Posts by: Britney Han

BULLETIN NO. 4-2023

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BULLETIN NO. 4-2023

To: All Health Insurance Companies, HMOS, and Other Interested Parties
Re: New Legislative Requirements for Step Therapy Protocol and Biomarker Testing (HB 1736, HB 2748, and SB 513)
From: Glen Mulready, Insurance Commissioner
Date: July 14, 2023

 

House Bills 1736 and 2748

Effective November 1, 2023, House Bills 1736 and HB 2748 mandate all health benefit plans to implement new requirements related to step therapy protocols. Although located in Title 63, these new requirements apply to health benefit plans as regulated by the Insurance Commissioner under Title 36.

House Bill 1736 adds a new section of law that applies to all health benefit plans that provide coverage for invasive or noninvasive mechanical ventilation to treat chronic respiratory failure consequent to chronic obstructive pulmonary disease (CRF-COPD). Health benefit plans requiring step therapy protocol for treatment of CRF-COPD must provide a clear and transparent process by which insureds can request an exception to step therapy protocols. The process must be readily available on the insurance issuer’s website. The new law also sets forth circumstances requiring an exception to step therapy protocols. Please review House Bill 1736 for additional details.

House Bill 2748 adds a new section of law that applies to all health benefit plans providing coverage for advanced metastatic cancer and associated conditions. It prohibits step therapy requirements for certain prescription drugs to treat advanced metastatic cancer and associated conditions. Please review House Bill 2748 for additional details.

Senate Bill 513

Effective January 1, 2024, Senate Bill 513 adds a new section of law in Title 36 requiring all health benefit plans to provide coverage for biomarker testing for certain purposes when the biomarker test provides clinical utility as demonstrated by medical and scientific evidence. Senate Bill 513 also amends Title 56 with respect to the State Medicaid Program (SoonerCare). Please review Senate Bill 513 for additional details.

Regulated entities can direct inquiries regarding this bulletin to Nicole Nash, Deputy General Counsel, at Nicole.Nash@oid.ok.gov or Kurt Cagle, Director of Rate and Form, at Kurt.Cagle@oid.ok.gov.

Column by Commissioner Glen Mulready – Insurance Tips After the Storm

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For Immediate Release:
July 3, 2023

Insurance Tips After the Storm

By Oklahoma Insurance Commissioner Glen Mulready

Recovery efforts are ongoing in Tulsa following the severe storms that hit over Father’s Day weekend, causing extensive damage, including fallen trees and widespread power outages. The storm has been far-reaching, leading to heat advisories, limited access to essential retail items and gasoline, and numerous residents still struggling to cope with the aftermath.

In response to this crisis, I issued an emergency order to help facilitate the recovery process. The order enables insurers to access out-of-state claims adjusters to assist in assessing the damage in Oklahoma and streamlines the claims processing by temporarily waiving local licensing requirements. I understand that recovering from a storm can be challenging and somewhat confusing when filing a claim for property damage. Here are a few easy tips.

  1. Take care of yourself and your family.
    Your first concern after a disaster is your family’s health and safety. If the storm destroyed your home, business or personal property, know that cleaning up and repairing the damage can be physically, mentally and financially challenging. Most homeowners policies have coverage for debris removal, but only if those trees or branches have caused other covered damage.  
  2. Contact your insurance agent as soon as possible. 
    Document all your damages before you clean up. Take photos or videos and make a list. Make necessary repairs to prevent further damage and save all your receipts for post-damage repair and cleanup. Work with your adjuster and complete proof of loss to support your claim. When an adjuster visits your property, make sure you ask for identification. You can call the Oklahoma Insurance Department (OID) or visit our website to verify his or her licensure. Get any necessary estimates for repairs to determine if it exceeds your deductible. Contact your insurance agent to start the claims process as soon as possible. 
  3. Report damage and be aware of dishonest contractors.
    Report damage to damage.ok.gov or call 2-1-1 even if you do not have insurance. This report helps emergency managers better coordinate recovery efforts and allows our state to potentially qualify for federal assistance. Also, unfortunately, behind every bad storm is a bad actor. Watch out for people going door-to-door or calling homeowners claiming to be building contractors. These could be scam artists, especially if they ask for financial information or money in advance. Report suspicious activity to local authorities and the FEMA Disaster Fraud Hotline at 1-866-720-5721. You can also contact the Attorney General’s Office at 1-833-681-1895 or ConsumerProtection@oag.ok.gov. Talk to your neighbors, friends or your agent for recommendations of reputable contractors. 

I want to remind all Oklahomans that we are here to help. OID has excellent disaster assistance resources and a team dedicated to helping in your time of need. I encourage anyone affected by the storm to contact us with insurance questions or concerns at 1-800-522-0071. If you feel your claim has not been properly resolved by your insurer or your insurer is not properly handling your claim, you can file a complaint with the OID at www.oid.ok.gov/complaint. For detailed guidance and more post-disaster information, visit www.oid.ok.gov/AFTER.

 

Media questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

OID Offers Guidance Following Storm Damage in Eastern Oklahoma

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For Immediate Release:
June 28, 2023

OID Offers Guidance Following Storm Damage in Eastern Oklahoma

 

OKLAHOMA CITY – The Oklahoma Insurance Department (OID) is available to assist Oklahomans affected by the recent severe storms that swept through Eastern Oklahoma over Father’s Day weekend. Insurance Commissioner Glen Mulready encourages residents to contact the OID with insurance questions or concerns at 1-800-522-0071.

“Navigating through the insurance claim process during this time can be confusing and stressful. I would like to remind all Oklahomans that we are here to help if you are overwhelmed by the insurance claim process or have issues with your insurance agent or insurer,” Commissioner Mulready said.

Commissioner Mulready also said understanding your coverage and deductible amount is important to decide whether you want to file a claim. If your damages do not exceed your deductible, the repairs will be an out-of-pocket expense.

The OID shares some commonly asked questions and the answers about storms and home insurance coverage:

  1. Will my insurance company pay for repairs if a fallen tree damages my roof? Your policy has a list of covered perils; if the tree falls on your house because one of the covered perils occurred, then the company would pay to remove the tree from the roof and repair the damage to the house. Insurance is not responsible for wear and tear or neglect, so if you have a dead and unsafe tree, they could deny coverage if it just topples from being dead.
  2. A tree fell and landed in my yard. Will my insurance pay to remove it?
    Typically, fallen trees are not covered unless it has fallen on your house or driveway. It will cover damage to your fence, roof, troughs, windows, porches and outbuildings. However, debris removal from your yard, in the absence of physical property damage, will generally be at your own expense.
  3. If a neighbor’s tree caused damage to my property, are they responsible for damages?
    Only if your neighbor was negligent would their policy pay for your damage. If the damage is from an act of nature, then the neighbor is not liable, and you would need to file the loss with your insurance company or agent.
  4. A storm caused my tree to fall on my car. Will my homeowners insurance pay for the damage to my car and to remove the tree?
    The homeowner’s policy pays for damage to the home and for liability when an insured is negligent. In this case, you would need to file the claim with your auto insurance carrier to have the vehicle repaired. If you only had liability coverage, then you would be out of pocket for repairs or replacing the vehicle.
  5. Does homeowners insurance cover the cost of a hotel in the event of loss of power?
    In the event of a covered loss, like fire, and your house is uninhabitable during repairs, unsafe living conditions, or loss of utilities, temporary lodging costs are often covered. However, homeowners insurance policies generally won’t pay for additional living expenses such as a hotel room simply because of an off-premises power outage. You would have to have a direct/physical on-premises loss before most insurance carriers would consider Additional Living Expenses (ALE) reimbursements for hotel stays. I encourage you to contact your insurance agent to determine if your policy would provide ALE for your particular situation.
  6. Does homeowners insurance cover spoiled food after a power outage?
    The homeowner’s insurance policy generally pays for food spoilage as long as the power outage was caused on your premises. Ask your agent or adjuster to verify how this scenario would be adjusted as it would follow your policy language. Finally, take pictures, keep a detailed list of the food items you had to throw away, and share it with your adjuster. This will assist the adjuster in assessing the loss.

When it comes to effectively submitting home insurance claims, the most important thing is to immediately document the damage to your property. Take photographs of the damage and make a list of everything you want to show the adjuster. Contact your insurance provider to get clarification and details regarding your policy. For more information, please visit our post-disaster resource page at www.oid.ok.gov/AFTER or call OID Consumer Assistance Division at 1-800-522-0071.

 

Media questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Commissioner Mulready Places Friday Health Plans of Oklahoma in Receivership

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For Immediate Release:
June 15, 2023

Commissioner Mulready Places Friday Health Plans of Oklahoma in Receivership

 

OKLAHOMA CITY – Insurance Commissioner Glen Mulready announced today that Friday Health Plans of Oklahoma, Inc. (FHP-OK) has been placed into receivership due to the declared insolvency of the company.

“Our number one priority is consumer protection,” Insurance Commissioner Glen Mulready said. “Given the company’s financial situation, I determined this strong approach was a necessary step to protect policyholders. Through this receivership, we can take control of the company and determine the best path forward for its Oklahoma members.”

FHP-OK was placed into administrative supervision by Commissioner Mulready on April 4, 2023, while the company made reasonable attempts to increase its capital surplus. During this period of supervision, the Oklahoma Insurance Department (OID) closely monitored the company and determined that continued operation of FHP-OK was not possible.

Placing FHP-OK into receivership allows Commissioner Mulready to take over the day-to-day management of the company’s operations as well as thoroughly examine the finances of the company. Members’ policies will remain in effect for now, and members must continue to pay their premiums to ensure continued coverage.

FHP-OK policies will no longer be effective after August 31, 2023. To ensure FHP-OK members have an opportunity to replace their current policy before it is terminated on August 31, 2023, the OID is coordinating with the Center for Consumer Information and Insurance Oversight (CCIIO) to implement a special enrollment period. This special enrollment period will allow FHP-OK members to select a new plan. However, members will need to act quickly to prevent a gap in coverage.

The special enrollment period will start on July 2, 2023 and ends on October 30, 2023. If you purchased health insurance from FHP-OK through the Health Insurance Marketplace® you must select a new Marketplace plan by August 31, 2023, to avoid a gap in health insurance coverage. OID has set up a website to assist impacted members with the process of selecting a new exchange health insurance plan.

Below are IMPORTANT DATES to keep in mind:

July 2 Special Enrollment Period Begins
August 31 Last Day to Enroll Without a Gap in Coverage
August 31 All Friday Health Plans Policies Are Terminated
October 30 Last Day of Special Enrollment Period

 

Finally, providers should continue to service all FHP-OK members and should not demand payment other than the proper cost share associated with the medical service provided and relevant health plan.

FHP-OK is a subsidiary of the Friday Health group. The Friday Health group is Colorado-based and provides health coverage to individuals and families in several states. The company was founded in 2015 and had been operating the FHP-OK HMO since 2021. FHP-OK has approximately 8,200 policyholders in Oklahoma.

Several states, including Oklahoma, are placing the subsidiaries into receivership, a proceeding at the District Court where a third-party is appointed to take control of the company’s assets, finances, and operations and manage the company under the general supervision of the Court.

For more information regarding FHP-OK, please call OID Consumer Assistance Division at 1-800-522-0071 or visit oid.ok.gov/fhpok.

 

Media questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Insure Your Summer Adventures: Tips for Safe and Exciting Seasonal Activities

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Insure Your Summer Adventures: Tips for Safe and Exciting Seasonal Activities

By Oklahoma Insurance Commissioner Glen Mulready

The first day of summer is June 21, and many Oklahomans are ready for a vacation. School’s out, days are longer and temperatures are on the rise. Your plans are likely to include more entertaining and outdoor fun. As summer approaches, it’s important to reassess your insurance needs to ensure you’re adequately protected. Here are a few things to consider: 

 

Pools and Trampolines

Consider purchasing an umbrella liability policy in addition to your homeowners insurance to increase your liability coverage. Some insurance companies may not insure your property if you own a pool or trampoline, or there may be policy exclusions for liability for related injuries. An insurance company can also deny coverage or cancel your policy if you do not follow the policy’s safety guidelines or fail to inform them when you build a pool or purchase a trampoline. 

 

Boats

While there is very limited coverage for certain types of boats on your homeowner’s policy, it is always recommended that you purchase at least boat owners liability insurance policy. There is an option to buy comprehensive and collision insurance to protect your boat from collisions, storm damage theft or vandalism. Boat insurance is written specifically for boats and will provide better protection for liability, bodily injury, and property damage.

Also, discuss the costs coverage for retrieving a boat that has sunk. You want to address this before a loss, not after, as the recovery of a boat can be very costly. If the company maxes out its policy limits, the rest of the costs will likely be owed by the boat owner. DUIs and reckless driving can affect your auto driver’s license, so boat responsibly and have a sober driver. When it comes to boats, keep in mind that coverage varies. Check your policy and ask your insurance agent for coverage and limitations on watercraft type and size. 

 

Motorcycles and Scooters

Your standard auto policy does not cover motorcycles and scooters. You will need a separate policy covering liability and, depending on the value of your motorcycle, comprehensive and collision coverage. Insurers have differing requirements for helmet use. Oklahoma law requires a helmet be worn by any motorcyclist or passenger age 17 and under, and helmets are required for use on some low-power scooters, as well. 

 

If you carry seasonal coverage on your motorcycle, which allows you to eliminate liability and perhaps collision coverage in winter months when you do not ride, be sure that your policy is active now that nice weather has returned and you’re back on the road.

For more insurance information, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov. 

OID Holds Medicare 101 Events to Help Oklahomans Understand and Navigate Medicare

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For Immediate Release:
June 12, 2023

 

OID Holds Medicare 101 Events to Help Oklahomans Understand and Navigate Medicare

 

OKLAHOMA CITY – The Medicare Assistance Program (MAP) at the Oklahoma Insurance Department (OID) announced today that they will host free educational events for Medicare beneficiaries in Oklahoma this summer. These events aim to provide unbiased Medicare resources to consumers and offer them an opportunity to ask questions directly to industry experts.

Medicare 101 is designed to help Oklahomans understand the complexities of Medicare and make informed decisions about their healthcare coverage. Whether they are approaching Medicare eligibility or looking to enhance their existing coverage, these events will provide the necessary insights to navigate the Medicare maze.

The events will be held in the OID’s public conference room, located at 400 NE 50th Street, Oklahoma City, Oklahoma 73105. Each event will run from 2 p.m. to 3 p.m. and will be open to the public.

Medicare 101 Event Schedule

  • June 19, 2023, at 2 p.m.
  • July 17, 2023, at 2 p.m.
  • August 21, 2023, at 2 p.m.
  • September 18, 2023, at 2 p.m.

“Our goal is to help Oklahomans feel knowledgeable about Medicare. These events are great for people who are new to Medicare or want a refresher. Our trained counselors will be there to answer any questions,” said Ray Walker, MAP Director.

Registration for the Medicare 101 events is not required. However, attendees are encouraged to arrive early as seating will be limited. For more information about the Medicare 101 Events and other educational resources offered by MAP, please visit map.oid.ok.gov or call 800-763-2828.

About MAP

MAP is part of the national Senior Health Insurance Counseling Program (SHIP) network, funded in part by the U.S. ACL, Office of Healthcare Information and Counseling. MAP provides one-on-one counseling and information for people eligible for Medicare. All services are free, unbiased, and confidential.

 

Questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

New Monthly Webinar Series: Medicare Mondays

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For Immediate Release:
June 6, 2023

New Monthly Webinar Series: Medicare Mondays

Oklahoma Insurance Department Successfully Launched Its First Webinar

 

OKLAHOMA CITY – Yesterday, the Medicare Assistance Program (MAP) at the Oklahoma Insurance Department (OID) successfully launched its new monthly webinar series, Medicare Mondays. The Medicare Mondays webinar series aims to provide unbiased information and valuable insights on various aspects of Medicare to help Oklahomans navigate the complexities of Medicare. 

Medicare Mondays will consist of short, concise 30-minute webinars, starting at 10 a.m. This virtual event will cover a wide range of topics, including Medicare fraud prevention, different parts of Medicare, Medicare Open Enrollment and more. Each session will be packed with essential information designed to educate attendees with the knowledge they need to make informed decisions on their Medicare plans. 

OID’s MAP Director Ray Walker will be the main speaker for all webinars in the series. With 12 years of experience in the field, Walker brings a wealth of knowledge and expertise to each session. In addition to Walker’s insights, the series will also feature occasional guest speakers, further enriching the learning experience. 

“We’re excited to launch the Medicare Mondays webinar series,” said Walker. “We know you’re busy, and there is a lot of information out there, which is why we’ve designed this webinar series as an opportunity to get unbiased answers to your big Medicare questions.” 

Registration for the Medicare Mondays webinar series can be accessed through the MAP website at map.oid.ok.gov. Participants are encouraged to sign up early to secure their spot as spaces are limited. 

Medicare Mondays Webinar Series Schedule 

  • July 10 at 10 a.m. – Low-Income Assistance Programs  
  • August 7 at 10 a.m. – Medicare Options (Getting Ready to Retire) 
  • September 11 at 10 a.m. – Get Ready for Open Enrollment  
  • October 2 at 10 a.m. – Open Enrollment 
  • November 6 at 10 a.m. – Medicare Marketing Guidelines 
  • December 4 at 10 a.m. – Medicare Changes for 2024 

For more information about the Medicare Mondays webinar series and other educational resources offered by MAP, please visit map.oid.ok.gov or call 800-763-2828. 

About MAP 

MAP is part of the national Senior Health Insurance Counseling Program (SHIP) network, funded in part by the U.S. ACL, Office of Healthcare Information and Counseling. MAP provides one-on-one counseling and information for people eligible for Medicare. All services are free, unbiased, and confidential. 

Questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Mental Health Awareness Month: Insurance Tips for Navigating Mental Healthcare

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For Immediate Release:
May 16, 2023

Mental Health Awareness Month: Insurance Tips for Navigating Mental Healthcare

By Oklahoma Insurance Commissioner Glen Mulready

 

Mental health is just as important as physical health. But, unfortunately, accessing mental health services is often challenging—from the shortage of health providers to the difficulties in understanding your policy terms and benefits. In addition, there is often the hesitancy to even ask for help due to the stigma that some may associate with mental health. That’s why I’d like to remind Oklahomans that all comprehensive major medical insurance plans are required by law to cover mental health and substance abuse services and there are resources to help you navigate this healing journey.

Under Oklahoma law, health insurance companies offering both medical and mental health insurance plans must have equal benefits between both plans. Here are a few insurance tips to help you understand your rights to access mental health services.

Mental Health Coverage Options The federal parity law generally applies to the following types of health insurance:

  • Employer-sponsored health coverage for small groups (under 50 employees) and large groups (over 50 employees).
  • Coverage purchased through health insurance exchanges created under the health care reform law, also known as the Affordable Care Act (ACA).
  • Children’s Health Insurance Program (CHIP).
  • Medicaid program (SoonerCare). Requirements may vary. Please contact the Oklahoma Healthcare Authority if you are unsure how the federal parity law applies to your Medicaid benefits.

Eligibility and Claim Issues Check your description of plan benefits — it should include information on behavioral health services or coverage for mental health and substance use disorders. If you still aren’t sure, contact your insurance company directly or contact us at 800-522-0071.

If your mental health claim is denied, always ask why. Your health plan will have a process to review and appeal denied claims. You or your provider may also file a complaint with us. Check out the National Alliance on Mental Illnesses’ tips for what to do if your insurance carrier denies your health services.

Additional Resources For more consumer rights and protection information, visit our Mental Health page at www.oid.ok.gov/mentalhealth. You can also visit the Oklahoma Department of Mental Health and Substance Abuse Services at https://www.ok.gov/odmhsas or call 2-1-1.

Getting mental healthcare can be difficult, but it doesn’t have to be. The Oklahoma Insurance Department is here to help and wants to ensure there are no barriers to accessing the care you need. If you encounter problems with your insurance company as you access mental health services, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov.

 

Questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Insurance Commissioner Mulready to Testify at Congressional Committee

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For Immediate Release:
May 16, 2023

Insurance Commissioner Mulready to Testify at Congressional Committee

Oklahoma Regulator Will Share Perspective from Nation’s Leading PBM Regulatory Program

 

WASHINGTON, D.C. – Oklahoma Insurance Commissioner Glen Mulready will testify in front of the United States House Ways and Means Committee this week. The committee invited Commissioner Mulready to share Oklahoma’s story on developing one of the strongest Pharmacy Benefit Manager (PBM) compliance programs in the country. Since 2021, Oklahoma has built a robust regulatory program that has issued over $3.5 million in fines and returned over $700,000 to local independent pharmacies through administrative action and settlement agreements.

Oklahoma has been a leader in this national conversation. Through its membership with the National Association of Insurance Commissioners (NAIC), Commissioner Mulready has shared many best practices with fellow states.

“I appreciate the opportunity to share our story with members of Congress,” Mulready said. “I am hopeful that our successful efforts to defend legal challenges, hold PBM’s accountable with administrative actions, and work with our legislature to make key policy changes will be a roadmap for others.”

The Oklahoma Insurance Department (OID) currently serves as vice-chair of the NAIC PBM Working Group. It has been a leading contributor to developing best practices for fellow regulators. OID has a team of investigators, attorneys, and license administrators who have resolved over 200,000 violations, issued over 15 administrative orders, and is a leading voice for PBM regulation with industry representatives and policymakers nationwide.

For more insurance information, please contact the Oklahoma Insurance Department at 1-800-522-0071 or visit our website at www.oid.ok.gov.

 

Questions or comments should be directed to
Chief of Communications, Liz Heigle
Liz.Heigle@oid.ok.gov | (405) 819-2221

Uninsured Motorist

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Although carrying liability insurance on your vehicle is mandatory in Oklahoma, Oklahoma’s percentage of uninsured motorists is among the highest in the nation. Don’t risk your financial future because someone else isn’t properly insured. You can protect your property from uninsured motorists by purchasing Collision and Homeowners insurance policies. But those policies do not protect you from bodily injury, lost wages, pain, and suffering.

Uninsured or Under-Insured Motorists (UM/UIM) coverage is a great addition to your auto policy to protect yourself, your family and your passengers. While this coverage is not mandatory, insurance companies must offer Uninsured Motorist coverage when you buy auto insurance. You can decline the coverage or select the coverage you wish to purchase. If you don’t wish to purchase this coverage, you must sign a form declining the UM/UIM portion of the policy. You will be charged for the minimum amount required by law for UM/UIM until those forms are signed and sent back to the agent or insurance company. 

Uninsured Motorist Coverage

Uninsured motorist coverage, referred to as UM or UIM, is a type of auto insurance to protect you when the driver who caused the accident didn’t have enough insurance. Uninsured motorist coverage also pays if you’re in a hit-and-run accident and the other driver can’t be found to pay for damages. You can buy the minimum limits of 25,000/50,000 or up to the limits of your policy or any value in between as set forth by the insurance company. Ask your agent what coverage amount would work best for you.

Uninsured/underinsured motorist coverage does not repair or replace your vehicle due to damages suffered in a collision with a vehicle driven by someone without sufficient insurance. Instead, uninsured/underinsured motorist coverage pays for medical care – or provides compensation for the loss of life – suffered by you or by passengers in your vehicle as the result of a collision involving a driver who has not fulfilled his obligation to buy insurance or whose minimal liability limits have been exhausted before your losses have been made whole. While the state does allow carriers to offer UM/PD (Uninsured Motorists Property Damage), it is not widely available at this time, so we recommend placing collision and comprehensive insurance on your vehicles.