Consumer Alert: FTC alleges Simple Health sold consumers worthless plans that left people uninsured

NEW ADDRESS

Arizona Department of Insurance
100 North 15th Avenue, Suite 261
Phoenix, AZ  85007-2630

Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).

Tue, 07/02/2019 - 14:35

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of a recent Consumer Alert issued by the Federal Trade Commission (FTC) regarding Simple Health Plans, LLC.  According to the release, tens of thousands of consumers who bought medical discount plans from Simple Health Plans, LLC that were deceptively marketed as comprehensive health insurance, and who are still currently paying monthly fees will receive notices informing them that:

1)  they do not currently have comprehensive health insurance and if you get sick or have to go to the hospital, you may have to pay almost all of your medical bills, but

2)  they can enroll in a comprehensive plan during a special enrollment period.  

UPDATE 7/30/19

The Centers for Medicare and Medicaid (CMS) has made a special enrollment period (SEP) available for consumers sho bought health insurance plans from Simple Health Plans LLC.  The SEP will run from July 1, 2019, until September 4th, 2019.  Eligible consumers should have received a notice from Health Insurance Innovations advising them of the availability of this SEP.  CMS will evaluate an individual's eligibility for the SEP using Simple Health Plan enrollment information that has been provided by Health Insurance Innovations. 

Simple Health claimed to offer comprehensive health insurance or PPOs that would cover many medical needs, but instead sold only medical discount memberships, limited benefit plans, and other products that provide a small reimbursement or discount for a few services. 

Consumer enrolled with Simple Health Plans do not have comprehensive health insurance.  If they get sick or need to go to the hospital, they may have to pay almost all their medical bills. 

To learn more about SEPs, follow this link.

To learn more on the Federal Trade Commission lawsuit against Simple Health, follow this link. 

For further information and helpful links with the FTC, please see the Press Release issued by the FTC.  

Federal Trade Commission (FTC)

Arizona Department of Insurance Consumer Protection Division

  • Visit https://insurance.az.gov/consumers
  • Or call the ADOI’s Consumer Protection Hotline at 602-364-2499, or 1-800-325-2548 if calling within Arizona but outside Maricopa County.

The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.
Insurers Offering Individual Health Insurance in Arizona

Lists insurance companies that are offering health insurance to individuals and families in Arizona in 2020.  Open enrollment starts November 1st and now runs through December 17th, 2019.  Individuals can start shopping for coverage now at healthcare.gov or cuidadodesalud.gov (Spanish)
Arizona's Surprise Bill Resolution Report for 2019

As shown in the attached report prepared pursuant to A.R.S. § 20-3118(A), the Department of Insurance received 91 requests for dispute resolution in Calendar Year 2019.  Of those, 53 have been resolved or closed, and health plan enrollees saved $41,538 by submitting their surprise bills for resolution.  

Not all health care bills qualify for the surprise bill resolution process.  The Department's Suprise Out-of-network Billing Dispute Resolution website (https://insurance.az.gov/soonbdr, and especially the section entitled, "I got a surprise bill. Can I submit a request for arbitration?") lists conditions when a health care bill may not qualify under Arizona law for the dispute resolution process.  But for those that do, the enrollee will only be responsible for paying the enrollee's cost-sharing amounts (copay, coinsurance and deductible) if the enrollee provides information the Department needs, and participates in an informal settlement teleconference with the health care insurer and the health care provider.
Notice of Proposed Rulemaking - Corporate Governance Annual Disclosure Model Regulation In 2019, the Arizona Legislature adopted the NAIC Corporate Governance Annual Disclosure Model Act at Arizona Revised Statutes (“ARS”) by enacting the Corporate Governance Act at Title 20, Chapter 2, Article 16 (Laws 2019, 1st Reg. Sess., Ch. 180, § 1).   The Department of Insurance (“Department”) seeks to adopt the correlate Corporate Governance Annual Disclosure Model Regulation.  ARS § 20-492.02 allows the Department to adopt rules to carry out the Act upon notice and an opportunity to be heard.  The Legislature has exempted the Department from Title 41, Chapter 6 for one year after the effective date of the Act.  (Laws 2019, 1st Reg. Sess., Ch. 180, § 2.)
Regulatory Bulletin 2020-01

Uninsured and Underinsured Motorist Coverage Offer Form; SB1087