Does Anybody else Think This Pushes the Limits?

[Ron305]

Email just received:

Subject: National Health Exchange: New Health Insurance Plan Starting at $135


National Health Exchange - Plans for Individuals, Families & Students
New Health Access Plan Now Available Great new plans affordable for your family starting at $135 If you are uninsured or overpaying for health insurance you need to take a look at the new Health Access Plan. Simplifed underwriting makes the application and approval process fast and easy. Call to qualify today.

• $25 copay for office visits
• $10 copay for generic drugs
• $200 deductible
• 80/20 co-insurance

If you would like to get a quote for health insurance you can go to www.nationalhealthxchange.comor call for a quick quote at 800.571.3165 ext.108. Quick Quote - Contact us direct at 800.571.3165 ext.108. Regards, C. M.
Benefits Administrator
National Health Exchange


I think its a little too close to saying "I work for the government. You can trust me". Same kind of crap that is the reason CMS has so many regs on what agents can and can't say to a prospect.

So I checked the TDI data base and the agent (I removed the name) wasn't even listed. It is a female so she may be hiding behind her maiden name (also a misrepresentation if you ask me).

Then I called the number. Got another agent. She told me that National Health Exchange was the name of the company selling Assurant. I looked her up and she is licensed and only has one appointment-Time Ins.

I asked her if this was part of the new govt. program, and she said that she didn't know of any new govt. program. Then I told her about what I had heard on the news about the health exchanges as a part of the health care reform bill. She then all of the sudden had full knowledge and told me that it would go into effect in 2014. CHEATERS!!!

 

[Mr. Bill]

I don't think "misleading" is quite the word. Geez!

 

[arnguy]

I think you should report this company to the Feds, This smacks of gross misrepresentation.

 

[STIBROKER]

Just sent the site to United/Golenrule to get their input.....

 

[HealthGuy]

What are the carriers going to do? Nothing! This site is ridiculous but what technically are they doing wrong?

 

[Dave020]

Is it a discount plan or a "bait and switch"?

On the one had they advertise major medical carriers. On the other they talk about 4 easy health questions and, no rate ups, no pre-ex issues, no height weight issues.

 

[STIBROKER]

did you hit the our partners tab......

Association Health Insurance Can Save up to 44%

What are the carriers going to do? Nothing! This site is ridiculous but what technically are they doing wrong?

 

[dimon]

any updates on the if they are doing anything wrong yet?

 

[Ron305]

Here is the update we got from TDI....

MS ****** ******
BENEFITS ADMINISTRATOR
NATIONAL HEALTH EXCHANGE
318 LEISURE LANE
WAXAHACHIE TX 75165

RE: Healthcare Email Advertisement
Received: July 12, 2010

Form ID​

Media Type​

Objection​

“New Health Insurance Plan”
Email
1, 2, 3, 4, 5
nationalhealthxchange.com
Internet
1, 2, 3, 4, 6, 7, 8
PARTNERS
Internet
1, 2, 3, 4, 6, 10
SERVICES
Internet
1, 2, 3, 4, 6, 7
SOLUTIONS
Internet
1, 2, 3, 4, 6
CONTACT
Internet
1, 2
QUOTES
Internet
1, 2, 3, 9
ACCIDENT
Internet
1, 2, 3
CIQUOTE
Internet
1, 2, 3

Form IDs:












Dear Ms. ******:

On July 20, 2010, the Advertising Unit of the Texas Department of Insurance received a complaint regarding an email that was received by a Texas agent (see attached complaint). We have reviewed the email and the website, www.nationalhealthxchange.com, for compliance with our Advertising rules, Title 28, Texas Administrative Code (TAC) and the Texas Insurance Code (TIC) without comparing the benefits/limitations listed in the advertisement to the provisions contained in the contract. All the advertisements were reviewed as invitation to inquire material except, CONTACT, which was reviewed as an institutional advertisement.

NOTE: On July 23, 2010, we sent a similar letter to ****** ******, Benefits Administrator of National Health Exchange (see attached letter). We have received no response from her. Using the link given in Ms. ******’s email, we requested a quote. On July 22 and 28, 2010, we received a response to our request for a quote from you (see the attached emails). Since we have been unable to receive a response from Ms. ******, we are requesting that you respond as indicated in the letter.

Based upon our review, we note the following objections:

1. To comply with TAC, §21.104(c) and§21.107(b), no advertisement may use a combination of words, symbols, or physical materials which by their content, phraseology, shape, color, or other characteristics are so similar to combinations of words, symbols, or physical material normally or usually used by agencies of the federal government or of this state, or that otherwise appear to be of such a nature that the advertisement or solicitation is connected with an agency of the municipal, state, or federal government. as well as imply, or create the impression directly or indirectly that the insure, its financial condition or status, the payment of its claims, or the agent is recommended or endorsed by any division or agency of this state or the United States government. Pursuant to the Federal Healthcare Reform which has introduces the term “Exchanges” in its program, the use of the name National Health Exchange can unfairly lead consumers into believing that this is the statutorily created federal program.

2. To comply with TIC, §101.051 and §101.102(a), no entity shall directly or indirectly act as an agent or aid on the behalf of another person or insurer in the solicitation, negotiation, procurement or effectuation of insurance or in the dissemination of information without procuring a license as an agent under the Texas Insurance Code. We have been unable to determine that National Health Exchange and ****** ****** are properly licensed to do the business of insurance in Texas. Please contact our Agents Licensing Division for information concerning licensing of ****** ****** and licensing National Health Exchange or registering it as a DBA.

3. To comply with 28 TAC, §21.104(a)(1) and §21.103(c), the full name of the insurer is required to be set out conspicuously in each of its invitation to inquire advertisements. This required information cannot be minimized, rendered obscure, presented in an ambiguous fashion, or intermingled with the context of the advertisement so as to be confusing or misleading. To comply with §21.104(a)(2), it is sufficient to state the full licensed name, assumed name registered with the department pursuant to §19.902 of this title or Texas agent’s license number of the agent when advertisements address coverages in general and do not describe a specific policy or coverages of a particular insurer.

4. To comply with 28 TAC, §21.103(b), the format and content of an advertisement of a policy must be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. The following statements are unclear as to what they are referring. In your response letter to us, please respond to the following questions:
· Form “New Health Insurance Plan:” What is the “New Health Access Plan Now Available?”
· The language in the upper left corner states that “Association Health Insurance Can Save up to 44%.” To what association is this statement referring?
· Please clearly define what a “national benefits organization” is as stated in the second paragraph in Form SOLUTIONS.

5. To comply with 28 TAC, §21.113(b), subject to TIC Chapter 1214 and the TIC Chapter 541 Subchapter B, an invitation to inquire concerning a health benefit plan may include rate information without including information about all benefit exclusions and limitations so long as any rate mentioned in any advertisement disseminated under this subsection indicates the age, gender, and geographic location on which that rate is based and so long as the advertisement includes prominent disclaimers clearly indicating that:
(1) the rates are illustrative only;
(2) a person should not send money to the issuer of the health benefit plan in response to the advertisement;
(3) a person cannot obtain coverage under the health benefit plan until the person completes an application for coverage; and
(4) benefit exclusions and limitations may apply to the health benefit plan.
None of the above-mentioned disclosures are included in the advertisement.

6. To comply with 28 TAC, §21.105(c), no advertisement may omit information or use words, phrases, statements, references, or illustrations, if the omission or use of such information has the capacity, tendency, or effect of misleading or deceiving purchasers or prospective purchasers as to the nature or extent of any loss covered, premium payable, or policy benefit payable. The advertisement must clearly disclose how and to what the discount is applied. Note the statement in the upper left corner of the web pages referring to “. . . Save up to 44%.”

7. To comply with 28 TAC, §21.112, an advertisement that has an omission of information, false implication or impression that is misleading or deceptive or has the tendency or capacity to be misleading or deceptive is prohibited. It is important not to exaggerate the benefit payments have on the insured’s general financial condition and social well-being. Refer to the following:
· In Form nationalhealthxchange.com: The language in the first paragraph under of the “What is Accident Insurance” heading, “It’s a way to stay ahead of the medical and out-of-pocket expenses that add up . . .,” has the tendency to imply that those medical and out-of-pocket expenses are guaranteed to be entirely covered by the payment of the insurance benefit which is an exaggeration and thus misleading. This problem may be avoided by inserting the term “help” or similar word(s) into the above-referenced language (e.g., “It’s a way to help stay ahead of the medical and out-of-pocket expenses . . . .”
· In Form SERVICES: The language in the second paragraph “. . . insurance is simply one of those necessities of modern life that you must have in order to protect yourself,” has the tendency to imply that those medical and out-of-pocket expenses are guaranteed to be entirely covered by the payment of the insurance benefit which is an exaggeration and thus misleading. This problem may be avoided by inserting the term “help” or similar word(s) into the above referenced language (e.g., “. . . insurance is simply one of those necessities of modern life that you must have in order to help protect yourself.”

8. To comply with 28 TAC, §21.103(a), it is required that advertisements be truthful and not misleading either in fact or in implication. The statement in Form nationalhealthxchange.com states that “. . . we’ll send cash benefits directly to you . . . .” The distribution of cash benefits can only be done by an insurer or third-party administrator. We have been unable to located National Health Exchange in our Company License database of insurers and third-party administrators.

9. Form QUOTES contains questions the answers to which commonly form a basis for determining one's eligibility for coverage. If the questions shown on the form and the answers obtained via this form are eventually attached to any issued policy then the form must be filed with our Life/Health division as an application. If this form has been approved by our Life/Health Division, please provide us with the TDI file ID under which it was approved. If the answers obtained and the questions shown on this form are never attached to a policy then our concerns are whether the obtained answers will be used to deny the respondent the opportunity to apply for the advertised coverage. If you would inform a proposed client that they are not eligible for the advertised insurance product based on the answers obtained from this form then any notification to the proposed client must not state or imply that the client is not eligible for the advertised product from any source. It is acceptable to indicate that the client is not eligible for coverage offered by your agency or the companies you represent. In your response to this letter, please certify that any communication to a proposed insured about their ineligibility which is based on responses to the questions shown in Form QUOTES complies with the above-described guideline.

10. To comply with 28 TAC, §21.107(g), if a person is compensated, directly or indirectly, for making a testimonial, endorsement, or appraisal, this shall be disclosed in the advertisement by language substantially as follows: "Paid Endorsement." Please include on Form PARTNERS the above-referenced disclosure or certify in your response letter if the endorsing entities on Form PARTNERS are not compensated for their endorsements.

You are requested to certify in writing that you voluntarily agree to discontinue dissemination in Texas of the above-referenced email(s) and any other similar active ads that are not in compliance with these stated violations, as well as respond to the any other questions presented in this letter. In addition, you are requested to block the above-referenced website and any other associated websites form the view of Texas residents until you have made all the appropriate revisions to bring the advertisements into compliance.

Pursuant to Section 38.001 of the Texas Insurance Code, a written response is required no later than ten (10) days after receipt of this letter. Please provide us with the date that you will either make corrections to the noncompliant web pages or block these noncompliant web pages from Texas consumers. If you are unable to respond within the 10-day limit, you must request an extension in writing. All extension requests must state in detail the specific reason you are unable to respond within the statutory time limit and indicate the date we can expect your complete response. Failure to comply could result in our referring the violations to our Enforcement Division for possible disciplinary action. You can reply by email or fax the response to my attention to . If you have any questions, please contact me.

Thank you for your prompt attention. We would like to resolve this matter quickly.

Sincerely,



Insurance Specialist
Advertising Unit, Consumer Protection
@tdi.state.tx.us

c: File

 

[Norwayguy]

Great response from the Texas DOI...Wonder if this was a securities issue wether FINRA or any Federal Agency could have responded in such a way....

I did notice section 9 about quotes...I can see what they mean because those questions can be used on an application but they would be questions any knowledgable person would ask to help determine which direction to go. For you Texas Agents do you have a quotes section of your website and has it been filed as an application with the DOI?