(Helena, MT – Insurance News 360) – State Auditor and Insurance Commissioner Matt Rosendale has proposed fines for Prime Therapeutics and two subsidiaries of Express Scripts, which are accused of operating without a license since 2017. The companies have not complied with requests from lawmakers for documentation, Rosendale said.

“These companies need to understand that we are serious about consumer protection and that they will be held accountable for their actions,” Rosendale said in a statement Wednesday.

Prime applied for a license in April 2018, but has not received the license because they have not provided information requested by the state.

These companies can request a hearing on the issue and fines. The fines could be up to $30,000 for each violation of the Montana insurance Code.

Prime Therapeutics is owned by Health Care Service Corporation, the parent company of Blue Cross and Blue Shield of Montana. It has handled nearly 6 million claims for Blue Cross in Montana since 2013, each of which could be considered a code violation, the commissioner’s office said. Express Scripts handled claims for the Montana Health CO-OP.

Source: Montana Department of Insurance.

(Jackson, MS – Insurance News 360) – In early June, the Mississippi Insurnace Department Issued a Cease and Desist order to James Michael Brand, who is the owner/operator of Brand Insurance Services, LLC after the department received complaints from insurance holders.

Those complaints allegedthat Brand did not send premiums to insurance companies and violated Mississippi Code Ann. §83-17-71(1)d.

They must not conduct insurance business until the state Commissioner of Insurance  issues a final determination.

Anyone doing business with James Michael Brand, Brand Insurance Services, LLC or Gulf Coast Insurance who has questions about coverage or claims should contact their insurance company directly. Those who do not have contact information for their company may contact the Consumer Services Division at MID by calling 1-800-562-2957 for assistance.

Source: Mississippi Department of Insurance.

(Saint Paul, MN – Insurance News 360) – Health insurance companies are proposing mostly decreased premium rates for 2019 in Minnesota’s individual health insurance market. The average proposed rates show decreases that range from 3-12 percent and higher. Health insurers submitted proposed rates for all 87 counties.

Insurers submitted proposed 2019 rates to the Minnesota Commerce Department on June 1.  These preliminary rates will be reviewed by the Department and final, approved 2019 rates will be announced by October 2, 2018.

The proposed rates include the Minnesota Premium Security Plan, a state-based reinsurance program enacted in 2017 and in effect for 2019. For an insurer, reinsurance offsets 80 percent of an individual’s total annual medical claims costs between $50,000 and $250,000. State law authorizes up to $542 million in 2018-2019 for the reinsurance program.

Proposed rates for 2019 are available on the Minnesota Commerce Department’s website (mn.gov/commerce).

Public comments accepted until August 15

Members of the public are invited to comment on insurers’ preliminary proposed rates for 2019 as the Commerce Department conducts its review.

Submit comments through Aug. 15 via email to  healthinsurance.ratecomments@state.mn.us.

Open enrollment begins on Nov. 1 and runs through Dec. 15, 2018.

Four percent of Minnesotans buy health insurance in the individual market; 5 percent through small group market

Individual health plans provide coverage for Minnesotans who purchase their own insurance instead of from an employer or public program. About four percent of Minnesotans  are covered through the individual health insurance market – with most buying coverage through MNsure.

Small group health plans cover businesses and organizations with 2 -50 full-time employees. About five percent of Minnesotans currently get their coverage through the small group health insurance market.

The Commerce Department will review each proposed rate filing, and the Minnesota Department of Health will review provider networks to ensure they meet state and federal adequacy requirements.

That rate review must show justification by the benefits for consumers, and the insurance company’s ability to pay medical claims costs based on premium revenue.

Insurers must also comply with state and federal laws that protect consumers, including coverage for pre-existing conditions, free preventive care, adequacy of the provider network and the procedures an individual must follow to enroll or have a claim paid.

Source: Minnesota Department of Commerce.

(Denver, CO – Insurance News 360) – On June 11, Colorado announced that the actions of the federal  government would not affect Colorado residents who have pre-existing health conditions.

 “Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law,” said Interim Insurance Commissioner Michael Conway. “Regardless of how the Justice Department or the Trump administration attempt to change the Affordable Care Act, the Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens.”

This announcement comes in response to the U.S. Justice Department and Trump Administration’s notice that it would not defend parts of the ACA from a lawsuit from 20 Republican State Attorneys General.

 “A single risk pool is also part of Colorado law. Gone are the days of being charged more because you have high blood pressure or because your child has asthma. While the ACA led the way on prohibiting insurers from such practices, Coloradans can rest assured that they will remain protected from any political gamesmanship at the federal level because of the foresight of our State legislators and Governor Hickenlooper,” said Commissioner Conway.

“Providing access to health insurance to people with pre-existing conditions and not charging them more simply because they’ve been sick are two of the fundamental improvements of the ACA,” continued Commissioner Conway. “That’s why the Division will continue to make sure that plans offered in Colorado conform to Colorado law. We won’t be turning back the clock.”

Source: Colorado Department of Insurance.

(Denver, CO – Insurance News 360) – On June 11, Colorado announced that the actions of the federal  government would not affect Colorado residents who have pre-existing health conditions.

 “Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law,” said Interim Insurance Commissioner Michael Conway. “Regardless of how the Justice Department or the Trump administration attempt to change the Affordable Care Act, the Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens.”

This announcement comes in response to the U.S. Justice Department and Trump Administration’s notice that it would not defend parts of the ACA from a lawsuit from 20 Republican State Attorneys General. 

 “A single risk pool is also part of Colorado law. Gone are the days of being charged more because you have high blood pressure or because your child has asthma. While the ACA led the way on prohibiting insurers from such practices, Coloradans can rest assured that they will remain protected from any political gamesmanship at the federal level because of the foresight of our State legislators and Governor Hickenlooper,” said Commissioner Conway. 

“Providing access to health insurance to people with pre-existing conditions and not charging them more simply because they’ve been sick are two of the fundamental improvements of the ACA,” continued Commissioner Conway. “That’s why the Division will continue to make sure that plans offered in Colorado conform to Colorado law. We won’t be turning back the clock.”

Source: Colorado Department of Insurance.