August 04, 2014

Anthem to return nearly $8 million to Missouri policyholders in record regulatory settlement

Some St. Louis area consumers paid more for substantially equivalent health plans

Jefferson City, Mo. - The Missouri Department of Insurance today announced it has reached a regulatory settlement with Healthy Alliance Life Insurance Company and HMO Missouri, Inc, subsidiaries of Anthem BlueCross BlueShield of Missouri, which are part of WellPoint, Inc. As part of the settlement, these insurers agreed to return $7.8 million to Missouri policyholders. The settlement is the largest settlement of a Missouri market conduct examination by the department.  

The insurers will, as required by the settlement, identify and contact affected policyholders and return premiums directly to those affected. Consumers with questions about the settlement may contact Anthem directly at 877-889-1954.

"Part of our mission of consumer protection is to ensure that consumers are fully informed about their insurance coverage options when they buy insurance," said John M. Huff, director of the department. "Missourians should know the department will remain vigilant and utilize all of its regulatory authority when companies fail to do that. Our department will continue to investigate and remedy practices by any insurer that it believes are unfair and which could violate Missouri law."

The Anthem settlement focused on allegations that some policyholders in the St. Louis region were charged materially more premium than other consumers with substantially equivalent health plans. The settlement found these health plans, beginning Jan. 1, 2007, were identical in benefits and substantially equivalent in terms of their provider networks. However, some consumers were charged materially more for their health plan. The department also alleged that consumers in the higher priced plan were not fully informed of the substantially equivalent lower priced plan. The plans were sold and marketed to consumers in the St. Louis area between 2007 and 2010. With this settlement, the Missouri market conduct section has recovered over $33 million in consumer restitution and fines since 2009. 

In states where insurance companies are required to file rates, state regulators can review rates before consumers buy insurance policies. Rate review authority allows insurance regulators to identify problems and can proactively prevent consumers from being charged health insurance rates that are excessive, inadequate or unfairly discriminatory. Missouri is the only state in the country where health insurance companies are not required by law to file rates with the state department of insurance.