August 8, 2013

Missouri Department of Insurance reaches million dollar settlement with major health insurer

Alleged violations include denying childhood immunization and cancer screening claims for Missouri consumers

Jefferson City, Mo. - The Missouri Department of Insurance announced today a settlement with Time Insurance Co., Union Security Insurance Co. and John Alden Life Insurance Co. related to their coverage of health benefits required by state law. State insurance regulators allege that the three health insurance companies that issue policies for Assurant Health violated Missouri law in how claims were being handled.

A market conduct examination into the three companies found several instances where the companies denied claims for childhood immunizations, colon cancer screenings, mammograms, Pap smears and prostate screenings. In some cases, claim payments were denied or reduced because the companies imposed waiting periods, copayments or deductibles for these preventive care procedures.

"Consumers pay their premiums and expect their health insurance companies to give them access to preventive care checkups, screenings and tests," said John M. Huff, director of the Department of Insurance. "When health insurance companies fail to provide these basic benefits required by Missouri law, the health of Missouri citizens suffers as a result."

Under the settlement agreement, the three companies will:

  • Agree to provide childhood immunizations to Missouri residents without copayments, coinsurance, deductibles or waiting periods.
  • Review all denied claims for childhood immunizations, colon cancer screenings, mammograms, Pap smears, prostate screenings and paid claims for short-term major medical submitted to each company since Jan. 1, 2004.
  • Pay those claims that should have been paid along with interest at a rate prescribed by law.
  • Modify their processes to comply with state law in the future.
  • Pay a $500,000 fine to the Missouri State School Fund.
  • Donate $500,000 to a Missouri charitable or nonprofit organization or organizations selected by the companies and approved by the department.

In market conduct exams and investigations, the department reviews insurance companies' practices regarding the treatment of policyholders for compliance with Missouri law. This includes the way premium rates are charged, the way insurers handle claims and other responsibilities under state law. These reviews can result in refunds for consumers, fines and corrections in business practices, as well as other remedies.

Since the beginning of 2009, the Market Conduct Section has recovered more than $16.3 million in recoveries for consumers or for the public and in fines, which by law go to the Missouri State School Fund.

Consumers with complaints or questions about their insurance can call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.

About the Missouri Department of Insurance, Financial Institutions & Professional Registration

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) is responsible for consumer protection through the regulation of financial industries and professionals. The department's seven divisions work to enforce state regulations both efficiently and effectively while encouraging a competitive environment for industries and professions to ensure consumers have access to quality products.

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