Regulator places HMO under conservatorship

THE Insurance Commission (IC) has placed Carehealth Plus Systems International Inc. (Carehealth) under conservatorship due to its failure to resolve policyholders’ complaints regarding health insurance claims.

In a letter issued last week, the commission told Carehealth that conservatorship would safeguard the interests of its policyholders as the complaints indicated the health maintenance organization’s inability to fulfill benefits offered in its products.

“[T]he Commission finds Carehealth to be continually incapable of complying with the order of the IC to address the issues and concerns of the complainants against it,” Insurance Commissioner Rey Regalado said in a statement.

“The additional complaints against Carehealth even reveal that the HMO has not improved its services towards its members, nor has it paid its obligations with accredited health care providers,” he added.

Last Oct. 10, 2023, the IC issued a cease and desist order against Carehealth, ordering it to stop selling health insurance but allowing it to continue serving existing policyholders.

Complaints continued to persist about Carehealth’s failure to provide benefits under its health insurance products and the reimbursement of expenses for covered medical procedures.

Circular Letter 2019-35 allows the IC to take over an HMO if the latter consistently fails to meet its obligations.

The commission recently rejected Carehealth’s request to lift the order and also declined to renew the firm’s license.