OAKLAND, CA – The Kaiser Foundation Health Plan is pushing for stricter and fairer rules to cover cancellations of individual health policies.
Kaiser is in discussions with the California Department of Managed Health Care to develop a set of standards that would be applicable to all carriers in the individual insurance market, said Kaiser spokesperson Matthew Schiffgens.
“We are working with the department to have a level playing field for health plans and individuals,” he said. “The point is (that) we need a clear process that works.”
After the department fined Kaiser in 2004, the health plan changed its processes for rescission and cancellation of individual policies.
“We have taken steps to improve our processes and make it clear to California consumers,” Schiffgens said.
The changes include making the application process easier for consumers to understand and complete and listing health signs or symptoms that are layperson-friendly. For present members converting to individual policies, Kaiser has increased its ability to scan existing medical records and improved its process for researching the information.
Kaiser is working with the department to develop a clear, fair and transparent process for providing the health plan with information it needs for review. Schiffgens said Kaiser wants rules in place that allow enforceability of cancellations on the basis of the contract.
In the end, Schiffgens said, the changes are all about “making coverage affordable and accessible.” As a way to differentiate itself in a competitive marketplace, Kaiser is “interested in providing a solution,” he said.
Kaiser spokesperson Beverly Hayon emphasized that the review of rescission and cancellation processes is not just a Kaiser issue but an industry-wide concern. “All insurers are involved in this,” she said.
Mohit Ghose, vice president of public affairs for America’s Health Insurance Plans, a Washington-based national association representing health plans, agreed. “All our members are working diligently to provide consumers with the peace of mind that the policies they purchase and the contracts they sign will not arbitrarily be overturned,” he said.
“That said, health insurance plans also have a responsibility to implement fraud detection and prevention programs for the good of the larger pool of insured consumers,” he added.
The DMHC had scheduled a public meeting for January 29 to obtain information and input regarding, among other things, the establishment of due process standards for plan rescission and cancellation of subscriber contracts.