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Credits And Refunds Determined After Review of Loss Experience

Superintendent Gregory V. Serio today announced that Empire HealthChoice Assurance is refunding and providing premium credits totaling over $23.3 million to certain Medicare Supplement Plan B or Plan H insurance contractholders. This is the result of the ratio of claims paid relative to premiums charged on these Medicare Supplement plans during 2000-2002 being at lower levels than threshold allowed under applicable Insurance Law.

Empire had reported such experience results to the Department and a plan was designed in accordance with requirements of the law for the issuance of either premium credits or refunds to eligible individuals for appropriate reimbursement amounts.

Earlier this year, during a review of Empire’s loss experience for 2002, Empire reported that Medicare Supplement Plan H policyholders would receive refunds or premium credits based on actual 2002 experience. The Department’s review of this information in addition to the renewed operation of the New York State Market Stabilization pools led to the determination that additional funds were also due to some Plan H and Plan B policyholders for calendar years 2000, 2001 and 2002.

Certain individuals who were contractholders of Medicare Supplement Plan B or Plan H during the period of 2000-2002 will receive a credit or refund on their premium. Empire HealthChoice will notify each affected policyholder by December 31, 2003 about a refund or credit. The Department will monitor the reimbursement proceedings to ensure consumers are adjudicated appropriately.

Empire subscribers enrolled in Plan B or Plan H who have questions regarding these refunds should call the customer service number on the back of their ID cards beginning Monday, December 1st. Consumers may also call the New York State Insurance Department consumer hotline at 1-800-342-3736.


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