Consumers

Project overview

We are examining health insurers' benefit designs, policies and procedures, and claims data related to accessing mental health and substance use disorder treatment services, including alternatives to opioids for treating pain. 

A 25-member advisory committee including consumer advocates, behavioral health and medical providers, and health insurers helps guide the project.  

The project started in 2018 and we are currently in the second of two cycles: 

Cycle II (Ongoing) 

OIC received additional federal funding to update and improve educational materials for consumers and behavioral health providers on their rights to access behavioral health services and how to appeal denials of requests for services. In addition, we will conduct a detailed claims analysis to understand trends in access to mental health and substance use disorder treatment services. 

• Cycle II Project Abstract (PDF 130.39KB)

Cycle II includes five projects: 

• Pursue market conduct activities related to health insurers’ responses to previous market scans. The OIC has hired a market conduct consultant/examiner and a contractor with expertise in behavioral health parity. This work is currently in progress. 
  • UnitedHealthcare fined $500,000 for not following mental health parity laws
• Refine the market scan documents and other materials the OIC uses to gather information and review parity compliance. This work is currently in progress.
• Improve OIC’s ability to assist consumers in understanding their rights under state and federal assistance with behavioral health parity laws, including how to use the Federal Department of Labor’s Consumer Parity Disclosure form (PDF, 179 KB). Also, improve our web content and create consumer and provider education materials. This work is complete. 
• Create legislative or rulemaking proposals to address issues found in Cycle I. This work is in progress. 
• Use the Washington state All Payer Claims Database to analyze recent claims data and compare it to past data to see if OIC’s parity compliance work has improved access to behavioral services. The study is currently in progress and targeted for fall 2023. This work is complete.

Cycle I (Aug. 2018 - July 2020)  

OIC issued two market scans to identify any barriers to mental health and substance use disorder d services as well as services for pain treatment. 

The University of Washington's Department of Psychiatry and Behavioral Sciences was contracted to help review the responses from the first market scan and produce recommendations. Its report informed the focus areas for the second market scan.  

• University of Washington report on insurer coverage of behavioral health services (PDF, 328.93 KB) (PDF 328.93KB)

The OIC also hired OnPoint to study how people in commercial health plans use behavioral health services. The claims data used is from Oct.1, 2017 – Sept. 30, 2018. This data set included both paid and denied claims for all medical and behavioral services, including substance use disorder treatment services. This "merged" claims data set combined information from the All Payer Claims Database (APCD) with additional data obtained from carriers offering health plans in Washington state

• State Flexibility Final Report (PDF, 431.57 KB) (PDF 431.57KB)
• Behavioral Health Crisis Study (PDF, 730.26 KB) (PDF 730.26KB)

Presentation

• Behavioral Health Services Council of State Governments Presentation (PDF, 2.04 MB) (PDF 2.04MB)
• Behavioral Health Services Association of Insurance Compliance Professionals Presentation (PDF, 2.23 MB) (PDF 2.23MB)

Technical cleanup bill (HB 1505 and SB 5262)

Sponsors: Walen, Berry, Lekanoff, Reed, Ormsby, Tharinger, Marci, Hill, Scott, Kauffman, Wilson J., Nobles, Shewmake, Trudeau

Our staff found several technical corrections in Title 48 RCW — the state insurance code. The bill includes approximately 16 amendments and seven repeals. 

The bill removes language related to eight one-time or outdated reports and workgroups, strikes obsolete language, updates terminology and clarifies how language is applied. 

Learn more about House Bill HB 1505 and Senate Bill SB 5262.

Strengthening consumer protection by increasing insurer accountability for violations of the insurance code (HB 1199 and SB 5331)

Sponsors: Taylor, Berry, Reed, Duerr, Tharinger, Paul, Simmons, Wylie, Pollet, Kloba, Salahuddin, Hill

This bill gives the insurance commissioner authority to order restitution, including interest, to consumers harmed by an insurance company’s violation of Washington state insurance laws.  

The bill recommends a simple interest rate of 8% applied to money paid back to consumers, which is the current practice. It also gives the insurance commissioner authority to assess fines against insurers for each violation of state insurance laws, which aligns the fine schedule for insurers with other regulated entities.  

Learn more about House Bill HB 1199 and Senate Bill SB 5331.

Modifying reports of fire losses (SB 5419)

Sponsors: Lovick, Muzzall, Nobles, Shewmake

Insurance data from fire loss is critical information for public safety, law enforcement and for the insurance regulator. Currently, the authority to collect insurance data from fire loss resides with the State Fire Marshal, within the Washington State Patrol (WSP); a remnant of when the State Fire Marshal was also the insurance commissioner.

After consultations with WSP and the State Fire Marshal’s Office, it is agreed that the authority to collect fire loss data is better served with the Office of Insurance Commissioner to ensure data is appropriately collected and shared with fire protection entities and law enforcement agencies.

This bill amends RCW 48.05.320 to require the Office of the Insurance Commissioner to collect insurance-related fire loss data from its regulated entities and insurance companies. It will:

• Require insurers to report known or suspected criminal activity to the local authorities.
• Allow the fire loss data to be protected from public records requests when they contain the insured’s property address, date of loss, the amount that the insurer paid on each coverage, the known or suspected origin and cause of the fire loss, except in cases of criminal investigations and charges.
• Allow our agency to share confidential information with the following entities, if confidentiality is maintained: State Fire Marshal’s Office (SFMO), National Association of Insurance Commissioners (NAIC), federal government, Tribal Nations, law enforcement and prosecutors, insurance rating bureaus and fire chiefs. 

Learn more about Senate Bill SB 5419.

Study of Disparate Impacts of Underwriting and Rating Factors (SB 5589 and HB 1748) 

Sponsors: Hasegawa, Kauffman, Lovelett, Nobles, Saldaña, Stanford, Wilson, C. 

In the wake of recent natural disasters and inflationary pressures, many Washingtonians are struggling to afford auto and homeowners insurance. Insurers determine coverage eligibility and submit their proposed rates based on their risk assessment, the Office of the Insurance Commissioner (OIC) then uses its authority to make sure the proposed rates are not excessive, inadequate or unfairly discriminatory.   

To protect against potential unfair discrimination, the OIC would like to examine whether certain underwriting practices might be disparately impacting residents of different races, ethnicities, sexes, socioeconomic status, or national origins.    

This requested study allows the OIC to take a closer look at insurers’ underwriting practices and current factors used to set rates. It includes an industry-wide survey to explore how underwriting affects eligibility and premiums:  

• The study will collect data from insurers on their use of credit scores, credit-based insurance score models, and other rate factors that may disparately impact policyholders.  
• The study will also examine alternatives to insurer reliance on factors with disparate impacts and how current and alternative factors may affect consumer costs and availability of insurance.    
• The bill will allow the Commissioner to contract with an actuarial firm, or other consultants, to assist in the work.  
• The bill requires OIC to deliver a report of findings, options, and recommendations to the Legislature. 

Learn more about Senate Bill 5589 and House Bill 1748. 

Budget requests

We are making a supplemental budget request for a federal grant unanticipated receipt.

• This request increases federal grant revenue for the 2023-25 biennium by $1,013,000 to match the federal requested appropriation. This follows the procedure for an agency receiving federal grant funding that wasn’t initially anticipated in the state budget.  
• The OIC needs increased federal expenditure authority starting in fiscal year 2025 to implement this package. The increase reflects the ongoing cost for one Health Insurance Advisor 1 and one Health Insurance Advisor 2 and the expenses, like advertising and contracting, to comply with federal grant requirements. 

Decision packages for the 2025-27 biennium budget

We are requesting funding for the creation of a new Claims Review Team (three full-time employees, $470,000 per year). 

Our agency faces rising consumer complaints in property and casualty insurance, fueling consumer frustration over how their claims are being handled. Economic shifts have hardened the insurance market, leaving Washington’s consumers struggling to navigate claims and benefits. This package requests ongoing funding, beginning in fiscal year 2026, to establish a Claims Review Team dedicated to managing and investigating claims-related consumer complaints that allege violations of RCW 48.30 and WAC 284-30. The team would seek a resolution between the insured and insurer and/or initiate regulatory enforcement activities, providing an additional level of claims-related case review and enforcement. 

We are also requesting funding to increase behavioral health parity compliance (three full-time employees, $666,000 per year). 

• State insurance departments enforce the federal Mental Health Parity and Addiction Equity Act (MHPAEA) for fully insured health plans. Washington state also has its own behavioral health parity law.  
• These laws require health carriers to provide access to mental health and substance use disorder services (behavioral health services) in a way that is comparable to coverage of medical care. Ensuring behavioral health parity compliance is complex and time-consuming and requires expertise from outside of the agency. The federal grant supporting work expired in September 2024. In the 2024 supplemental budget, the Legislature included funding to extend these efforts through fiscal year 2026.  
• This package requests ongoing funding, beginning in fiscal year 2027, for three positions and subject matter expert contracting costs to continue addressing behavioral health parity compliance. 

Follow our rulemaking activity 

We manage an ongoing public rulemaking development process to write regulations  that provide guidance to consumers, insurers, carriers, producers and other regulated entities. 

Requesting a list of individuals

You must fill out a commercial use declaration (DOCX 59.70KB) if you are requesting a list of individuals. You will be able to upload the declaration when you submit your record request form.

The Public Records Act prohibits state agencies from providing “lists of individuals requested for commercial purposes.” To follow RCW 42.56.070(8), you must state the intended purpose if a list of individuals is requested.

Activity by any type of business to generate revenue or financial benefit is considered commercial purpose.

Examples of purposes that are commercial in nature:

• To recruit new agents
• To spread awareness of your industry-leading insurance solutions
• To offer your product to agents so they can better serve their clients

Once received, we review your declaration and make a decision on releasing the information.

You may find helpful information on our online database which allows searches to be performed for agents, agencies and companies.

Submit a public records request

Education providers:

An exception to this law exists for education providers requesting lists of license applicants or professional licensees. If you are a pre-licensing or a continuing education provider, please contact our Education Analyst at 360-725-7144.