CANCELLATION REVIEWThe Company reported 1, 773 cancellations between April 1, 2005 and October 31, 2005. Asample of 223 cancellations was reviewed for compliance with Section 636.208, Florida Statutes.The statute requires a full refund of all periodic charges if the member cancels within 30 days ofthe effective date of enrollment and returns the membership card.Six (6) members who cancelled their membership within the first 30 days after the effective dateof enrollment in the plan and returned the membership card did not receive a refund as requiredby Section 636.208(2), Florida Statutes.Careington International Corporation 4 February 17, 2006
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Corrective Action: The Company should establish procedures to ensure that all members whocancel their membership within the first 30 days after the effective date of enrollment and returnthe membership card receive a full refund of all periodic charges.COMPLAINT/GRIEVANCE REVIEWA review of the Company's complaint log revealed that 254 complaints were recorded during thescope of the examination. The following issues were noted:• 164 complaints were related to discounts not being received or a member beingovercharged;• 18 complaints were related to the provider or that the provider did not accept the plan;• 18 complaints were related to members not receiving needed dental services or receivingunnecessary services;• 5 complaints were related to quality of service;• 3 complaints were from members requesting a refund of charges;• 11 complaints cited miscellaneous issues, such as the provider charging for records, usingan out-of-network provider, wrong address issues, or provider inquiries; and• 35 complaints had no indication of the nature of the complaint. The Company failed todocument the nature of these complaints; therefore, it failed to follow its written