Insurance Commission places CareHealth Plus under conservatorship

THE INSURANCE Commission (IC) has placed health maintenance organization (HMO) CareHealth Plus Systems International, Inc. (CareHealth Plus) under conservatorship for being unable to address policyholder complaints.

The IC informed CareHealth Plus in a letter dated April 5 that it is being placed under conservatorship due to numerous complaints that the HMO was unable to provide the benefits stipulated in its products.

“Foregoing considered, the Commission finds CareHealth Plus to be continually incapable of complying with the order of the IC to address the issues and concerns of the complainants against it. The additional complaints against CareHealth Plus even reveal that the HMO has not improved its services towards its members, nor has it paid its obligations with accredited healthcare providers,” Insurance Commissioner Reynaldo A. Regalado said in the letter.

CareHealth Plus is a licensed HMO based in Manila with several branches in the country.

The IC issued a cease-and-desist order to CareHealth Plus on Oct. 10, 2023, preventing the HMO from selling new policies.

However, CareHealth Plus was allowed to continue servicing the claims of existing policyholders.

The IC in a resolution dated April 3 denied CareHealth Plus’s motion to lift the cease-and-desist order.

The regulator also denied the HMO’s application for a license renewal, which was previously put on hold due to the complaints filed against CareHealth Plus.

Under Circular Letter No. 2019-35 dated July 18, 2019, the IC may put an HMO under conservatorship if the company is unwilling or unable to comply with its obligations under the law and its issued policies.

The IC found that there was a total of 66 pending complaints against CareHealth Plus, with some involving corporate accounts and government agencies.

The HMO industry incurred a net loss of P4.269 billion in 2023, larger than the P1.433-billion net loss in 2022, due to higher spending on benefits and taxes, latest data from the IC showed. — A.M.C. Sy