If you received your insurance coverage from HealthMarkets before August, 2005, there is shortly to be a toll-free hotline you can call to learn more about your policy’s limits and benefits. This is part of the settlement resulting from a 36-state investigation into HealthMarkets’ violations of insurance regulations.

Regulators in Washington state and Alaska lead a team which delved into insurance records and practices from 2000 to 2005. This was in response to many complaints from policy holders, who stated that HealthMarkets did not always disclose their policy limits, and did not pay claims promptly enough.

HealthMarkets is owned by three private firms and services about 612,000 policy holders spread over 44 states. Its subsidiaries are Mega Life and Health Insurance, Chesapeake Life Insurance, and Mid-West National Life Insurance. Most policy holders are self-employed.

A History of Violations

According to Securities and Exchange Commission (SEC) documents, HealthMarkets posted a net income of $70.2 million in 2007, having taken in $1.6 billion. Since 2002, it has been fined by seven states and sued by several dozen policy holders.

  • In 2006, Massachusetts required that they rethink their denials of policyholder medical bills as far back as January 2002
  • In 2008, Maine fined them $1 million and ordered them to refund $5.6 million to policy holders

Now they have agreed to pay $20 million to settle the violations laid out in the investigation report published on July 21.

A New Start?

Since 2005, HealthMarkets has made a lot of changes, one of which is to call all new policyholders and ask them if they understand their coverage. Another is to improve sales agent training, in efforts to better inform their potential policy holders about what they are purchasing. Phillip Hildebrand, HealthMarkets CEO stated that the company cooperated willingly with the investigators and that it is “committed to serving the health insurance needs of individuals, families, the self-employed, and small businesses in a fully compliant manner.”

If it does not, it could face as much as $10 million in additional fines. If you have been one of HealthMarkets’ policy holders, this settlement does not require the company to refund you for any past disservice.

At Robert W. Kerpsack Y Co., we represent people who have been victims of insurance bad faith. If you are wondering if you might have such a case, please contact us for a free consultation.