Health insurance provider breaks regulations in North Carolina

Health Insurance company merger Aetna

Aetna could face fines and other penalties from state regulators for numerous infractions

Health insurance provider Aetna has run afoul of North Carolina’s insurance regulators. According to the North Carolina Department of Insurance, the company has sold policies to several hundred consumers without the state’s approval. The agency approved these policies in order to ensure that people do not lose their health insurance coverage, but Aetna may be subject to fines and other penalties for selling insurance products without the states authorization.

Company reports its own infractions, which may have been the result of a misunderstanding

Health Insurance AetnaAetna’s initial application to sell health insurance policies had been denied by the state, but the insurer had sold products anyway. According to the state’s Department of Insurance, there are more than a dozen instances in which Aetna could have denied providing coverage that it was required to by state and federal law. The agency does note, however, that Aetna reported its infractions itself, which suggests that the insurer did not intentionally break regulations for malicious purposes.

State agency does not know how many people have been affected by this issue at this time

The North Carolina Department of Insurance is not yet sure how many people have been affected by the issue because Aetna is still collecting information concerning its infractions. The company sold health insurance coverage to some 349 consumers in the state that could be affected by the infraction. Compared to the 685,000 people that currently have coverage through Aetna, this could be a tiny fraction that will have little impact on the overall health insurance market.

State agency requests that changes be made to Aetna’s application

Aetna’s application to sell certain health insurance products had been rejected for numerous reasons. Some projects were considered too expensive, while Aetna’s overall application for policies was considered inadequate. The North Carolina Department of Insurance had requested for changes to be made to Aetna’s application. The agency had requested the company to rewrite policy terms in order to make it more clear that minimum hospital stays after the birth of a child do not require pre-certification.

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