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- Committee Leaders Request Documents & Information from Twelve Companies on Troubling Practices Like Denying Coverage & Misleading Consumers
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Energy and Commerce Chairman
The Committee leaders continued, "Additionally, we are troubled that consumers who sign up for these plans are being misled about the nature of the coverage they are purchasing. Consumers are being denied coverage even for medical care that is rightfully covered under the terms of their contract, through a process known as post claims underwriting. As such, we request further information about the plans your company is offering and about these industry practices."
In the letters, the
The Committee leaders also noted their concerns with accounts of consumers being misled by insurance brokers and agents about whether the plans they are signing up for comply with the Affordable Care Act's (ACA) comprehensive consumer protections. According to a study from the
As part of the investigation, the Committee leaders are requesting documents and responses to a series of questions from each of the companies, including:
* All documents provided to applicants seeking to purchase your company's STLDI plans, including plan applications, all underwriting documents, and health questionnaires that applicants must answer about their health status and medical history.
* What percentage of applicants are denied coverage for these policies?
* An explanation of how your company markets STLDI plans to consumers, and copies of marketing materials and plan documents for STLDI plans offered in each state in which you sell these plans.
* Information on how much commission STLDI insurers pay to agents and brokers for STLDI plans.
* A written explanation of whether and how your company conducts post-claims underwriting on STLDI plans, including what constitutes a pre-existing condition under your company's policy.
* Have you received complaints from consumers or from insurance regulators in any state about deceptive advertising?
The letters sent to each of the companies are available below:
National General Accident and Health (https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/Barry%20Karfunkel%20Letter.pdf)