Salem – The Oregon Division of Financial Regulation (DFR) is warning consumers to carefully review health insurance coverage offered through “self-funded” limited-partner plans or other unlicensed entities.
Oregonians should exercise caution before enrolling in a limited partner plan. Companies may offer plans that refer to consumers as “limited partners” or “employees” to avoid Oregon consumer-protection regulations. Many limited partner plans cover only preventive care, such as check-ups and annual health screenings. The plans tempt consumers with promises of low premium costs. However, consumers often end up with higher out-of-pocket costs due to uncovered medical bills. With open enrollment rapidly approaching, it is important to know what the difference is between these plans and standard plans. Open enrollment, which begins Nov. 1 and goes through Jan. 15, is for those who do not get insurance through their job, Medicare, or the Oregon Health Plan.
DFR warned of these plans back in April. They are not compliant with the Affordable Care Act (ACA) and do not provide comprehensive medical coverage, although they may be marketed otherwise. This leaves consumers with the possibility of being unexpectedly responsible for unpaid medical bills. Individual health plans that comply with the ACA are available only through a licensed insurance agent or through the Oregon Health Insurance Marketplace. Consumers should pay close attention to ensure that they are on the “.gov” website as there are other websites with similar web addresses that offer non-ACA-compliant plans.
“Consumers should remember the adage that if a deal looks too good to be true, it probably is,” said Oregon Insurance Commissioner TK Keen. “If a health insurance policy offers unusually low premiums and low deductibles yet promises full or unlimited coverage, be skeptical.”
Red flags to look for include:
- A salesperson marketing limited partner plans or other “ERISA plans” directly to consumers
- A salesperson claiming they do not need a license because their product is not insurance or is exempt from regulation
- A salesperson offering to sign you up outside open enrollment and without eligibility for a special enrollment period
- A health insurance plan seeming abnormally cheap or referencing “stop-loss” insurance
- A group issuing coverage with minimal requests about an applicant’s health
- A company attempting to quickly collect a large amount of premium
- A company delaying or denying claims and making excuses for failure to pay
Before providing an insurance sales agent with any payment or personal information, DFR encourages consumers to request the agent’s full name and National Producer Number. Consumers can verify the agent’s licensure status by visiting DFR’s check a license webpage.
DFR urges Oregonians to be careful when choosing a company to purchase health care coverage from. Organizations and health plans that DFR and other state regulators have identified as having marketed limited partner or self-funded coverage include:
- Socios Buenos, LP aka Vista Health
- Affordable Benefit Choices LLC
- LP Management Services, LLC
- Aither Healthcare Competitive Health
- NXT Level Health
- Multiplan PHCS Network
- Verdegard Administrators, LLC fka Hawaii Mainland Administrators, LLC
- Pioneer Health/Innovative Healthcare Solutions
- ClearShare Health and Clearwater Benefits LLC
- Emergency Management Alliance
- Premier Health Solutions
- Strategic Limited Partners, LP
- The Vitamin Patch, LLC
Consumers who believe they may have been deceived or have questions can contact our consumer advocates at 1-888-877-4894 (toll-free) or email [email protected].
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