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Healthcare Consumer Information Alert   BEWARE of FRAUDULENT GROUP HEALTH INSURANCE PLANS What are they? How to avoid them. The 10 warning signs. IF IT SEEMS TO GOOD TO BE TRUE… Financial woes impacting small businesses and rising costs of health insurance premiums are bad enough…add to that, sham group health plans and it spells disaster. When faced with all of the above, phony group health coverage is attractive to the employer not only due to it’s low cost…. (sometimes as little as 1/3 of the going rate for health coverage), but also because of it’s comprehensive benefit plan. There is evidence of a growing trend countrywide of this type of fraud and numerous states have ongoing investigations into these health plans. While most of these have cropped up in southern and western states such as Florida, North and South Carolinas, Texas, Oklahoma and California, the northeastern corridor has opened files on sham organizations.   One ‘insurer’ took in over $15,000,000 in premiums from 29,000 policyholders and left over $6,500,000 in unpaid medical expenses.   Some of these organizations will tell you that they are exempt due to federal ERISA laws. In early 2002, the U S Department of Labor had 76 civil and 14 criminal investigations underway. Some of these groups or associations, in addition to offering low cost, comprehensive coverage, do not require medical underwriting or questionnaires…all you have to do is join the group or association (in some cases a union) and then pay the premium. Some sham companies operate similarly to ponzi schemes, paying some claims initially until the whole scheme collapses, victimizing the policyholders. HOW CAN YOU AVOID THIS TYPE OF FRAUD? Ask tough questions… Contact your state insurance department. Ask if the insurance company is licensed in your state or has a history of complaints. Request copies of the organization’s financial statements Demand references from other so-called insureds Is the company and salesperson licensed? How many risks do they cover? How much have they collected in premium/paid in claims? What happens if the plan becomes insolvent? Legitimate healthcare companies are pleased to answer any of your questions. Consumer Advice: Because of the increasing number of fraudulent and/or unlicensed companies selling health insurance, we encourage consumers to purchase health insurance through our partners. They ONLY provide quotes from the best licensed insurance companies. Have no worries of getting involved with bad health plans! Get a free health insurance quote at the lowest prices! THE 10 WARNING SIGNS OF FRAUD (Courtesy of the Coalition Against Insurance Fraud)* Watch for these warning signs of a possible swindle… The coverage costs 25% or more below the norm, yet promises generous benefits and a large provider network. The plan readily accepts people with serious illnesses and other medical conditions that other plans normally reject. The insurance has few or no underwriting guidelines – the agent or rep appears almost too eager to sign you up. You’re approached by an agent, phone or direct mail. Honest group plans normally are sponsored by your employer – and aren’t sold directly to individuals. The plan is not licensed in your state and the agent (falsely) assures you the federal ERISA law exempts the plan from state licensing. The plan seems like insurance, but the agent or rep avoids calling it “insurance” and instead uses evasive terms such as “benefits”. The agent or rep does not have clear answers to your questions, seems ill informed, or avoids sharing information. You’ve never heard of that health plan – and no one else has either. You have to join an “association” or “union” to obtain the health coverage. But you get no voting rights, receive no bylaws or other material and aren’t involved in the group’s activities. Your hospital keeps calling you to complain that your health plan isn’t paying your medical bills. Often the plan’s rep keeps making flimsy excuses, or stops returning phone calls altogether. Here is a Suspect List of many operators/companies that state regulators are currently working to shut down. *The Coalition is a nonprofit organization of consumers, government agencies and insurers dedicated to combating all forms of insurance fraud through public information and advocacy.  (website: www.insurancefraud.org) Contact your state insurance department if you have a question about whether an insurance company or agent is licensed to sell insurance in your state. For assistance you can also contact: U. S. DEPARTMENT OF LABOR 1-866-275-7922

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