Insurance Act, R.S.O. 1990, c. I.8, as amended, in particular section 441;
AND REGARDING Platinum Health Benefits Solutions Inc.
PERMANENT REMEDIAL ORDER
Platinum Health Benefits Solutions Inc.
5090 Explorer Drive, Suite 501
On July 31, 2017, the Superintendent of Financial Services (the “Superintendent”) and Platinum Health Benefits Solutions Inc. (“Platinum”) entered into Minutes of Settlement imposing certain obligations and sanctions against Platinum including,
inter alia, an administrative penalty of $50,000, a revocation of Platinum’s corporate insurance agent licence and certain obligations in respect of winding down Platinum’s business.
Paragraph 14 of the Minutes of Settlement state that in the event that Platinum fails to comply with the obligations within the deadlines in Schedule “A”, Platinum consents to the Superintendent making orders pursuant to section 441 of the
Insurance Act (the “Act”) requiring it to comply with those obligations in Schedule “A”.
Schedule “A” is attached hereto.
Platinum has failed to comply with the obligation to pay all eligible health and dental claims arising under all TPA agreements by December 31, 2017 and the obligation to pay all commissions owed to licensed agents or brokers in accordance with the terms of the contracts under which those commissions are owed, as set out in Schedule “A”.
Platinum Health Benefits Solutions Inc. is ordered to immediately comply with the obligations set out in Schedule “A” of the Minutes of Settlement, attached hereto.
AND TAKE NOTICE THAT pursuant to subsections 447(2)(b) and (3) of the Act,
every person who fails to comply with an order made under this Act is guilty of an offence and every person convicted of an offence under the Act is liable to a fine of not more than $250,000.00 on a first conviction and to a fine of not more than $500,000.00 on each subsequent conviction.
AND TAKE NOTICE THAT pursuant to subsection 447(4) of the Act, every director or officer of a corporation who caused, authorized, permitted or participated in the corporation or unincorporated association committing an offence, or who failed to take reasonable care to prevent the corporation or unincorporated association from committing an offence, is guilty of an offence, whether or not the corporation is prosecuted or convicted, and liable to a fine of not more than $100,000.00 on a first conviction and a fine of not more than $200,000.00 on each subsequent conviction.
Si vous désirez recevoir cet ordre en français, veuillez envoyer votre demande immédiatement à: Adjointe, audiences, Greffe, Commission des services financiers de l’Ontario, 5160 rue Yonge, 14em, Toronto ON M2N 6L9.
ISSUED at the City of Toronto, Ontario, April 25, 2018.
Original signed by
Superintendent of Financial Services
WIND DOWN OF BUSINESS
Refrain from renewing or entering into any new third party administrator (“TPA”) agreements or other agreements relating to insurance or benefits programs.
Send a notice to every insurer with whom Platinum has an executed and in-force agreement for insurance brokering or third party administration services (“Insurer Agreement”) informing them that (i) Platinum has ceased entering into new or renewal TPA agreements, and (ii) intends to wind down its insurance agency and TPA business effective December 31, 2017.
August 10, 2017
Provide a solicitor’s undertaking confirming that the notice to insurers has been sent, together with copies of the notices that have been sent.
August 18, 2017
Use commercially reasonable efforts to remove any content from Platinum website and online social media that solicits or advertises the sale of insurance products or TPA services (except as it relates to claims handling services and content).
August 15, 2017
Send a notice in a format agreed to by the Superintendent to every person with whom Platinum has an executed and in-force TPA agreement (an “Employer”):
- advising that Platinum is winding down its business effective December 31, 2017;
- giving notice of termination of the TPA agreement pursuant to the terms of the TPA Agreement;
- advising the Employer that they may terminate the contract earlier if they wish;
- use commercially reasonable efforts to negotiate the earliest termination of the TPA Agreement as is reasonably possible considering the rights and interests of the covered employees under the TPA Agreement; and
- terminating the TPA Agreement in accordance with its terms, or such earlier date as agreed to by the Employer.
September 1, 2017
Provide a solicitor’s undertaking confirming that the notices have to been sent to every Employer together with copies of the notices that have been sent.
September 22, 2017
Return any premiums or deposits received from Employers in respect of any month after November, 2017.
December 1, 2017
Pay all commissions owed to licensed agents or brokers in accordance with the terms of the contracts under which those commissions are owed. Monies paid by licensed agents or brokers to Platinum, with the exception of insurance premiums and deposits, may be deposited into Platinum’s general bank account.
December 31, 2017
Pay all eligible health and dental claims arising under all TPA agreements by December 31, 2017 or as otherwise agreed to by the Superintendent considering the rights and interests of the covered employees.
December 31, 2017
Remit all insurance premiums collected on behalf of Employers to insurers underwriting the policies to which the premiums relate in accordance with the terms of Platinum’s Insurer Agreements
December 31, 2017
Provide to the Superintendent copies of the monthly bank statements for each account held by Platinum for each month until December 31, 2017 by the 15th day of the next succeeding month, together with electronic transfer documentation to support each deposit transaction and copies of cancelled cheques to support each withdrawal or payment transaction occurring in such month
Provide a statement of cash flow 60 days from the later of (1) the date of the last claims payment effected prior to wind up or (2) December 31, 2017. Statement of cash flow to cover the period from January 1, 2017 to December 31, 2017 or the date the last claims payment is effected.