Date: September 10, 2008
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov

Insurance Commissioner Announces Regulatory
Action Against Humana Insurance Company

Madison, WI—Insurance Commissioner Sean Dilweg today announced that Wisconsin has assessed a forfeiture of $750,000 as part of a regulatory settlement agreement between the Office of the Commissioner of Insurance (OCI) and Humana Insurance Company.

"With this settlement, we protect our senior citizens by addressing issues with marketing of Medicare Advantage and Medicare Part D products," said Dilweg. "The settlement also resolves long-standing issues with company claim adjudication, customer service and underwriting practices."

The regulatory settlement is based in part on a market conduct examination which was conducted as a follow up to a previous examination of Humana, and in part due to concerns over Medicare Advantage and Medicare Part D marketing practices. The examination report documented multiple problems involving compliance with previous recommendations from the OCI. The report also documented significant issues with compliance procedures and oversight of Medicare Advantage and Medicare Part D marketing activities. Humana had notified the OCI that it had developed procedures to prevent agents who were not properly certified and licensed from receiving commissions for Medicare Advantage and Medicare Part D products. However, the examination determined that Humana continued to accept applications and pay commissions. The company was one of the largest Wisconsin writers of Medicare Advantage and Part D plans during the review period.

Humana denies the allegations in the examination report, and any violation of law, but still agreed to the settlement. According to the terms of the settlement, Humana must implement the recommendations in the market conduct examination report, comply with all Wisconsin insurance laws, and pay a forfeiture of $750,000. Deputy Commissioner Kim Shaul acknowledged that Humana has agreed to correct their issues. "We appreciate their cooperation in resolving the problems we have identified," said Shaul.

Wisconsin consumers with questions concerning insurance are encouraged to call the OCI complaints line, 1-800-236-8517. Additional tips and more information about insurance, including a link to the Insure U Web site, can be found at the OCI Web site, oci.wi.gov.

Market Conduct Examination of Humana Insurance Company (p d f)
Stipulation and Order (p d f)

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.