Blue Cross Blue Shield of North Dakota paid the North Dakota Department of Insurance $30,000 on September 11, 2009, in response to a consent order issued by the DOI on August 21, 2009.
BCBSND agreed to pay the fine for technically failing to file a physician agreement (also called a provider contract) and failing to include premium taxes as part of total premium equivalents in marketing materials. Premium equivalents are the claims the company pays plus the related administrative costs for self-funded groups, and the actual premium for fully insured groups.
In October 2008, the Department of Insurance requested BCBSND provide a copy of the physician agreement and evidence that it had been filed. BCBSND conducted a search and was unable to find evidence that the contract had been filed with the DOI. The physician agreement was originally written and presumably filed more than 40 years ago under the regulations at that time. BCBSND then provided a copy of the physician agreement to the DOI on October 29, 2008, and updated the language in the agreements as requested by the department. The new language went into effect in February 2009.
Regarding changes in marketing materials, BCBSND has agreed to include premium taxes as part of its total premium equivalents, which would change the 2008 claims as a percentage of premium equivalents from an average of 93 percent (and in one example, 93.6 percent) to a specific 92.8 percent.