Kaiser to pay D.C., Maryland and Virginia $375,000 for vendor error

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Kaiser Foundation Health Plan of the Mid-Atlantic States agreed to pay a total of $375,000 in fines to insurance regulators in Maryland, Virginia and Washington, D.C., to resolve paperwork problems it blamed on a vendor.

The Rockville, Md.-based health insurer reported to regulators in mid-June 2008 that it had problems with its timely issuance of Evidence of Coverage to subscribers, according to the settlement agreement.

An investigation, led by the Maryland Insurance Administration, found that Kaiser failed to issue or make available Evidence of Coverage to “a majority of its subscribers” from Jan. 1, 2008, through Sept. 30, 2008.

Investigators found that the failure was “largely the result of transitional issues related to a new vendor which began producing EOCs effective January 1, 2008,” according to the order. The vendor was not identified.

Kaiser officials told regulators in Maryland, where it is domiciled, that it was correcting the problem and by Dec. 31, 2008, had issued or made EOCs available to all subscribers.

“Kaiser identified an issue with a new vendor that was responsible for issuing the EOCs and was proactive in reporting its violation and engaging in corrective action,” said Maryland Insurance Commissioner Ralph S. Tyler. “However, the potential damage had already been done by consumers not having accurate information about their coverage for nearly a year. Health insurance is complicated enough and consumers should expect to be treated fairly and receive timely and accurate information about their benefits.”

As part of the order, Kaiser officials agreed to “adjust claims to pay the more generous 2007 benefit” to any member who experienced a reduction in benefit, or who filed or files a complaint with Kaiser or insurance regulators.

Each jurisdiction’s insurance department received $125,000 of the settlement.

Kaiser Permanente Insurance Co. of Oakland, Calif., was also named in the settlement, but not assessed a fine, according to the order.

Officials with Kaiser could not be reached for comment.

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