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

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.
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Health Insurance Telemarketers Annoy; Pose Fraud Risks

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of scams involving aggressive telemarketers attempting to sell health insurance plans and, in some cases, attempting to gain personal and financial information possibly for criminal purposes.

The ADOI has received complaints from people who received multiple phone calls, robocalls, and text messages claiming to be from the National Health Enrollment Center, the Healthcare Enrollment Center and from Healthcare.gov. Some people report that they were contacted multiple times a day, sometimes from different phone numbers, despite requests to be placed on the companies' do-not-call lists. Additionally, some people report having been asked to provide health insurance enrollment information, including such information as address, date of birth, social security number, and personal health information that, in the wrong hands, could be used in identity theft or other fraud schemes.

Arizona citizens who have received persistent phone calls or text messages from these or other callers attempting to sell them health insurance are encouraged to file a complaint with:

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.

We can all take steps to avoid becoming victims of fraud.

  • Never provide someone who calls you with your bank account number, your social security number, your credit card number, or your personal health information. If you are asked to provide this information, hang up.
  • Research the insurance agent and insurance company you are considering using by finding their license information through the ADOI’s License Search webpage (https://insurance.az.gov/license-search), and use contact information in the license record to contact them. Be skeptical and do research.
  • For information about insurance available from Health Insurance Marketplace, visit the Healthcare.gov website or call Healthcare.gov directly at 1-800-318-2596. 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.

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.
FY 2020 INSURER ANNUAL ASSESSMENT INVOICES ARE AVAILABLE

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Follow the instructions on the first page of the document to locate the invoice that applies to your company.  

Please consider using the OPTins "Assessment" account to pay your assessment invoice.  
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Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event.  The law requires a small employer (with an average of at least 1 but fewer than 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrollee's qualifying event.  Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website.  A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements.  On January 23, 2019, the Department uploaded a new version of the form.
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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 2019-01

Use of Credits and Premium Rebates in the Health Insurance Market