Health insurance premium overcharges lead to ordered refunds of $114.5 million
Wednesday, November 9, 2011 - 2:36 pm

Eleven insurance companies have been ordered to refund $114.5 million to holders of policies that cover 573,748 people who were overcharged for health insurance premiums in 2010.

Under New York State law, insurers are required to spend 82 cents of every dollar collected in premiums on providing medical care. If the amount spent on care, known as a "medical loss ratio" or "MLR," is less than the 82 percent requirement, insurers are required to refund the difference to policyholders. The purpose of this requirement is to encourage health insurers to operate as efficiently as possible so that most premium dollars go to providing medical care. The amount of premium over the 82 percent mark goes to insurer overhead, administrative expenses, and profit.

According to Department of Financial Services (DFS) information, plans offered by 11 health insurance companies failed to meet the 82 percent requirement.

• Most of the refunds – a total of $44.7 million -- are being made to policies covering 141,829 members in the large group market where plans are used to cover groups of 51 members or more.

• Another $25 million is being refunded to small groups covering 290,520, for companies with groups of 50 or fewer people.

• A total of $27.2 million is being refunded to 16,773 people who purchased insurance coverage as individuals.

• Policies covering 27,907 people with plans in HealthyNY, a state-sponsored health insurance program for individuals and small proprietors, are seeing $2.7 million in premium refunds.

• Another $14.9 million is being refunded to 96,719 people with Medicare Supplemental and Medicare Complementary policies.

Refunds have already been made to policyholders in the small group and individual, direct-pay market. DFS has instructed insurers to make refunds to affected policyholders in the large group market by December 15.

These are the insurers required to make the refunds:

• Empire -- $61,080,867

• Excellus -- $21,426,603

• Aetna Health Inc -- $11,495,614

• Health Net of New York -- $5,052,467

• Oxford Health Insurance Co -- $4,838,675

• HealthNow -- $4,492,327

• GHI -- $4,168,935

• MVP Health Plan -- $1,319,640

• CDPHP Health Plan -- $487,768

• HIP Health Plan of Greater New York -- $182,194

• ConnectiCare of NY -- $15,462

Governor Andrew Cuomo and Department of Financial Services Superintendent Benjamin Lawsky also announced the completion of a successful effort to ensure that health insurer rate filings will be made public. All insurers have now withdrawn their objections to the public release of this information by the Department of Financial Services. The public release of these filings will help protect consumers and promote competition, Cuomo and Lawsky said.