Guam News - Guam News

Guam - Vice Speaker B.J. Cruz says he is appalled at the conduct of  TakeCare which won't be paying rebates to its subscribers under ObamaCare's Medical Loss Ratio rule.

Instead the company will pay $15 million in surplus premiums to their shareholders, not the subscribers who paid those premiums.

SEE the TakeCare statement of revenues HERE

SEE the TakeCare list of officers HERE

Although TakeCare has not returned PNC's call for comment, what they did appears to have been entirely legal under the law which allows for a loophole called capitation which enables a company to transfer administrative costs to sub-contracted medical groups, like clinics. And then count those costs as medical expenses, even if they're not spent.

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Insurance Commissioner Art Ilagan declined comment on the TakeCare issue citing a conflict of interest and he referred us to his Regulatory Administrator John Carlos who said he could not comment on TakeCare's 2011 Audited Financial Statements because they are confidential. He also said he could not comment on whether Rev and Tax is investigating TakeCare.

The copy of  TakeCare's 2011 audited financial statement given to PNC News reveals not only the $15-million TakeCare is paying its investors. It also reveals $11.3 million in claims unpaid to its subscribers. That naturally raises the question of  whether or not TakeCare has sufficient funding to pay its claims.

Last month, in a local newspaper, TakeCare posted a public notice, as required by law, which answers that questions.

The notice says:

"In accordance with the order of the Banking and Insurance Commissioner TakeCare Insurance Company, Inc. [TakeCare] hereby announces its intention to effect a distribution of surplus in July 2012, from its unassigned surplus as of March 21, 2012. Under applicable National Association of Insurance Commissioners [NAIC]'s guidelines for total capital and surplus, following the distribution, TakeCare will have a total capital and surplus base which is significantly more than the minimum requirement by NAIC to underwrite its risk portfolio and to meet operating requirements."

 

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