Washington State Fines Carrier Over Benefit Maximum Omission

Regulators are punishing a managed care company for leaving key dental plan information out of materials sent to plan members.

The Washington state Office of the Insurance Commissioner says it has imposed a $100,000 fine on Kaiser Permanente Health Alternatives, Portland, Ore., for selling dental coverage to 567 Washington state residents without explaining that the plan had a $1,000 yearly maximum benefit.

Washington regulators have suspended $50,000 of the fine because Kaiser dealt with the consequences of the omission by spending more than $50,000 to reimburse 188 members of the dental plan who exceeded the $1,000 dental claims limit.

Insurance Commissioner Mike Kreidler suspended half of the fine against Kaiser Permanente Health Alternatives after the company agreed to reimburse 188 dental plan members more than $50,000 for dental services that would have been covered if there had been no benefit maximum.