Massachusetts Health Insurers Settle Charges Over Mandatory Benefits Violations

Strategic Insights -

Massachusetts Attorney General Tom Reilly recently announced settlements with three health insurers over charges that their plans violated the state's mandatory benefits laws. The insurers, UniCare Health and Life Insurance Co., New England Life Insurance Co., and John Alden Life Insurance Co., agreed to pay statutory penalties of $5,000 each and reprocess consumer reimbursement claims for certain treatments that were not covered. This marks the latest in a series of settlements and lawsuits filed by Reilly against health insurance companies over alleged violations of the state's mandatory benefits law.

Key Takeaways:

  • Three health insurers, UniCare Health and Life Insurance Co., New England Life Insurance Co., and John Alden Life Insurance Co., settled charges with Massachusetts Attorney General Tom Reilly over alleged violations of the state's mandatory benefits laws.
  • The insurers agreed to pay statutory penalties of $5,000 each and reprocess consumer reimbursement claims for treatments such as infertility, contraception, mental health, and diabetes treatments that were not previously covered.
  • The settlements are part of a broader effort by Reilly to ensure that Massachusetts citizens receive the health benefits they are entitled to.
  • Reilly has previously settled similar charges with Fallon Community Health Plan, Harvard Pilgrim Health Care, and Genworth Life and Health Insurance Co., and has also filed a lawsuit against Mega Life Insurance for alleged violations of the state's mandatory benefits law.
  • The state's mandatory benefits law aims to ensure that health insurance plans cover essential treatments and prevent exclusions of pre-existing conditions.

Statistics:

  • The three health insurers agreed to pay statutory penalties of $5,000 each, totaling $15,000.
  • The settlements require the insurers to reprocess consumer reimbursement claims for certain treatments that were not previously covered.
  • Massachusetts Attorney General Tom Reilly has now settled similar charges with six health insurance companies, including Fallon Community Health Plan, Harvard Pilgrim Health Care, Genworth Life and Health Insurance Co., UniCare Health and Life Insurance Co., New England Life Insurance Co., and John Alden Life Insurance Co.
  • Reilly has also filed a lawsuit against Mega Life Insurance for alleged violations of the state's mandatory benefits law.

Sources:

  • A. M. Best via COMTEX
  • Boston, Nov 03, 2006
  • Reilly, Tom. "Statement on Settlements with UniCare, New England Life, and John Alden Life Insurance Companies." (Source unknown - date not provided)
  • Comtex SmarTrend(SM) Alert, an automated pattern recognition system, indicated an UPTREND on 07-20-2006 for MET @ $52.54.