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State fines CIGNA for insurance violations

Posted March 25, 2011

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— The state Department of Insurance has fined CIGNA Healthcare of North Carolina $600,000 to resolve conduct violations toward policyholders, officials said Friday.

The violations occurred between 2002 and 2004, and CIGNA has agreed to issue another $638,000 in refunds and credits to affected employers with group policies because of the insurer's failure to accurately calculate premiums, officials said.

Most of the refunds were issued last year, but about 60 employers couldn't be located, officials said. CIGNA listed the employers still due refunds on its website.

Other violations noted by the DOI include failure to process pre-certification requests in a timely manner; failure to properly process claims, which resulted in incorrect payments or improper denials; failure to provide written notification of decisions for member grievances within 30 days of receipt; and failure to sufficiently monitor the activities of delegated entities.

Undercharges in excess of $1.3 million that occurred during the same period as the overcharges were factored in when determining the credits and refunds, officials said.

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