Calif. Notes Settlement with Blue Shield

California Insurance Commissioner Steve Poizner announced that the California Department of Insurance (CDI) has reached an agreement with Blue Shield of California Life & Health Insurance Company to offer new health insurance to 678 consumers whose policies were rescinded between Jan. 1, 2004 and May 31, 2008, reimbursing them for out-of-pocket medical expenses and implement significant changes in its underwriting and claims practices.

Under the terms of the settlement covering allegations of unfair claims handling and improper rescission practices, Blue Shield will immediately offer coverage to 678 consumers whose individual, family, or short-term health policies were previously terminated without subjecting them to medical underwriting or exclusions for pre-existing conditions. Any medical expenses that would have been covered under the rescinded policies that are not covered by another source will be reimbursed or paid by Blue Shield. An expedited independent arbitration process has been established to resolve any disputes regarding these expenses.

As part of the settlement, Blue Shield has agreed to make significant changes to its application forms, underwriting process, agent/broker training, notification to consumers and providers of an investigation regarding information in the application and oversight of its claims handling. It has also agreed to establish an independent third party review process for rescissions going forward. Blue Shield is subject to up to a $5 million penalty if corrective actions are not implemented in the prescribed timeline.

For details about eligibility under this settlement, call Blue Shield at 888-575-3439.