From DCCA Insurance Division January 7, 2014

2013 Report of the Insurance Recoupment Working Group

Senate Concurrent Resolution No. 129, S.D. 1 (2013) (S.C.R. No. 129 or Resolution) requested the Insurance Commissioner to form a working group to study insurance recoupment (the "Working Group"). A copy of the Resolution is attached as Appendix A. The Working Group was requested to:

(1) Assess the problems of insurance recoupment, if any;

(2) Study the impact of limiting the period allowed to initiate any recoupment or offset demand efforts;

(3) Review how other states mandate recoupment.

2013 Report of the Electronic Insurance Notices and Documents Working Group

Senate Concurrent Resolution No. 159, S.D. 1 (2013) (“SCR 159”) requested the Insurance Commissioner to do the following:

(1) Convene a working group to explore the use of electronic transmission of insurance notices and documents; and

(2) Develop alternatives for insurance notices and documents that balance the convenience of electronic notices and documents with consumer protection.

2013 External Review Report

From July 1, 2012 to June 30, 2013, 15 IRO external review requests were filed. Of the 15 requests received, 11 were from members of private employer sponsored group health plans, three (3) were from EUTF members, and one (1) request involved individual coverage. The nature of the cases reviewed involved 12 cases regarding denial of coverage; two (2) cases involved participating vs. non-participating provider reimbursements; and one (1) case involved a claims appeal. Of the 15 requests received, the health plan’s denial was upheld in nine (9) cases, the denial was overturned in two (2) cases, and four (4) cases were dismissed as they were not eligible for the external review process per the statutory requirements. The external reviews during this period resulted in consumers saving over $34,500.

2013 Report of the Insurance Commissioner of Hawaii

Pursuant to Hawaii Revised Statutes § 431:2-211, I am pleased to present to you the Annual Report of the Insurance Division of the Department of Commerce and Consumer Affairs.

This report shows the official transactions of the Insurance Division for the fiscal year ending June 30, 2013, and presents condensed financial statements and insurance transactions in Hawaii for the year ending December 31, 2012 of all authorized insurance companies and associations.

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