Health Republic Insurance of New York

Dear Sir/Madam:Thank you for your inquiry in connection with the above referenced complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received on June *, by the Revdex.com (“Revdex.com”)The member enrolled with Health Republic, effective January *, The member states, in December she requested to terminate coverage effective January and continues to receive premium invoicesThe member’s complaint includes reference of Health Republic requesting coverage terminations be submitted via fax and she believes Health Republic needs to consider more progressive ways to terminate coverageHealth Republic immediately terminated the member’s coverage retroactive to January and reconciled the account balance to zero, upon receipt of this written complaintSince Health Republic continues to be dedicated to the mission of providing affordable healthcare to all New Yorkers we appreciate the suggestion of considering other methods to terminate coverageHealth Republic apologizes to the member for the inconvenience experiencedRespectfully, [redacted] , [redacted] , [redacted] Health Republic Insurance of New York

[redacted] *** [redacted] Dear *** [redacted] : Thank you for your correspondence concerning the above captioned memberHealth Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted] , which Revdex.com relayed to Health Republic on October **, COMPLAINT SUMMARY According to the complaint, while on vacation the member was admitted to the Emergency Room (“ER”) with [redacted] *** The member states that the claims for services rendered have since been denied by Health Republic as the provider of service is out-of-network (“OON”) The member has been balanced billed in the amount of $816.41, which Health Republic refuses to pay Based on the foregoing the member filed the captioned complaint with DFS RESPONSE On October **, Health Republic received the complaint from the Revdex.com On the foregoing date the complaint was forwarded to the claims department for further investigationThe claims department later confirmed that the claim in question was correctly paid in accordance to the member’s certificate of coverage As the provider is not participating with Health Republic’s MagnaCare Extra network it is within their purview to balance bill the memberAs a consumer oriented and operated plan, Health Republic strives to provide quality service that serves our members best interestsAs such Health Republic is committed to working with the provider’s office to learn if any further assistance is available for the memberWe believe that this issue has been satisfactorily investigated and addressed Payments Relating to Emergency Services Rendered The amount We pay a Non-Participating Provider for Emergency Services will be the greater of: (1) the amount We have negotiated with Participating Providers for the Emergency Service received (and if more than one amount is negotiated, the median of the amounts); (2) 100% of the Allowed Amount for Services provided by a Non-Participating Provider (i.e., the amount We would pay in the absence of any Cost-Sharing that would otherwise apply for services of Non-Participating Providers); or (3) the amount that would be paid under MedicareThe amounts described above exclude any Copayment or Coinsurance that applies to Emergency Services provided by a Participating Provider You are responsible for any Deductible, Coinsurance, or Copayment

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me and the matter has been resolved Sincerely, [redacted] ***

[redacted] [redacted] Dear Sir/Madam:Thank you for your inquiry in connection with the captioned complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received on June **, by the Revdex.com (“Revdex.com”).The member enrolled with Health Republic, through the New York State of Health (“Exchange”), effective, February *, The member terminated his policy, through the Exchange, in May The member avers the Exchange then informed him that Health Republic would waive the remaining balance outstanding against his accountHaving completed our investigation, Health Republic can advise that the member filed several claims in May 2015; however, the member was not then paid through to May **, In order to access the full benefits of his policy for the requisite period, the member is required to cover the remaining balance outstanding against his accountThe member was contacted on June **, Health Republic can now confirm that he has remitted a premium payment, which removed his outstanding balanceTherefore, the complainant’s coverage period now reflects as active from February *, through to May **, Health Republic apologizes to the member for the inconvenience experiencedRespectfully, [redacted] ***

[redacted] : I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me and the matter has been resolvedAll refunds were granted Sincerely, [redacted]

Revdex.com: At this time, my complaint, ID [redacted] regarding Health Republic Insurance of NY has been resolved (By clicking "OK", your complaint will be closed as Resolved.) Sincerely, [redacted] **

[redacted] [redacted] Dear *** [redacted] : Thank you for your inquiry in connection with the captioned complaint, Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted] , received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on October **, COMPLAINT SUMMARY According to the Complainant, he subscribed through New York State of Health (the “Exchange”) with Health Republic for a policy of insuranceAccording to the complainant at no point did he enroll for Health Republic’s automatic recurring ACH program, by which premium payments are deducted from a participants account every month to satisfy any and all due and payable balances ; The complainant states that sometime in May, 2014, became aware that unbeknownst to him, he had been registered for the recurring ACH program, at which point the complainant contacted Health Republic to confirm his ACH status, and after validating same, recanting his consent and thereafter cancelling the authority of Health Republic to deduct any further payments on his accountAccording to the complainant, he was assured by a representative of Health Republic that he was no longer a participant in the program; Despite the foregoing, Health Republic deducted a further premium payment from the complainant’s account in June, 2014, and when the complainant called to query the deduction, he was informed that he was still enrolled in recurring ACH, and further, that the only means by which a refund could be processed was to terminate the policy through the Exchange; According to the complainant he contacted the Exchange and terminated his coverage, but the Exchange failed to process his termination correctly, instead filing an appeal with the Department of Health (“DOH”) which is still pending, with no substantive steps being taken to address his overall concerns; According to the complainant, though the Exchange failed in its mandate, the greater part of the blame for his present predicament lies with Health Republic, for: enrolling him in recurring ACH without his authority, failing to terminate the recurring ACH after having assured him that it was so terminated, deducting payments form his account without his consent and/or knowledge; failing to honor its word issued by an authorized representative; and for failing to issue a refund when it became clear that one was owed; After attempts to resolve this matter without avail, the complainant filed this complaint with the Revdex.com (“Revdex.com”) RESPONSE The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof On October **, Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com; On October **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”); The team confirmed that, on December **, 2014, the complainant registered himself for recurring ACH via Health Republic’s websiteConsequently, Health Republic had the requisite authority to deduct payments from the complainant’s account using this means; On June **, 2014, the complainant called Health Republic to verify that he was enrolled for recurring ACH, the complainant was informed that he has been enrolled since, December **, 2013, at which point the complainant directed the cancellation of the programThe complainant was led to believe that no further steps were required to cancel the recurring ACH, and as such, he took no further action with respect to this matter; Health Republic can advise that it’s policy for terminating recurring ACH, is to have the participant send a request in writing; As the recurring ACH was not cancelled in accordance with Health Republic guidelines, the complainant’s account was deducted for a further premium payment allocated against the month of July, 2014; Health Republic recognizes that the complainant expressed an interest to terminate his policy as well as to cancel recurring ACH as of July **, 2014, as such; it has coordinated with the Exchange to rectify the complainant’s enrollment record to reflect termination as of July *, 2014, thus voiding the balance outstanding for the month of July; In view of the foregoing, the complainant is entitled to a refund for the month of July, which has been authorized by Health Republic Health Republic apologizes for the inconvenience caused to the complainant; and Based on the contents of the foregoing, we believe the Complainant’s matter has been satisfactorily addressed

[redacted] Dear Sir/Madam: Thank you for your inquiry in connection with the above referenced complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received on June **, by the Revdex.com (“Revdex.com”)The member enrolled with Health Republic, through the New York State of Health (“Exchange”), effective, January *, The member states she was eligible to receive an Advanced account to reflect the receipt and Premium Tax Credit (“subsidy”) for plan year The member requests an update of her allocation of a subsidy during plan year Since enrollment and enrollment changes are done directly with New York State of Health, we can confirm that the Exchange has knowledge of the member’s subsidy issue and is working diligently to ensure that her account is updated to reflect the receipt of an apportioned subsidy from January *, through November **, After we receive the correct transaction file, we will reconcile the member’s account; and reprocess all of her eligible claimsHealth Republic apologizes to the member for the inconvenience experiencedRespectfully, [redacted] ***

July **, 2015The Revdex.com VIA WEB: http://newyork.Revdex.com.org/respond 'Lucida Sans Unicode', sans-serif;"> [redacted] ***Re: Member Complaint Revdex.com Complaint ID: [redacted] Dear Sir/Madam:Thank you for your inquiry in connection with the above referenced complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received on July *, by the Revdex.com (“Revdex.com”).On January **, the member states she received a test in which she was advised by a Health Republic customer service representative, would be covered as routineThereafter, the member was informed she had a balance owed from her visitPer our review, the claim was originally processed in error on 32015, leaving the member a balanceThe claim has since been reprocessed and paid in full on 7/*/2015, with no balance owed by the memberHealth Republic apologizes to the member for the inconvenience experiencedRespectfully, Stacey B***-G [redacted] Vice President, Operational Policy ImplementationHealth Republic Insurance of New York

Revdex.com:First of all, I would like to thank you for assisting me in this matterI was calling and calling and getting no actionsTo my frustration and angst, I wrote to you and to my State Senator for help.I think three months to fix this simple problem is rediculously long for a reputable health insurance companyI feel I should receive some due compensation for my three months of utter frustration I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me and the matter has been resolved Sincerely, [redacted]

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] After additional intervention on my end, my problem has been satisfactorily resolved by the companyThanks for your assistance /> Sincerely, [redacted]

Unicod #333333;"> [redacted] Dear [redacted] : Thank you for your inquiry in connection with the captioned complaint, Freelancers Health Service Corporation, d/b/a Health Republic Insurance of New York (“Health Republic”) hereby responds to the complaint ID [redacted] received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to the Respondent on August *, COMPLAINT SUMMARY According to the Complainant, he subscribed through New York State of Health (hereinafter the “Exchange”) with Health Republic for the policy of insurance, categorized as the Essential Care Platinum Plan, through which his daughter accesses benefits as a designated dependent; Sometime in or about March, 2014, his daughter was taken to the Emergency Unit, where, unbeknownst to the complainant at the time, she was provided with care by an Out-of-Network provider; Health Republic has since refused to cover the full costs of benefits provided by the provider; and the complainant is now being balanced bill for the difference between the costs of medical services provided, $1,608.00, and the amount that Health Republic has elected to cover, $**5.00; According to the complainant, the summary of benefits and coverage (“SBC”) connected with his policy provides that he is responsible for a co-pay of $on emergent visit, without limitations or exceptionsAccordingly, he should not have to pay for any balance billed by the provider; According to the complainant he has since been able through negotiating with the provider to reduce his balance, which is now $691.45; The complainant believes Health Republic is shirking its responsibility pursuant to contract by its failure to pay the outstanding balance; and After attempts to resolve this matter without avail, the complainant filed this complaint with the Revdex.com (“Revdex.com”) RESPONSE The following is a timeline with references to supporting documentation describing the matter and the steps Respondent took to ensure satisfactory resolution and communication thereof On August **, Respondent received the Complaint from the Dispute Resolution Services Department of the Revdex.com; On August **, 2014, Respondent began its internal review and escalated this Complaint with Respondent’s Enrollment Specialist team (“team”), which confirmed that member enrolled for a policy of insurance with Health Republic for coverage effective January *, 2014; The team confirmed that, on March **, 2014, the member’s daughter, presented to an in-network facility, with emergent symptoms and was seen by an out-of-network (“OON”) provider; On April **, 2014, Health Republic received the claims for services rendered on the abovementioned date of service totaling $1,608.00; On May **, the claim was sent for negotiations and returned denied, as the provider was unwilling to negotiate the rates On June *, Health Republic paid the claim for services rendered in the amount of $**5.00, 125% of the fee Medicare would have paid in accordance to the member’s certificate of coverage; On August **, 2014, the matter was again referred to the claims department based on a complaint filed with the Department of Financial ServicesThe claims department confirmed: aThe member’s claims history as illustrated in Paragraphs through bThe $copay referenced by the complainant, pertains to the ER facility Fee and not charges associated with any physician services rendered [redacted]

Dear Sir/Madam: Thank you for your inquiry in connection with the captioned complaint, Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to us on March **, The member enrolled for a policy of insurance with Health Republic, through the New York State of Health (the “Exchange”), effective, May *, According to the member he has been experiencing significant customer service issues with Health Republic, more specifically, he enrolled for a policy under which his two (2) daughters would be able to access benefits; however, although the member is current with his premium payments; Health Republic has been unable to establish current active status of his daughters under his policy to access benefitsAccordingly, the member would like a valid confirmation from Health Republic that his policy is currently covering both of his children and that member identification cards have been issued to themHaving completed our investigation, Health Republic can advise that one of the complainant’s children is currently a covered as a dependent under his family policy with Health Republic; while the other child is enrolled as a subscriber in a separate policy with Health Republic, through the Exchange effective January *, Health Republic can confirm that member ID cards were generated and mailed to the member, for his family policy on March **, 2015; additionally, ID cards were generated for the second child with respect to their separate policy on February **, Health Republic sincerely apologizes for any inconvenience experienced by the member in his attempts to confirm coverage of his dependentsHowever, we trust this response satisfactorily addresses the concerns raised by the member

I purchased health insurance from this company for my Dad in November By Dec 2014, he was informed that he got qualified for a Government subsided health insurance plan due to his most recent financial statusI contacted Health Republic around December **'s, every day via their online "Contact Us" service to cancel his account, but nobody got back to meI finally spoke to a representative on Dec [redacted] who told me to fax in a cancellation letter for my Dad and they would take care of itI faxed them this letter that was confirmed on their endI still received a bill for him on January Called them (waited at least half an hour) and was promised that they would take care and cancel his accountGot another bill in FebruaryCalled them againGot a profuse apology and was promised that this problem would be take care immediatelyNow, I got the March billCalled them, but the waiting time was so long so I gave upI have made at least calls to their company and multiple emails to their Customer Service online but nothing has happenedI am extremely furious and tired about themMy Dad does not have this extra amount of money to spend every monthThis was exactly what happened to me with [redacted] mobile service that I must called them every month for months in a row but nothing fixed and I had to go to a [redacted] store and terminate my cell phone service with them immediatelyNow, this company is illegally charging my Dad $every month, which I don't know when it will end

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: [Your Answer Here] I would like to keep this complaint open for the months of July and AugustI have been told for months this has been resolvedYet, here I amI have been told the issue has been solved but until months pass without an issue, I am not willing to believe themPlease keep this complaint open until I receive both the July and August bills to confirm the issue is resolvedThank you In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]

Dear [redacted] ***: Thank you for your correspondence concerning the above captioned memberHealth Republic Insurance of New York (“Health Republic”) hereby responds to the complaint herein, which your Department remitted to us on July *, COMPLAINT SUMMARY According to the complaint, the member enrolled in a family plan with Health Republic for coverage starting January *, and on February **, the member’s spouse had a baby The member states that Health Republic refuses to pay claims from the baby’s date of birth, notwithstanding, the he has been paying in excess of $1,per month, for which he has yet to derive any benefits on behalf of his child; According to the complaint, Health Republic is required to satisfy his child’s medical expenses which is now in excess of $10,000.00, and notwithstanding the many assurances by Health Republic, this has yet to be resolved; and Based on the foregoing the member filed the captioned complaint with Revdex.com RESPONSE On July *, 2014, 2014, following receipt of the complaint herein, Health Republic cross-referenced it’s records and found that the material elements of the complaint was already directed to the Department of Financial Services for resolution; Notwithstanding the foregoing, Health Republic can confirm the following time-line of events, leading to the remediation of the complaint: (i) On December **, Health Republic received the member’s electronic enrollment file from the Exchange, for coverage effective January *, 2014; (ii) On December **, Health Republic received the member’s binder payment thereby effectuating his January coverage; (iii) On March *, Health Republic received an additional file thereby adding the newborn for coverage effective March *, to the policy, changing it to an Individual + Family plan; (iv) The member contacted both Health Republic and the Exchange to have the newborn’s coverage effective date changed to February **, 2014, the date of birth of the dependent child, so that claims submitted on the child’s behalf for nursery and well-baby visits would we paid; (v) Health Republic advised the member that effective date changes would need to be addressed to the Exchange; (vi) The member made several attempts to have the effective date changed through the Exchange to no avail; and on April **, a member services [redacted] conferenced the member in on a call to the Exchange’s Appeals DepartmentThe member service [redacted] and the member were advised that the incorrect effective date for the newborn is a “defect” with the eligibility department which would be correctedHealth Republic now awaits the corrective file from the Exchange in order to make the necessary changes; (vii) Health Republic can confirm that several of the member’s reimbursement claims have been processed and approved; and for those that were not: they did not fall within the parameters of his plan benefits; (viii) The Complainant should have already received an Explanation of Benefits (“EOB”) and therefore ought to be aware of the reason for the denial for those claims which were deniedFurther, there is an established appeals process, which Health Republic recommends the member take advantage of; (ix) Health Republic regrets that the member felt frustration regarding his newborns coverageWe strive to provide exemplary service at every level and corrective action has been taken; and (x) The issues within the complaint have been investigated and addressedHealth Republic herein asserts that Member’s claim has been fully resolved Respectfully, HRINY Operations Team

Dear Sir/Madam: Thank you for your inquiry in connection with the captioned complaint, Health Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received by the Revdex.com (“Revdex.com”) on January **, Health Republic received a transaction from the New York State of Health (“NYSOH”) enrolling the member for coverage effective, April *, Health Republic has since coordinated with NYSOH to cancel the member’s policy, effective September **, as per his requestThe billing associated with his account shows a zero balanceOn February *, 2015, we contacted the member and advised him of the current status of his account to which he expressed satisfaction with steps taken to resolve the matterHealth Republic apologizes for the inconvenience experienced by the member and we trust this solution satisfactorily addresses the member’s concernsSincerely, Health Republic Insurance of New York

Thank you for your correspondence concerning premium payments remitted for health insurance coverageHealth Republic Insurance of New York (“Health Republic”) hereby responds to the complaint filed by the member via the Revdex.com (“Revdex.com”), which the Revdex.com relayed to Health Republic on January **, Health Republic can confirm that a refund of premium payments totaling $ was issued to the member by check on January **, 2016, to the [redacted] address listed on fileIf the member fails to receive the refund check within (15) business days, they are advised to contact [redacted] referencing the captioned Revdex.com case numberRespectfully, Member Solutions Health Republic Insurance of New York

Dear Sir/Madam:Thank you for your inquiry in connection with the captioned complaint IDHealth Republic Insurance of New York (“Health Republic”) hereby responds to complaint ID [redacted] , received by the Revdex.com (“Revdex.com”), which Revdex.com relayed to us on July **, 2015.The member enrolled with Health Republic, through the New York State of Health (“Exchange”), effective, May *, The member resided in New York State until late 2014; thereby, terminating his policy with Health Republic as of December **, However, the member indicates that he subsequently received three (3) monthly billing invoices from Health Republic during plan year Additionally, since the member was previously signed up for re-occurring ACH payments, the member states his billing invoices resulted in three monthly (3) ACH premium payments being deducted towards his plan year coverageThe member contacted Health Republic to inquire about his termination dateThe member was informed due to enrollment through the Exchange, he would need to contact the Exchange directly in order to terminate his policy and to stop the re-occurring ACH paymentsUpon terminating his policy, through the Exchange, to March **, 2015, the member filed an app eal to the Exchange requesting a December **, termination dateThe member requests that the Exchange terminate his policy with Health Republic to December **, 2014; and process a refund of his three (3) plan year ACH premium paymentsHealth Republic can advise that we did not receive notification that the member was moving outside of New York prior to the beginning of plan year Accordingly, we could not terminate his policy until we received a directive doing soWith respect to our deduction of ACH premium payments, Health Republic can advise that as the member was enrolled in re-occurring ACH payments, we proceeded to deduct his monthly premium payments as they became due via automatic ACH until we received a directive to terminate the member’s policy.We have terminated the member’s policy with Health Republic, through a directive of the Exchange, effective, December **, Therefore, we have processed a refund of the three (3) premium payments deducted from his account against his plan year coverage, in the amount of $The refund will be processed within hoursHowever, should the member fail to receive same, he is directed to contact our customer service during regular business hours.Health Republic apologizes to the member for the inconvenience experienced

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because: There is no way to log into an account on the website to see the update of my claimsThere is no phone number to call, and no correspondence with the companyThe claims that have not been paid are going to collections soon if they do not payThey should not be on hold, as they have been processing for NINE MONTHS In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]