Kaiser fined for conduct violations

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Kaiser Permanente Insurance Company and Kaiser Foundation Health Plan of Colorado have been fined for several conduct violations.

Kaiser health plan was fined $201,000, and the insurance company was fined $166,000.

“The violations were pretty typical for a large insurance company,” said Carol O’Bryan, director of market regulation for the Division of Insurance. “We have some very Colorado-specific statutes and those were where most of the violations occurred.

The examinations covered calendar year 2007 and both companies submitted payment for the fined last week, according to a release from the division of insurance.

O’Bryan said the companies had corrected most of the problems found in the report.

Failures listed in the report include:

  • maintaining and providing records
  • providing coverage for newborn or adopted dependents
  • providing coverage for maternity care
  • including certain provisions in a contract
  • giving correct information about termination and continuation of coverage
  • inncluding correct co-pays and co-insurance requirements in basic membership agreements
  • providing accurate information regarding coverage for emergency services
  • providing written notice of the availability of basic standard health benefit plans to businesses that were denied coverage
  • paying, denying or settling claims within the time periods required by Colorado law
  • adjudicating claims resulting in erroneous denials

Full reports can be found at http://www.dora.state.co.us/insurance/mcexam/mcexam.htm.