HARRISBURG – Acting Pennsylvania Insurance Commissioner Michael Humphreys announced that the Pennsylvania Department of Insurance (PID) has recovered more than $18 million in 2022 for nearly 75,000 consumers who had stolen funds, improperly processed payments or other forms of restitution or credit owed as a result of company mistakes or unethical behavior.
In his budget address, Governor Shapiro expressed concern about the effective implementation and enforcement of mental health equity laws in this country. The Governor has directed Acting Insurance Commissioner Humphries to make mental health parity a real reality here in Pennsylvania and hold insurers accountable so that mental health benefits are covered fairly.
“Comprehensive market conduct examinations of our largest health insurers focused on ensuring that consumers receive coverage for mental health and substance use disorder care on par with medical and surgical coverage as required by the state and federal law,” Humphreys said. “Governor Shapiro knows that mental health and substance use disorder benefits are critical protections for consumers, and PID will make every effort to ensure that Pennsylvanians receive the benefits to which they are entitled.”
In 2022, approximately 75,000 Pennsylvania consumers received some form of refund, restitution payment or credit as a result of the Department’s efforts across all lines of insurance. Below are some examples:
- Reprocessing claims that were mishandled, in many cases due to financial requirements and visitation restrictions inconsistent with mental health parity laws and regulations.
- Recovering stolen funds when an agent collected a payment from a consumer for a policy or annuity but did not send the money to the insurance company.
- Reimbursement of co-payments and payment of previously denied or underpaid claims when a company has not paid a claim as it should under consumer policy.
- Reimbursement of excess premiums when an insurance company is found to be charging premiums above the rate approved by the Insurance Department.
Humphreys added that in some cases, the department’s findings could lead to additional penalties against the offending insurance provider. For example, after extensive reviews and investigations, the department levied more than $960,000 in fines for violations of Pennsylvania insurance laws in 2022.
“PID works diligently to hold insurance licensees accountable to Pennsylvania consumers and to ensure that consumer rights and protections guaranteed by state laws and regulations are upheld to the highest standards,” Humphreys said. “Predatory practices will not be tolerated and we will continue our work to ensure consumers get the coverage they deserve at the prices they agreed to pay.”
To date, approximately 60,000 Pennsylvania consumers have received a total of $5.87 million in restitution as a result of the department’s ACA market reviews since 2018, when the first exam was completed.
The Insurance Division also helped provide more than $165 million in benefits to 6,425 Pennsylvanians last year through participation in the National Association of Insurance Commissioners Life Insurance Policy Locator Service. Established in 2016, this service helps users find lost life insurance policies and annuity contracts for deceased loved ones.
PID is charged with upholding fair business practice standards for consumers, companies and insurance professionals to ensure Pennsylvania consumers receive all the protections they are entitled to under state laws and regulations. This work includes investigating and resolving consumer complaints, investigating allegations of misconduct by insurance companies, agents, brokers and others, and ensuring that practicing professionals are properly licensed.
Consumers who have questions about their insurance or need to file a complaint can contact the Insurance Division’s Consumer Services Bureau at 1-877-881-6388 or online.