DORA’s Colorado Division of Insurance recently completed market conduct examinations that identified violations of Colorado insurance laws by two Humana companies. The final market conduct orders resulted in fines totaling $184,000 for Humana Insurance Company and $115,000 for Humana Health Plan, Inc. Both companies are licensed in Colorado to sell health insurance products and are headquartered in Louisville, KY. The Colorado Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues.The market conduct examinations, which covered the period July 1, 2007 through June 30, 2009, identified a number of issues for both companies, including:
· Missing or incorrect information provided in policy forms, which in some cases related to mandatory benefits coverage.
· Using rates not filed with the Division of Insurance
· Failing to pay claims within time frames required by Colorado law
· Failing to use correct underwriting criteria for small groups
· Using incorrect utilization review procedures
· Failing to use correct procedures when terminating coverage
The final agency orders require both companies to correct the problems listed in the report and report back to the Division of Insurance in writing, documenting changes and corrections within specific timeframes.
If any Humana policyholders believe they have been denied a benefit unfairly or have been harmed in any other way by a Humana company, the policyholder should contact DORA’s Division of Insurance at http://www.dora.state.co.us/pls/real/Ins_Complaint.Submit_Form or by mailing a letter to the Division of Insurance, 1560 Broadway, Suite 850, Denver, CO 80202.
The examination reports and Final Agency Orders can be viewed on the Division of Insurance’s website: http://www.dora.state.co.us/insurance/mcexam/MarketRegChron.htm
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