Ohio Orders Anthem Blue to Refund $6 Million to Policyholders in Individual Health Plans

Anthem Blue Cross and Blue Shield in Ohio was ordered to pay $6 million to 45,000 policyholders in its individual health insurance plans for charging premiums that didn't match up with the rates it filed with the state Department of Insurance.

The department investigated "multiple consumer complaints earlier this year," Mary Jo Hudson, director of the Ohio insurance department, said in a statement. The rates Community Insurance Co., also known as Anthem, filed with the department on Nov. 6, 2009 for use as of October 2009 weren't consistent with the rates it was charging policyholders.

The matter involves only some of the company's 3.3 million members in Ohio, said Kim Ashley, a spokeswoman for Anthem, a unit of WellPoint Inc. (NYSE: WLP). Less than 30,000 people are affected, as an individual policy may include more than one person, such as a family policy, she said.

The average adjustment or refund is $19.12 a month, Ashley said.

"Even though some members would have seen an increase in their premiums with this adjustment, Anthem has chosen not to issue those increases," said Erin Hoeflinger, president of Anthem Blue Cross and Blue Shield in Ohio, in a statement.

The filings were made as a result of H.B. 1, which took effect in October 2009, the department said. The company "used the rates that we believed were in accordance with the new regulations," Hoeflinger said in the statement.

Impacted policies included some of the company's Blue Access Plans and Blue Traditional Plans, Blue Economy, Blue Access Saver Plans, Lumenos HIA and Lumenos HIA Plus.

In 2005, WellPoint said it would buy Lumenos Inc., which provides consumer-driven health plans, for about $185 million (BestWire, May 6, 2005). Lumenos offers health savings account plans and health reimbursement accountplans.

Recently, the California Department of Insurance said Aetna withdrew its rate filing, which would have raised premiums by an average of 19% on 65,000 policyholders in its individual health plans. That came after mathematical errors were found in an actuarial review (BestWire, June 25, 2010).

Aetna was the second major health insurer to have withdrawn its rate request, as Anthem Blue Cross withdrew its request in April to raise premiums by up to 39% on members in its individual plans in California after the department found errors in its rate filing (BestWire, April 30, 2010).

The issue in Ohio "has nothing to do with" math errors, Ashley said.

Anthem cooperated with the investigation and agreed that no rates would be increased in this action, Hudson said in the statement.

Community Insurance Co., a member of WellPoint Health Networks Group, currently has a Best's Financial Strength Rating of A (Excellent).

(By Fran Matso Lysiak, senior associate editor, BestWeek: [email protected])