Health plan PacifiCare of California has agreed to restore coverage to consumers whose individual policies, the state says, were canceled unfairly. Under the terms of its agreement with state's Department of Managed Health Care, the health plan will offer coverage to three consumers whose coverage was canceled within the last four years, and stand ready to reimburse for past medical claims. The health plan will also offer coverage to 57 former members, as well as expedited dispute resolution for claims. In addition, PacifiCare has agreed to pay a $50,000 fine and agree to a corrective action plan. It must comply with the corrective action plan within one year or face another fine of $500,000.
In settling with the state, PacifiCare is following in the footsteps of Kaiser and Health Net, both of which were slapped with fines of $300,000, and potential added fines of $3 million, over charges that they rescinded coverage inappropriately for members with individual policies. The state has also offered settlements to Blue Shield and Anthem Blue Cross, which are pending.
To learn more about the state's actions:
- read this Sacramento Business Journal article
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