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Life Health > Health Insurance > Your Practice

Evergreen State Fines Managed Care Company

By Staff Writer

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Washington state officials fined a large health maintenance organization plan in connection with allegations that it missed dental plan filing deadlines and failed to give policyholders adequate notice of coverage changes.

Regulators imposed a total of $111,850 in fines on Kaiser Foundation Health Plan of the Northwest, Portland, Ore., a unit of Kaiser Permanente, Oakland, Calif., and a sister company, but they suspended $45,000 of the fines on the condition that the companies fix the violations and commit no further violations for 2 years.

In 2005, Kaiser filed dental coverage plans that were not completely compliant with state laws and regulations, sold non-compliant plans to 215 groups, and then missed deadlines for resubmitting the plans, officials say.

In 2006, Kaiser changed health benefit plan provisions in ways that, under Washington law, effectively canceled the policies and violated state guaranteed renewal laws, officials say.

Kaiser has taken corrective action to avoid future filing delay problems, and it now understands that it has to give 90 days’ notice of health plan changes that constitute plan cancellations under Washington rules even when Kaiser managers believe the changes to be minor, company spokesman Mary Sawyers says.

In one case, Sawyers says, Kaiser ran into problems in Washington because it decided it would impose only one co-payment, rather than several, when members needed several laboratory and imaging tests on a single day, Sawyers says.

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