Investigation Uncovers Possible Added Benefits for MEGA Policyholders

November 25, 2005

Nearly 10,000 Washington consumers with health insurance from MEGA Life and Health Insurance Company of Oklahoma (MEGA) may be entitled to additional coverage for doctor visits.

An investigation launched by the Office of the Insurance Commissioner’s Consumer Protection division on behalf of a consumer, uncovered an error in the certificates of insurance MEGA had mailed their policyholders. Certificates of insurance are documents consumers receive outlining their specific policy benefits once they’ve signed up for a health plan.

MEGA issued certificates of insurance to some of their policyholders from Oct. 4, 2000 to May 19, 2003 that erroneously indicated no coverage limit for doctor visits. However, according to MEGA’s brochures and marketing material, the certificates should have contained a $60 maximum benefit limit for each doctor’s office visit.

As a result of the investigation, affected consumers will receive a letter from MEGA along with a new endorsement which corrects their certificate of insurance. They also are eligible to have claims reprocessed if they had covered expenses for doctor office visits which cost more than $60 prior to receiving the new endorsements.

Anyone who believes they are entitled to additional coverage should contact MEGA’s Claims Customer Service Department at 1-800-527-2845, Monday through Friday, 8 a.m. to 5 p.m.

“I encourage any consumer who believes they’ve been wrongly denied coverage to contact our Insurance Consumer Hotline at 1-800-562-6900,” said Insurance Commissioner Mike Kreidler. “Our Consumer Protection division investigates thousands of complaints a year and has recovered more than $8 million for consumers just this year.”

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