Cigna Health and Life Insurance Co. was fined $2 million on Tuesday by New York’s Department of Financial Services for violating state insurance law.
An investigation by the department found that Connecticut-based Cigna illegally sold stop-loss insurance, which may only be sold to large group employers that self-fund underlying medical expenses in an effort to limit their liability in the event of an unexpected amount of claims. The investigation also found that Cigna illegally sold fully insured policies outside of the state to New York-based small groups with New York employees, which harmed the community-rating program, DFS said. New York mandates pure community rating, meaning that insurers aren’t able to charge more to older customers who are more likely to have a higher need for medical care.
“By deliberately choosing to write New York risks outside of New York, Cigna’s actions harmed New York’s community-rating program for small group employers,” Superintendent Maria Vullo said in a news release. “Cigna cherry-picked risks, which may have improperly induced forum shopping in the New York small-group market.”
In an emailed statement, a Cigna spokesman said “our objective is to improve the health and health care affordability in the communities we serve. We have agreed with the New York Department of Financial Services to resolve this matter and would welcome the opportunity to work with the Department and insurers in developing industry guidance regarding the scope of New York’s small group law in order to ensure a level, competitive playing field.”
The investigation by DFS began after the regulator received complaints in July 2016 about Cigna selling stop-loss and fully insured health insurance policies outside of the state to New York-based small employer groups, which the state and Affordable Care Act defines as having one to 100 employees.
DFS states in the order that between Jan. 1, 2016, through Jan. 1, 2017, Cigna violated state insurance law by issuing 43 fully insured health insurance policies and 38 stop-loss insurance policies outside the state to evade the small group community-rated market in New York, harming the integrity of New York’s small-group risk pool.
The consent order signed by Cigna’s president, Julia Huggins, claims that the insurer initially agreed to end selling of stop-loss insurance and fully insured health insurance policies outside New York, but Cigna “later resumed its practices.”
As part of the agreement, the insurance company must provide written notices to all small groups that were issued coverage under the illegal circumstances by Dec. 1. Cigna must also provide the state agency with a list of the names and addresses of all small group policyholders to whom written notices were sent.
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Josefa Velasquez
Josefa Velasquez is a regulatory and Court of Appeals reporter for the New York Law Journal based in Albany, N.Y. Contact Josefa Velasquez at [email protected]. Twitter: @j__velasquez
