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September 16, 2008

Health Net To Reinstate Canceled Health Insurance Policies In California, Pay Fine, Reimburse Former Plan Members For Denied Claims

Health Net on Thursday agreed to reinstate coverage for 926 former members in California whose health insurance policies were canceled after they filed claims and to pay $3.6 million in fines, the Los Angeles Times reports. The company also will pay as much as about $14 million to reimburse expenses for medically necessary care that would have been covered had the policies not been cancelled.

In the last year, Health Net -- California's largest health insurer -- has been forced to pay a number of fines and penalties related to the company's policy rescission and cancellation practices, according to the Times. An investigation by the California Department of Insurance found that the company did not follow state laws whKen handling policyholders' claims and treated them unfairly. Health Net also will work with the department to make improvements to its cancellation and rescission practices and could face an additional penalty of as much as $3.6 million if a follow-up investigation finds that the company has not corrected all deficiencies, the Times reports.

The agreement allows Health Net to avoid any further penalties for potential legal violations uncovered by auditors. The California health insurance company did not admit any wrongdoing. Chief Executive Jay Gellert said his company did "not necessarily agree with the California Department of Insurance," but the settlement was a chance "to move forward and make sure these affected individuals can obtain coverage" (Girion/Lifsher, Los Angeles Times, 9/12).

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Posted by healthinsurance at 07:24 PM | Comments (0)

September 04, 2008

Thousands of California children in danger of losing health insurance

Thousands of Californian children are in danger of losing health insurance, indicating the failure of the state's promising strides toward extending medical coverage to all its children, the Los Angeles Times reported on Sunday.

Increased premiums for low-income families are expected to put the program out of reach for many and a new insurance policy in California is also expected to cut enrollees, the paper said.

"The trend is likely to further destabilize California's already shaky healthcare system," the paper noted.

Studies have found that children without health insurance are less likely to go to the doctor for routine visits that allow early diagnoses and treatment for diabetes, obesity and other increasingly common ailments, according to the paper.

Between 2001 and 2005, the number of Californians younger than 19 who were uninsured at any given time decreased 25 percent to about 763,000, according to the for Health Policy Research at the University of California in Los Angeles.

Uninsured children in California
tend to perform worse in school and miss more classes than those with coverage, several studies have found.

Most of the drop came through aggressive enrollment efforts in state and private healthcare programs and despite the erosion of employer-based insurance, which was leaving more adults without coverage, the paper said.

But legislative budget negotiators this year have decided to increase premiums for the state's California's Healthy Families program, which pays for medical care for more than 850,000 children of low-income workers who are above the federal poverty line.

The state estimates that the parents of 19,000 children will end up dropping out of the program by July because of the two-dollar or three-dollar monthly increases. A family with three or more children, earning between two and 2 1/2 times the federal poverty level of 24,800 dollars a year, would see the monthly premium rise to 51 dollars.

The state expects the rule to pare Medi-Cal rolls by about 196,000 children over the next two years.

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Posted by healthinsurance at 07:50 PM | Comments (0)