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Brokers Information - 12/02/2016

FAQs for Broker Commission Claims

HealthyCT To Move Into Liquidation; Help Clients Find Other Coverage Immediately

The Connecticut Insurance Commissioner in her role as Rehabilitator of HealthyCT has determined that the rehabilitation efforts for HealthyCT have been unsuccessful and the company will be moving into liquidation.

Filing a petition for liquidation is anticipated to occur in early December 2016 requesting an order to liquidate the company effective December 31, 2016. Outlined below is what it means to be in liquidation.

Please help your clients immediately find different coverage now. Taking action now is especially important to your group clients as their coverage will end January 31, 2017, if it has not terminated earlier.

Group Coverage

If employers have not already replaced coverage by January 1, 2017, the Connecticut Life & Health Insurance Guaranty Association will provide coverage for the month of January 2017, provided the group pays the billed premium for January. But, it is important that you work with your groups to find alternative coverage by February 1, 2017 to avoid a gap in coverage.

Although pharmacy and medical claims will continue to be paid for covered services received until coverage is cancelled, all claims paid from January 1, 2017 going forward will be funded by the Connecticut Guaranty Association.

$500,000 Claims Limit

Under the Guaranty Association, there is a $500,000 per member limit on medical and pharmacy claims; this $500,000 limit does not include member cost share and is based on the contracted rate HealthyCT reimburses providers – not what the provider charges. Any medical and pharmacy claims in excess of $500,000 could be the member’s responsibility if there are not sufficient assets in the HealthyCT estate to cover the overlimit amount.

Coverage Ends Notice

A notice will be mailed soon to employers officially notifying them when their HealthyCT group coverage will be ending. Groups are strongly encouraged to look for other coverage options now to avoid a gap in coverage. An alert to employers regarding the impending liquidation and termination of coverage by January 31, 2017 was mailed with their January premium invoice and posted on the HealthyCT website.

Deductible Credit Reports

HealthyCT can provide group medical loss ratio experience and deductible reports.

Commissions

Commission payments to brokers and agents were suspended when the Rehabilitation Order was entered November 1, 2016. Brokers and agents will have a claim in HealthyCT’s liquidation for commissions owed from October-December 2016. Payment of unpaid commissions will depend on assets available in the HealthyCT liquidation estate or further order of the Court. In the rehabilitation proceeding and in liquidation, processing and payment of HealthyCT’s insureds claims receive priority for expenditure of HealthyCT and Guaranty Association funds. The claim process in liquidation proceeding will be set out in the Liquidation Order.

Communications to Providers

An update also is being sent to providers explaining that HealthyCT is moving into liquidation and that their covered claims will be funded by the Connecticut Guaranty Association when liquidation is triggered. The communications reminds providers of the following:

• Providers should continue to provide healthcare services without interruption to HealthyCT members
• Providers will be paid for covered services delivered to HealthyCT members per their contract
• Providers should submit claims for services as usual

Websites for Up-to-Date Communications

For updates on HealthyCT, visit the HealthyCT or Connecticut Insurance Department websites.

For more information: