Anthem to Return $7.8M to Missouri Policyholders in Market Conduct Settlement

August 4, 2014

The Missouri Department of Insurance announced it reached a regulatory settlement with Healthy Alliance Life Insurance Co. and HMO Missouri Inc., subsidiaries of Anthem BlueCross BlueShield of Missouri, which are part of WellPoint Inc. As part of the settlement, these insurers agreed to return $7.8 million to Missouri policyholders.

The settlement is the largest settlement of a Missouri market conduct examination, the department said.

The insurers will, as required by the settlement, identify and contact affected policyholders and return premiums directly to those affected.

The Anthem settlement focused on allegations that some policyholders in the St. Louis region were charged materially more premium than other consumers with substantially equivalent health plans.

The settlement found these health plans, beginning Jan. 1, 2007, were identical in benefits and substantially equivalent in terms of their provider networks. However, some consumers were charged materially more for their health plan.

The department also alleged that consumers in the higher priced plan were not fully informed of the substantially equivalent lower priced plan. The plans were sold and marketed to consumers in the St. Louis area between 2007 and 2010.

With this settlement, the Missouri market conduct section has recovered over $33 million in consumer restitution and fines since 2009.

In states where insurance companies are required to file rates, state regulators can review rates before consumers buy insurance policies. Rate review authority allows insurance regulators to identify problems andcanproactively prevent consumers from being charged health insurance rates that are excessive, inadequate or unfairly discriminatory. Missouri is the only state in the country where health insurance companies are not required by law to file rates with the state department of insurance, regulators said.

Source: Missouri Department of Insurance, Financial Institutions & Professional Registration

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