Carson City, NV June 23, 2023
Summary of what has happened:
On June 1, 2023, Nevada Insurance Commissioner, Scott
Kipper, filed legal action with the Nevada District Court to place Friday
Health Plans of Nevada under regulatory supervision (referred to as a
receivership) due to growing concerns about the reliability of Friday’s
financial reporting to the Division.
This action will allow the Commissioner to assume
oversight and management of the day-to-day operations of the company, while
performing a thorough financial analysis.
Policyholders’ contracts will remain in effect and
members will need to continue to pay their premiums in accordance with the
terms of their policies to ensure there is no disruption to their coverage.
Once the court approves the receivership, the
Commissioner will appoint a Special Deputy Receiver (SDR) to communicate with
policyholders during the receivership process.
Information may also be accessed through the Nevada
Division of Insurance website at doi.nv.gov or
by calling the Division of Insurance at (888) 872-3234.
The Division of Insurance offers
the following guidance for FHP-N members:
Question #1: Is FHP-N still in business?
Yes. The company will be placed into a conservation
receivership; however, it is not writing new or renewing policies at this time.
Question #2: What does receivership mean?
A receivership is a court proceeding similar to a
bankruptcy proceeding. A company can
continue to operate in receivership. A
company can come out of receivership, or it can be shut down. In a receivership, the Commissioner is
appointed the Receiver of the insurance company. The Receiver takes over the
troubled insurance company to conserve or rehabilitate it for the protection of
its members, providers, and the public. Under the Receiver, a Special Deputy
Receiver (“SDR”) is appointed to handle the day-to-day administration of the
company.
A conservation receivership allows the Receiver to
analyze the company’s operations and financial situation in order to determine
the best option for policyholders and creditors—either by rehabilitating the
company, liquidating the company, or returning the company to private
management.
A rehabilitation receivership results in a plan to
adjust company operations that led to the receivership.
If it is determined that there is no way to correct
the deficient operations, the court can order liquidation. In liquidation, the company’s assets are
sold, debts are paid, and the company is closed.
The Commissioner is requesting that FHP-N be placed in
a conservation receivership at this time.
Question #3: Why was it necessary to place FHP-N in
receivership?
Friday
Health grew very fast and needed additional capital in order to sustain the
growth. It was unable to secure additional capital. A receivership allows the
Receiver to protect the capital and assets to ensure funds are paid out by
priority—in Nevada, policyholder claims are one of those priorities
Question #4: Do I still have health insurance?
Yes. FHP-N’s
health insurance is still in effect. If
anything changes, the SDR will notify all members.
Question #5: Do I need to keep paying my premiums?
Yes. Members will need to continue to pay their
premiums in accordance with the terms of their policies.
Question #6: Can my doctor or other provider refuse to
see me because I have a 2023 FHP-N health insurance policy?
Members can continue to see plan providers (your
doctors, hospitals, pharmacies, etc.) under the terms of their policies. If you
believe that your provider is refusing to honor their network agreements,
please inform FHP-N (see Question #14.)
Question #7: Who should I contact for problems with my
EXISTING claim?
Contact FHP-N. Refer to Question #14 for contact
information.
Question #8: What should I do if I currently have a
claim check that was issued for a claim on an FHP-N policy?
You should cash the check or deposit it with your bank.
Question #9: I received a bill from the doctor, what
should I do?
Claims should be submitted to FHP-N in the same manner
via the website portal. Refer to Question #14 for contact information.
Question #10: I have moved since submitting my
claim; how do I update my address?
Contact FHP-N. Refer to Question #14 for contact
information.
Question #11: I have a surgery approved and scheduled
in 2023, will it still happen?
At this time your coverage will continue under the
terms of your policy.
Question #12: Can I renew, make changes, or add
coverage to my FHP-N coverage?
No renewals or new policies will be issued.
Question #13:Can
I change insurance companies right now?
Not at this time unless you have a qualifying event.
The Patient Protection & Affordable Care Act allows individuals to get new
insurance coverage because of a qualifying event or during open enrollment,
which begins on November 1, 2023, and continues through January 15,
2024. For more information, contact the Nevada Health Link.
Question #14: How can I contact FHP-N?
Friday Health Plans of Nevada
Phone: 844-535-2000, Monday-Friday 8 a.m. – 5 p.m.
PT
Email: questions@fridayhealthplans.com
Website: https://www.fridayhealthplans.com
Question #15: How do I keep up with what is going on
in the receivership?
Once the court orders the receivership, a website will
be set up with all of the information related to the receivership.
Guidance For Producers:
Question #1: Can I switch my individual clients to a
different carrier now?
On-exchange individuals are not able to switch at this
time unless they have a qualifying event or there is a special enrollment.
Generally, changes in insurance providers for on-exchange individuals must
occur during open enrollment, which begins on November 1, 2023, and
continues through January 15, 2024. For
more information, contact the Nevada Health Link.
Question #3: Can I switch my group clients to a
different carrier now?
Yes. The small
group market is not subject to the open enrollment requirements.
Guidance For Providers:
Question #1: Do I have to continue to see patients
with a FHP-N policy?
Yes.
FHP-N is still operating in Nevada and the network contracts between FHP-N and
providers are in effect.
Question #2: Will I be paid for services rendered to
patients with an FHP-N policy?
Yes.
FHP-N is still operating in Nevada and the network contracts between FHP-N and
providers are in effect.
Question #3: Do the federal and state surprise billing
laws apply?
Where
applicable, these laws continue to apply until FHP-N coverage ends.
Question #4: How should I file claims?
You
should continue to file claims in the same way as before.
These
FAQs will be updated as information becomes available.
About the Nevada Division of Insurance
The State of Nevada Division of Insurance, a Division of the
Nevada Department of Business and Industry, protects the rights of Nevada
consumers and regulates Nevada’s $22 billion insurance industry. The Division
of Insurance has offices in Carson City and Las Vegas. For Fiscal Years 2021
and 2022, the Division investigated 5,062 consumer complaints, answered
approximately 25,000 inquiries, and recovered over $8 million on behalf of
consumers. For more information about the Division of Insurance, visit DOI.NV.GOV and
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