Skip to content

Judicial Watch • State Records Reveal Health Insurance Cancellations in GA

State Records Reveal Health Insurance Cancellations in GA

State Records Reveal Health Insurance Cancellations in GA

Page 1: State Records Reveal Health Insurance Cancellations in GA

Category:FOIA Response

Number of Pages:46

Date Created:December 16, 2013

Date Uploaded to the Library:December 16, 2013

Tags:PPACA, independence, Medical, ACA, SRRHIC, Commissioner, coverage, Madison, exchange, obamacare, Company, GEORGIA, health, HHS, Insurance, policy, individual, State Department, National, State, Market, EPA, IRS, ICE, CIA


File Scanned for Malware

Donate now to keep these documents public!

  • demand_answers

See Generated Text   ˅

Autogenerated text from PDF

Edward Patanka
Counsel Assistant Secretary
;yCignar 
November 12, 2013
The Honorable Ralph Hudgens
Two Martin Luther King, Drive Routing BGLPA
West Tower, Suite 704 900 Cottage Grove Road
Atlanta, 30334 Hartford. 06152
Telephone: 860.225.3413
Edward.Potanlia@Cigna,oom Cigna Heallhcare Georgia. Inc. CHC-GA
Noti cation Intent Withdraw From the HMO Medical Conversion
Market
Dear Commissioner Hucigeris.
This letter serves noti cation CH6-GAs Intent withdraw from the medical conversion market
eftective May 31, 2014, accordance with Georgia Regulation 120-2 67-.10 (b)(5) and the applicable
iederal regulations under the Public Health Service Act (45 CFR l47.105(d)). The oompany will
longer issue any new medical conversion policies after that date. and the nine (9) existing
conversion contract holders will receive 180 days prior notice the termination their medical
i-pnvarsinn coverage
The individuals being notified will able purchase replacement coverage through the new health
insurance Marketplace for their state created the Health Care Reform law, with coverage becoming ective early January 2014.
CHC-GA group contract holders will noti regarding the amendment their group contracts
remove the medical conversion privilege and new group contracts issued them will longer include
medical conversion privilege
Please refer the enclosures tor copy the customer noti cations.
Thank you for your time and attention this ling, Should you have questions require additional
information, please feel free Contact 86022643418.
 Sincerely,
 @2147
Edward Potanka Esq
Counsel Assistant Secretary
Enclosures. Ciisloiiiei Nolilicatiuns
C.igna regisiered service rna*1i,erid the Tree logo service mark, CignaInteIIminaIPropei1y, inc roamed use tiy
Cigna Corporation and its operating subsidiaries All products and services provided mrwgh such operating subsidiaries and
not Cigria Corporation Sudi operating subsidiaries include Connecticut General Liie insurance Company. Cigna Health and Liie
Insurance Company. and HMO service company subsidiaries Cigria Health Corporalionarid Cigria Dental Health, Inc
Tom Carswell
 
From; Tindall, Jeffrey (Jeff) B6LPA 
Sent: Wednesday, November 13, 2013 10:27
To: Torn Carswell
Subject: Withdrawal CHC-GA Medical Conversion
Attachments: Signed Notification Commissionenll.12l13lpdf; HMO Customer Notice
FlNAL.REV.11.1Z.13.doc
Good morning, Tom Attached letter notifying the department ofCigna intention withdraw from the conversion market,
well sample copy the custnmer noti cation. you could let any concerns, would appreciate it.
Thanks you and the entire Department worlung through this issue with the carriers. eff FIDENTIALITY NOTICE: lfyou have received this email error,
please immediately notify the sender e-mail the address shown.
This email transmission may contain con dential intbnnation. This
inforrnation intended only for the use the ir1dividual(s) entity
whom intended cven addressed incorrectly. Please delete from
your les ifyon are not the intended recipient. Thank you for your
ccunplianec. Copyright (C) 2013 Cigna Companion Life
COMPANION LIFE INSURANCE COMPANY
7909 Parxlam Road, Suite 200, Columbia, South Carolina 29223-5665 Box 100102, Columbia, south Carolina r202~31u2
(503) 735-1251
August 29, 2013
Mr. Ralph Hudgens, Commissioner
Office Insurance Safety Fire Commissioner
Two Martin Luther King, Jr., Drive
West Tower, Suite 704
Atlanta, Georgia 30334
RE; Companion Life insurance Company, NAIC 77828
Small Group Major Medical Market Exit Georgia
Dear Hudgens:
Pursuant the revised Code Georgia, are writing notify the Georgia insurance Department
that Companion Life insurance Company lCornpaiiion Life exiting the small group major medical
health insurance market the State Georgia effective March 31, 2014. This decision was prompted the federal governments passage the Patient Protection Affordable Care Act (PPACA). the
increased regulation will make difficult for Companion Life continue operate and compete
meaningfully iii Georgias small group major medical market beginning April 2014.
Companion Lifes market exit will affect our currently force groups and 171 covered lives. who are
covered under policy number CLICA1/iMASGA 0503 Georgia, The policy and all forms marketed
and/or issued connection with it, i.e., applications, riders will longer marketed renewed
our March 31, 2014, market exit. enclose for the Dcpartinents review our draft letter our Georgia groups, informing them the
discontinuation their coverage due our small group major medical health insurance market exit.
The notice will mailed our groups early September, 2013, providing the requisite 180 days prior
notice their coverage non-renewal. Our letter indicates that the groups coverage will terminate
their plans annual anniversary date 2014.
Companion Life regrels its need withdraw from Georgias small group major medical insurance
market. understand that inaiket reaentry prohibited for the five vear period commencing our
non-renewal (late. Our intent that may enter the market someday, but, for now, Companion
Liie concentration will our many other insurance offerings, including employer excess loss,
short; tcrm medical, limited medical, critical illness, disability, life, dental and vision, amongst others.
 
Mr. Ralph Hudgens, Commissioner
August 29, 2013
Within the next few davs, Companion Life will sending all Georgia and other State Insurance
Departments notice informing them which states nationwide will exiting the small group
major medical health insurance market This being done across the board satisfy the requirement several states that every commissioner each state which the carrier licensed and each state which covered individliial isknuwn reside notified our market exit. you have any questions concerns about this submission, please feel flee contact (800)
7530404 ext. 45008 email
Respectfully,
5.413 David Wythe, FLMI, HlA
Directur Compliance_
 
CLQ Companion Life
COMPANION LIFE INSURANCE COMPANY
7909 Parklane Road, Suite 200, Columbia, South Carolina 29223 5656 Box 100102, Columbia, South Carolina 29202-3102
(503) 7351251
[Date]
Group Policyholder
Address
Address
RE: Companion Life Insurance Company
Discontinuance ofSmal Employer Group Coverage
[insert plan anniversary end date 2014]
Vour Group Number: [ADD it]
IMPORTANT: THIS NOTICE AFFECTS YOUR INSURANCE CONTRACT RIGHTS, PLEASE READ CAREFULLY
Dear [Name]:
This notice inform you and your covered employees that may covered under your
referenced major medical insurance coverage that Companion Life Insurance Company Cmnpzininn Life) will exiting the small group major medical insurance market Georgia
effective March 31, 2014. This decision was prompted the increased regulation since the
federal govemmen passage recent federal health care reform, commonly referred
the Patient Protection Affnrdahle Care Act PPACA). The increased regulation will make
difficult for Companion Life continue operate and compete meaningfully Gcorgiifs small
group IIUIJDI medical market beginning April 2014, such, your referenced insurance
coverage will terminate [insert Icnn date], earlier your premium not received when
due are pleased infonn you that there are many options for you secure health insurance
coverage beginning April 2014. You may purchase insurance the general marketplace
through the federal exchange. hnelh-acl-(ground for you, PPACA mandates most residents
the United States have health insurance beginning 2014. PPACA created new mechanisms
for purchasing insurance coverage called Exchanges, which are entities that have been will
set states create organized and competitive market for health insurance quali
individuals and employers, PPACA mandates the availability medical insurance
guaranteed issue basis beginning January 2014, for coverage purchased off
Exchange. This means federal law prohibits insurance companies from denying medical
insurance anyone the basis their past present medical conditions, Group employers
will able obtain coverage from other carriers who write small group coverage their state.
 
Provided below contact information for the Georgia Insurance Department for you consider
the option purchase health insurance coverage the Georgia Exchange. you reside
State other than Georgia, please refer insurance companies offering coverage off the
Exchange your State.
Office Insurance Safety Fire Commissioner
Two Martin Luther King, Jr., Drive
West Tower, Suite 704
Atlanta, Georgia 30334
www.oci.ga.gov
Please remember that your health insurance with Companion Life effective through [insert
plan anniversary end date ZOI4]. has been our pleasure serve your health insurer.
you have any questions concerns, please feel free contact 1-800-969-5238 email Carolvn(a}totalplan.com.
Sincerely,
COMPANION LIFE INSURANCE COMPANY
Independence American
Insurance Company
Independence Group www.inrlepenrlmicearnerman.cum
September 20, 2013 SERFF
Office Insurance and
Safety Fire Commissioner
Attention: Ralph Hudgens, Commissioner
Two Martin Luther King, Jr. Dr.
West Tower: Suite 704
Atlanta, Georgia 30334
RE: Independence American Insurance Company; NAIC# 26581
Individual Major Medical Market Exit Georgia
Dear Commissioner Hudgcns:
Pursuant Georgia Slatutc 120-Z-6710(5), are writing notify the Department insurance
that Independence American Insurance Company Independence American exiting the
individual major medical health insurance market the State Georgia effective March 31,
2014 midnight. This decision was prompted the federal government passage the
Patient Protection Affordable Care Act PPACA The increased regulation will make
difficult for Independence American continue operate and compete meaningfully
Georgias individual major medical market after January
Independence American market exit will affect our 158 currently in-force Georgia individual
insureds. Our insureds are covered under policy form IAIC PPO 107, which will
longer marketed renewed Georgia our market exit. enclose for the Departmcnt review dra ofour notices discontinuation coverage and
market exit our insureds. The notices will mailed our insureds October 2013,
providing lcast the requisite I80 days prior notice their coverage piration. Please note,
Exhibit will mailed our insureds with annual anniversary dates from April through
December 3], 2013, and Exhibit will mailed our insureds whose coverage subject
annual renewal anniversary dates between January and our March 31, 2014 exit. Exhibit
explains the individual that their current coverage will extended their current rate via the
enclosed amendment and will terminate thcir tirst policy premium due date March
31, 2014. Exhibit also informs them, you will see, that they may elect procure coverage the general marketplace the Federal Exchange earlier and not extend their coverage with they choose.
 
Independence American seeking, part our market exit plan, the Departments permission
that extend the term our insureds coverage which would otherwise end December 3], 20l their current rate until our March 31, 2014 market exit date, rather than
renewing their coverage EI-IB compliant plan until March 31, 2014. are exiting the 435 Madison Avenue, Floor, NewYorlg 
kLisa Virgona, 
First Vice President, Legal/Compliance
Encls.: Exhibits Form IAIC 1l/EM 4-l
IFi :HSf Lett rhe
September 19, 2013 regular mail
 
Re: Independence American Insurance Co__npa
Discontinuance ofYouij Coverage [insert
Your Plan Number: ADI)
 
ive end;a ac3 2014;
IMPORTANT NOTICE: THIS AFl< H(ITS YOUR INSURANCE CONTRACT RIGHTS.
PLEASE READ CAREFULLY.
Dcar Instired:Naine:
This notice inform you that Independence American Insurance Company Independence
American will exiting the individual inajnr medical insurance market Georgia effective
_/larch 31, 2014 midnight. This decision was prompted the increased regulation since the
federal governments passage its recent federal health care rcform, commonly referred
the Patient Protection Affordable Care Act .A), The increased regulation will make
difficult for lndependence American continue operate and compete meaningfully
(ieorgia individual m5,i_ medical market. such, your rcfcrcncctl insurance coverage will
terminate [insert pl-an anniversary end date 2014], earlier our premium not
rcc vcd when due. [This termination dnteaclcnowledgcs that you have accepted our offer
early reiiewfyour contract with for one year December 2013.] are pleased inform you that there are many options for you secure health insurance
coverage aller our March 3], 2014 exit, your policy termination date, whichever later.
You may purchase insurance the general marketplace through the Federal 1.-xchange.
brief background for you, PPACA created new mechanism for purchasing insurance coverage
called Exchanges Marketplaces, which are entities that have been will set states the Federal Government create organized and competitive market for health insurance
for quali individuals and employers
Please https://uwvw.lrs:nlthcuru gov/marketnlace/individut1 for information concerning
health insurance coverage the Federal Exchange.
 
 
miyei that yollrrhcaltig insuyance with Independence American effective until
imniversary and date_:in 2014]. has been our ES111 serve your health
insurer. you have any questions concerns, please feel free contact 1-800-518-4510 email questions agilicgrougcom.
Sincerely,
TNDFPENDENCE AMERICAN INSURANCE COMPANY
 
IHC Letterhead
EXHIBIT
(for policies with anniversaries Jan-March 2014)
September 16, 2013 regular mail xddreiss
Re: Independence American Insurance Company
Discontinuance Your Coverage
Contract Amendment extend coverage until [in premium due:.d:ite_ n1r.or our 3/3V1];1.4 eititfe niiuiii_diTe 3Zl47l4, the (la ujuld 4/_l4)1i4].
Your Plan Number Add
 
IMPORTANT NOTICE: THIS AFFECFS YOUR INSURANCE CONTRACT RIGHTS.
PLEASE READ CAREFULLY.
Dear Individual Name
This notice inform you that Independence American Insurance Company Independence
American will exiting the individual rnqor medical insurance market Georgia effective
March 31, 2014 midnight. This decision was prompted the increased regulation since the
federal govemmenfs passage its recent federal health care reform, commonly referred
the Patient Protection Affordable Care Act PPACA The increased regulation will make
difficult for Independence American continue operate and oonipclt; meaningfully
Georgia individual major medical market, such, your referenced insurance coverage will
terminate your first premium due alter our March 31, 2014 market cxit (date
reflected above), earlier ifyour premium not received when due,
 
Your current coverage with Independence American for its annual renewal [insert plan
anniversary date 2014]. Typically, you would receive renewal notice from prior this
date with offer renew with new rates. However, since are exiting the market, cannot
offer you renewal PPACA compliant major medical product calendar year 2014.
Instead, will extend your current coverage from your policy anniversary date through your
premium date after our March 31, 2014. This coverage will provided your current
rate. Please cncloscd amendatory endorsement include with your current insurance
contract indicating your health insurance coverages new termination date [insert premium
due date after our 3/3]/14 exit, c.g. premium due 3/14/14., the date should
4/14/141. are pleased inform you that there are many options for you secure health insurance
coverage after your coverage termination date with prior. You may purchase insurance
the general marketplace through the Federal Exchange. brief background for you, PPACA
created new mechanism for purchasing insurance coverage called Exchanges Marketplaces,
which are entities that have been will set states create organized and competitive
market for health insurance for quali individuals and employers. Please
httgs[www.heaIthr:are.gov[marlretglace gdivlduaI for information concerning health insurance
coverage the Federal Exchange.
Please remember___that your health insurance with Independence (A.meric_an_is__ effective until
[in ]T.l>( 11l dziteoho r.aftcr our 3/31 ext premium du:e 3/14/]4; the-date
s_li0ulLl.be gt/;14/14], long your premiums are paid through lhat date. has been our pleasure serve your health insurer. you have any questions concerns, please feel free contact 800 5l8 45lO email guesticmsE ihcgrougtcon).
 
Sincerely,
INDEPENDENCE AMERICAN INSURANCE COMPANY
Encl: Form IAIC IMM
 
 
INDEPENDENCE AMERICAN INSURANCE COMPANY Delaware insurance Company
AMENDATORY ENDORSEMENT understood and agreed that the Policy and Certificate which this Amendatory Endorsement
attached amended follows with respect Covered/lnsurecl Persons residing the state Arizona
when their Certi cate Coverage/Policy was issued them evidencing their insurance coverage under
the Policy:
Any Renswability Termination Insurance provisions Your Certi cate/Policy that indicates that
insurance coverage will terminate following 180 days after Our decision discontinue offering health
insurance the individual market the state your coverage was issued amended adding the
following:
The health insurance coverage for Vou and any Dependents covered under the Policy
will terminate [Insert prer__nium due date after our 3/31/14 exit: e.g.
premiurii;due 3I14I14,1he -date wouldbc 31/14/14]. Pursuant the terms the
Policy, WIIl continue Your health insurance coverage the current rates and benefits
for Insured/Covered Persons this termination date, unless coverage terminates
earlier accordance with the Policys provisions regarding termination due the non-
payment required premiums when due.
This Amcridatory Endorsement endorsed and made part the Policy and Certificate which
attached October 2013.
This Amendatory Endorsement subject all provisions the Policy which are not conflict with the
provisions this Amendatory Endorsement. Nothing this Amendatory Endorsement WIII held
vary, alter, waive, extend any the terms, conditions, provisions, agreements, limitations the
Policy other than stated above. WITNESS WHEREOF, the insurance Company has caused this Amendatory Endorsement
signed its President,
INDEPENDENCE AMERICAN INSURANCE C_OMPANY
4297 name:
David Kettig Adam Vandervooit
President Secretaw
 
IAIC IMM /E
 
SERFF System for Electronic Rate and Form Filing Page of2
Home About SERFF Contact naic,org
welcome, Tom Carswell.
Georgia}-l Help Logoff Tracking Number:
 
Filings Plan Management Messages Settings Filing Rules Reports intake Fllin ort Create Pager Filing Report
Ass Reviewers Update Create Objection
Set Public Access
 
 
Move Workfalder
PDF-Pipeline-M
Georgia
View Filing Log
Flllng Company Independence American Insurance Company SERFF Num: ICC!-129215199
TOI: H161 Individual Health Major Medical SERFF Status: Submitted State
Sub-TOI: H16I.005A Individual Preferred Provider (FPO) State Num:
Filing Type: Form State Status:
Assigned TO: Num: INDIVIDUAL MARKET EXIT
Date Submitted: 09/23/2013 Disposition Date:
State Filing Description:
General Form Rate/Rule Supporting Companies Filing
Information Schedule schedule Documentation and Contact Fees
Filing
Correspondence niiAil Viilluigse All schedule Item
Status:
 _Actuarial Memorandum
j......,...., ......~-u...._...< ,l,. W... ml-_= 
 rajhird Party Authorization
:33 PPACA Uniform Compliance Summary compliance Checklist and Certi cation
 
 BJAIC Individual market exit letter and ExhibilA
 IAIC IMM exit gkg ror,4,-1,-irl G/.pdr
Submitted
https:/./login.scrffcoiii/sclf iipd(lteFil ingView.dn 923/2013
 
SERFF System for Electronic Rate and Form Filing Page of2
By: Brenda Dawson
Date Submitted: 09/23/2013
Icon Legend: Action Taken Satis Bypassed User Added Draft Schedule Item Open Objection
 
 
set Public Access
Create Rem tier
Assign Reviewers update
 
 
__. .ove woykrgiger
par
ational Association Insurance Commissioners. AI! Rights
SERFF Rei ase 5.1.2 oiuyr/[giii 1997-201
Reserved.
 
hnps://login,ser lcom/ser hipdati-:Fi1ingVicw.ilo 923/2013
SERFF System for Electronic Rate and Form Filing Pagg of2
Home About SERFF] Contact llBlC.(lIg
welcome, Tom Carswell.
GeargiaH
Help Logoff
Tracking Number:
 
 
Filings lPan Managementll Messages Settings Filing Rules Reports nse mygpgig Inrakeriiings Seaghl ggort Create Pager_Fiing EFT Raging Assign Reviewers Updateji SetPubicAccess -Moveto-Warkfolder
 
Create Objection Create Reminder
 
 
Georgia
View Filing Log
Filing Company Madison National Life Insurance Company, Inc. SERFF Num: ICCI-129215205
TO]: H151 Individual Health Major Medical SERFF Status: Submitted State
Sub-TOI: H16I.D05A Individual Preferred Provider (FPO) State Num: 
Filing Type: Form Stale Status:
Date Submiltedz O9/23/2013 Disposition Date:
Slate Filing Description:
Assigned To: Num: INDIVIDUAL MARKET EXIT
General Form Rate/Rule Supporting Companies Filing
Inlormation Schedule Schedule Documentation and Contact Fees
Filing
Correspondence
View[Edit State
Narrative ppAi:pi; Not PPAC/-Related Heallhcaragov
gang; -ID:
PPACA?
PPACA
Notes:
 Include
 Exchange Intentions? Product MNL Individual Market exit Deemer
Name: Dale:
Project Individual market exit Project MNL Individual Market exit 
Name: Number:
Implementation Armroval
Dale
Requested:
Status Filing Dale Approved Domicile: Domicile:
httpgj//loginvserff,C0111/serff/Silowl ling.d0?id:l 2921 5205 9/23/2013
 
SERFF System for Electronic Rate and Fm-m Filing page
Domicile Status
Comments: Status 09/23/2013 sme 5,3,;
Changed: Changed:
Requested Vlievleww ii-Apprni/alu 
Filing Mode:
Submissionmlvrerw Submissiun
Type:
Overall Rate
 
 
Tndividu Individual 
Market Type:
Brenda Dawson
 
 
Brenda Dawson sunmsne:s awsan By:
Corresponding
Filing Tracking
Number:
Filing the Siipporting Documems tab for Con$any letter and Exhi 
Description:
 
 
 
 
Assign ewers Update Set Public Access Create Objection Create Reminder
 Move Warkfolder wpnr Pipeline 
 
ERFF Release 6.1. ight i997-2013,-Mammal Association oflnsurance Commissioners All Rlgms
Reserved.
hlips://Iogin.serf com/serlI7sh0wFiIing.do7id=I29215205 9/23/2013
RU. Box 5008, Madison, was
.Madison National
Life insurance Company
independence Holding Group
September 20, 2013 SERFF
Office Insurance and
Safety Fire Commissioner
Attention: Ralph Hudgens, Coininissioner
Two Martin Luther King, Jr. Dr.
West Tower, Suite 704
Atlanta, Georgia 30334
RE: Madison National Life Insurance Company, Inc.; NAIC 657
Individual Major Medical Market Exit Georgia
Dear Coinniissioner Hudgcns:
Ptirsiiaitt Georgia Statute 120-2-67.1 0(5), are writing notify the Department Insurance
that Madison National Life Insurance Company, Inc. Madison National exiting the
individual major medical health insurance market the State Georgia effective March 31,
2014 midnight. This decision was prompted the federal govcmmcnfs passage the
Patient Protection Affordable Care Act ACA). The increased regulation will make icult for Madison National continue operate and compete meaningfully Gt;orgia
individual major medical market after January 2014.
Madison Natiunal market exit will affect our 147 currently in-force Georgia individual
insureds. Our insureds are covered under policy Form MNI. PPO l07. which will
longer marketed renewed Georgia our market exit. enclose fur the Department review draft our notices discontinuation coverage and
market exit our insureds. The notices will mailed our insureds October 2013,
providing least the requisite 180 days prior notice their coverage expiratioii. Please note,
Exhibit will ht: mailed our insureds with annual ani1iversaiy dates from April through
Decerriiicr 11, 201 and iixliibit will mailed our insureds whose coverage subject
annual renewal anniversary dates between January and our March 31, 2014 exit. Exliibit
explains the individual that their current coverage will extended their current rate via the
enclosed amenclment and will terminate their first policy premium due date alter March
31, 2014. Exhibit also informs them, you will see, that they may elect procure coverage the general marketplace the Federal Excltange earlier and not extend their coverage with they choose.
Madison National seeking, part our market exit plan. the Department permission that extend the term our insureds coverage which would otherwise end after December
31, 2013 their current rate until our March 31, 2014 market exit date, rather than renewing
their coverage I-LHB compliant plan until March 31, 20l4 are exiting the individual
www madlson/ife. cam
Strength. Vision. Stability.
major medical market three short months into the 2014 calendar year and have not yet developed 2014 EH13 compliant product file with the State provide renewal coverage for that period, would greatly appreciate the Department accommodation this process.
Madison National regrets its need withdraw from Georgia individual major medical
insurance market. understand that market re-entry prohibited for the ve-year period
commencing our non-renewal date. Our intent that may enter the market someday,
but, for now, our concentration will those states where have ascertained the value
staying the individual and small group major medical market and our many other insurance
offerings, including employer cxeess loss, short-term medical, limited medical, critical illness,
disability, life, dental and vision, amongst others. trust our exit from Gcorgia individual
major medical insurance market will not affect our license market any other products
currently market Georgia any may choose market the future. you have any questions concerns about this submission, please feel free contact
(212 355-4141 ext 3029 email lvir ona r1)sslien
Respe fully, 76/21 6%.?
 Lisa Virgona,
First Vice President, Legal/Compliance
Enclsr: Exhibits Form IAIC IMM Al-L 4vl-14 regular mail
Rc: Madison National Life Insurance Company, Inc.
Discontinuance Your Coverage [inser ann1y ry~eri iiate
Your Plan Number: ADD}.
 
i)1}4]
IMPORTANT NOTICE: THIS FECTS YOUR INSURANCE CONTRACT RIGHTS.
PLEASE READ CAREFULLY.
Dear lnsured Nan1e:
This notice inform you that Madison National Life Insurance Company, Inc. Madison
National will exiting the individual major medical insurance market Georgias effective
March 31, 2014 midnighl This decision was prompted the increased regulation since die
federal government passage its recent federal health care reform, commonly referred
the Patient Protection Affordable Care Act PPACA The increased regulation will make
dif cult for Madison National continue operate and compete meaningfully Georgia
inrliyidual major medical market, such, your referenced insurance coverage will terminate
[insert plan anniversary end date 2014], orwcarlierrif y_o_uz_ premium not re_eeivoI._l when
due. [This tcmiiiiatimi date acknowledges that you have accepted our offer early renevxi your 
contract with for one- year December 2013.] are pleased inform you that there are many options for you secure health insurance
Coverage our March 31, 2014 exit. after your policy terrnination date, whichever later.
You may purchase insurance the general rrizrrketplace through the Federal Exchange.
brief background for you, PPACA created new mechanism for purchasing insurance coverage
called Exchanges l/Ia1l;etpiace.
Your Plan Number: ;ADD- 
 
IMPORTANT NOTICE: THIS Al+1i ECTS YOUR INSURANCE CONTRACT RIGHTS.
PLEASE READ CAREFULLY.
Dear individual Namd:
This notice inform you llwl Madison National Life Insurance Company, [D64 Madison
National will exiting the individual major medical insurance market Georgia effective
March 2014 midnight. This decision Was prompted the increased regulation since the
federal government passage its recent federal health care reform, commonly referred
the Patient Protection Affordable Care Act PPACA). The increased regulation will make
difticult for Madison National continue operate and compete meaning illy Gcorgia
individual major medical market. such, your referenced insurance coverage will terminate
your first premium due date after our March 31, 2014 market exit (date cctctl above),
earlier your premium not received when due.
Your current coverage with Madison National for its annual renewal [insert plan
anniversary date 2014]. Typically, you would receive renewal notice from prior this
date with offer renew with new rates. However, since are exiting the market, cannot
offer you renewal PPACA compliant major medical product calendar year 2014.
instead, will extend your current coverage from your policy anniversary date through your
premium date aller our March 31, 2014. This coverage will provided your current
rate. Please lind enclosed amcndatory endorsement include with your current insurance
contract indicating your health insurance coverages new termination dale [insert premium
rlue date after our 3/31/14 exit, 2.1;. premium duc 3/14/J4, the date should
4/14/14]. are pleased inform you that there are many options for you secure health insurance
coverage after your coverage termination date with prior. You may purchase insurance
the general marketplace through the Federal Exchange. brief background for you, PPACA
created new mechanism for purchasing insurance coverage called Exchanges Marketplaces,
which are entities that have been will set states create organized and competitive
market for health insurance for quali individuals and employers. Please
httgs:[www.heaIthcare.gou/[mavketolace ndividual for information concerning health insurance
coverage the Federal Exchange.
Ifl emernber that your health insur_a_nce with Madison National effective ur_1il [insert mrlue Llate orhftcr our 3/31/14 exit, i:.g. premium due 3/14/14, the date should 4/14/.1_4]t, long your premiums are paid through that date. has been our pleasure serve your health insurer. you have any questions concerns, please feel free Contact
800-513-4510 email guestions@ihc_g;oup.com.
Sincerely,
 
MADISON NATIONAL LIFE INSURANCE COMPANY, INC.
l-Incl: Form MNL I.H/I 4-1
MADISON NATIONAL LIFE INSURANCE COMPANY, INC. Wisconsin insurance Company
AMENDATORV ENDORSEMENT understood and agreed that the Policy and Certificate which this Amendatory Endorsement
attached amended follows with respect Covered/Insured Persons residing the state Arizona
when their Certificate Coverage/Policy was issued them evidencing their insurance coverago under
the Policy:
Any Renewahiiity Termination Insurance provisions Your Certi cate/Policy that indicates that
insurance coverage will terminate iollowing 180 days after Our decision discontinue offering health
insurance the individual market the state your coverage was issued amended adding the
following
The health insurance coverage lor You and any Dependents covered under the Policy
will terminate [insert premium due date alter our 3/31/14 exit, e.g.>i1 mijum due.3I1A/1-.1, the date would -4114114]. Pursuant the terms the
POIICY will continue Your health insurance coverage the current rates and benefits
for Insured/Covered Persons this termination date, unless coverage terminates
earlier accordance with the Polloy provlsions regarding termination due the nun-
payment required premiums when due.
This Amendatory Endorsement endorsed and made part the Policy and Certi cate which
attached October 2013.
This Amendatory Endorsement subject all provisions the Policy which are not con ict with the
provisions this Aniendatory Endorsement Nothing this Amendatury Endorsement will held
vary, alter, waive, extend any the terms, conditions provisions agreements limitations the
Policy other than stated above. WITNESS WHEREOF the insurance Company has caused this Amenclatory Endorsement
signed its President
MADISON NATIONAL LIFE INSURANCE COMPANY, INC.
,;{/A/H 
Larry Graber Adam Vandervoorl
President Secretary
ivlNL IMM
 
 
Madison National 
Life Insurance Company 
independence Holding Group /V d/son/ifecom
SENT VIA SERFF
September 27, 2073
Georgia Office Insurance and Fire Safety Commissioner
Attention: Commissioner Ralph Hudgens
Two Martin Luther King, Jr. Drive
West Tower, Suite 704
Atlanta, Georgia 30334
Re: Madtlson National Life Insurance Company; NAIC: #5573]
Georgia Notice Plan Nan-Renewal and Rt-placenieni
Dear Commissioner HUlig$HS are writing notify the Georgia Office Insurance that Madison National Life Insurance
Company Madison National will not renew policy fonn MNL MMP 0205 (the Policy). Instead,
Madison National will replace the Policy with new Patient Protection and Affordable Care Act
(AC/ complaint policy.
 
 
The discontinuation this Policy will affect our currently in-force Geur
group insureds, with total number 147 lives affected counting all employers and their employees. enclose for the Offices review drall our notices ufnon-renewal and rcplaceinent the
Policy that will send covered policyholders and certi cate liolilers, pursuant Ga. Comp.
Regs. 120-2-67-.09. The notices will mailed our insureds October 2013, providing the
requisite days prior notice discontinuation their policy. The notice letter explains the
employer groups that their current coverage will not renew. also informs them that Madison National
will replacing their coveiage with new ACA compliant policy. Please note that the notice letter
refem the groups the exchange should they choose not extend their coverage with us. you have any qiicstions coiiccrns nhout this suliiiiissioii, please feel free contact
(602) 395-7060 c-mail l.ZEi[ ul)l @1lCgI0up.C0m.
Respectfully,
Lizette Rubio
Manager Legal and Compliance
1241 ioiiri Ilammons lirwe, Vind:_1n..
Clcwl;w< Glue 441194155
MEDICAL MUTUAL: 
CAROl.lN CARE PLAN CONSUMERS LIFE 
heptcmlm 201
l)1*Ar /lvmlzvm 
Alter mutlv ((mSl lll0H, Medical Mutual and amily (.ornpan1cs lmvc made the clilltcull ClC(. 15l(7l1 mix
the Mcdicarv Supplrmmt nn-a1rl- value nur C.lSl(mL and want unsurt they (OTll1nL1t: have access quality hualthcare covclagc. Plc-use
vis1t Georgias Office 11! lH5llnmLL and Saliny ire Ct1nnIi5siuners web sue p://www.0ll1t:rnpl11ms lnr Medicare Supplement ruve-rage
Unles-4 you dmusc pu1ch2L-se alternative UV(l2]gt tween now and the and lllc mverage ll0Ll, your
covcragu will llllU unchangecl accmding the Irrrns your policy. lfyuur cnvcragt: gull w1th nsumers
Lil: ln Company March 2014, and you are hospltallzed have ])n>( {llr Il:t.l.l during that
limc pcnotl, please call our (iusmmct Care (lt pE1TlTTL [1l. the numbm listed ynur II.) card for more
irilurmution. you regtstcred fol :.ucuu- wt-hsvte, Health Plan, you will have ynur account log one yeax allur
ynur coverage ends. You will able rev past lixplanazitwn Bcntrllh 7Pt) documents, plus any nzhcr
benelits and clmms inlvrmanun your at-ctr-.1n:, unul zntdnight March 3], 20] has been plea:.L .Ie aexving yuur h5al:h coverage needs, and wish yuu succ achtevmg your hualth 
goals lfyou have any queszinns, please rall our Customer Care depattmcnt the number listed your card.
 
Smcerely,
 
_v_ ,_H.._..,,_.... ..,>;. _..e--
 
Health insurance
Tom Carswell
 
From: Luna, Susan 
Sent: Wednesday, April 03, 2013 12:20
To: Torn Carswell
Subject: RE: HeathMarl