHOP premiums will not be lower than non-SHOP premiums.

Factors that may stimulate enrollment growth include the phase-out of pre-SHOP plans, the implementation of employee choice with an increasing number of SHOPs, improved coordination with agents and brokers, and increased marketing to small employers. For more information, visit GAO.

Immigrant Families Benefit Significantly from Obamacare

Immigrants and their U.S.-born children have been one of the primary beneficiaries of Medicaid growth, according to a report by the Center for Immigration Studies. A key part of the Affordable Care Act is Medicaid expansion for those with low incomes. Immigrants and their children accounted for 42% of the growth in Medicaid enrollment from 2011 to 2013. It seems almost certain that immigrants and their children will continue to benefit disproportionately from Obamacare as they remain much more likely than natives to be uninsured or poor. The available evidence indicates that the Medicaid growth associated with immigrants is largely among those legally in the country.

The Center’s Director of Research and co-author of the report, Steven Camarota said, “The high rate and significant growth in Medicaid associated with immigrants is mainly the result of a legal immigration system that admits large numbers of immigrants with relatively low-levels of education, many of whom end up poor and uninsured. This fact, coupled with the extensive supports we provide to low-income residents, unavoidably creates very significant costs for taxpayers.”

The study reveals the following:

  • The number of immigrants and their U.S.-born children on Medicaid grew twice as fast as the number of natives and their children on Medicaid from 2011 to 2013 — 11% versus 5%.
  • Immigrants and their children accounted for 42% of Medicaid enrollment growth from 2011 to 2013, even though they accounted for only 17% of the nation’s total population and 23% of U.S. population growth over this time period.
  • About two-thirds of the growth in Medicaid associated with immigrants was among immigrants themselves, rather than the U.S.-born children of immigrants.
  • The increase in Medicaid enrollment among immigrants and their children can be roughly estimated as costing $4.6 billion annually.
  • By 2013, 25% of immigrants and their children were on Medicaid, compared to 16% of natives and their children.
  • Partly because of increased Medicaid enrollment, the share of immigrants and their children without health insurance declined more dramatically than for natives, from 28% in 2011 to 23% in 2013 — a 5% decline. Among natives and their children, it fell from 13% to 11% — a 2% decline.
  • Medicaid accounted for 41% of the decline in uninsurance associated with immigrants, while it accounted for only 24% of the decline in uninsurance among natives and their children.
  • Although Medicaid use among immigrants and their children is substantially higher than for natives and their children, it is still the case that 23% of immigrants and their children were uninsured in 2013 — twice the rate for natives.
  • Forty-eight percent of immigrants and their children were uninsured or on Medicaid in 2013, compared to 27% of natives.

For more information, visit

The ACA Helps Create the Most Complicated Tax Seasons Ever 

IRS Chairman John Koskinen said the 2015 tax filing season, “will be one of the most complicated filing seasons we’ve ever had.” Speaking at a recent tax conference in Washington, D.C., Koskinen said that the primary things that will affect the new tax are ACA provisions and Congress’ potential to extend tax breaks set to expire at the end of the year. Internet retailers are spared from legislation requiring them to collect sales taxes on purchases made by online shoppers in different states — at least for now. A bill in the House of Representatives that would have supported provisions in The Marketplace Fairness Act, which passed through the Senate, is now on hold and reportedly won’t be moved forward by House Speaker, John Boehner. However, parts of the bill that legislators on both sides of the aisle agree on could be added to separate legislation. For more information, visit


More Transactions Involve Survivorship Universal Life policies

Jeff Hallman, co-founder of Asset Life Settlements, LLC, says that his company is seeing increased interest in life settlements on survivorship universal life policies. This conclusion is based on day-to-day communications with insurance agents. The company also noted more rigorous bidding competition among institutional investors for policies sent to market. Both trends point toward growth in the marketplace, he said.

“The interest level in life settlements has surged, over the past year, in terms of agents wanting to discuss potential cases. We’re seeing an increased number of situations involving multi-million dollar survivorship universal life policies where one spouse passes away and the surviving spouse is saddled with expensive premium payments for a policy they no longer need. When agents are confronted with policies about to lapse, they call us to explore solutions. In today’s economy, it’s simply not acceptable for senior consumers to leave large sums of money on the table if there is a better option,” he said. Company co-founder Scott Thomas said, “There is a change in attitude on the part of agents. They are excited when they can offer clients a more lucrative option for policies [that are] about to lapse or be surrendered. We’ve had recent success finding buyers for life settlement cases where agents thought they had no opportunity, such as life settlements involving term conversions to permanent insurance.”

Industry leaders agree that increasing public awareness of life settlements is critical to sustaining the market’s momentum. The company recently produced a slide presentation titled, “Five Life Settlement Scenarios That Make Sense to Seniors.” Designed for laptop use by agents during client meetings, the presentation illustrates typical life settlement scenarios that seniors can easily relate to. For more information, visit or call 1-888-335-4769.


Consumer Reports’ Open Enrollment Tools

Consumer Reports has a web-based tool at to help consumers navigate their healthcare options. The newly updated web-based tool offers personalized guidance to help consumers understand how they may be affected by the Affordable Care Act. The tool is also available in Spanish at www.AseguraTuSalud and across a variety of platforms, including mobile and tablet.

Dental Coverage on Individual Exchanges 

Guardian Life is offering its dental insurance through the American Health Benefit Exchange, an individual public exchange, in Texas, Fla., Illinois, and New York. Guardian also offers plans on the individual public exchanges in Ariz., Calif., Colo., Nevada, Texas, and Utah through Premier Access, a wholly owned subsidiary of Guardian. For more information, visit

2015 Medicare Benefits Analyzer

Mark Farrah Associates released the 2015 Medicare benefits data and Star Quality Ratings in its Medicare Benefits Analyzer. Medicare Benefits Analyzer presents more than 100 benefit attributes including the latest plan premiums, PCP and specialist co-pays, prescription drug tier pricing, co-pays for inpatient and outpatient procedures, specialty benefits and many additional data elements in a comparative 24/7 online database format. For more information, visit at

Payroll and HR Cloud Solution

BenefitMall is offering HRFocus, which simplifies payroll and HR related tasks. HRFocus makes it easy to transition out of manual, time consuming paperwork to a streamlined, cloud based solution flexible enough to handle all types of work scenarios. It provides an effective way for employees to answer their own questions about time off, job history, and company policies. For more information, visit

CLARIFICATION. We removed one article concerning three major health carriers and the DMHC because it is out of date. For current information visit for further updates.

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