Elite PPO Health Insurance

mschlange

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Received information on a self-funded plan offered through Employers Network Association. Was told this can be sold to individuals outside of the employer.
Rates are not aged banded.Some planes are available in all 50 states.
They state they are aca compliant plans.
Interesting concept for individuals and wanted to feedback if anyone was aware of these plans and this association.
 
Received information on a self-funded plan offered through Employers Network Association. Was told this can be sold to individuals outside of the employer.
Rates are not aged banded.Some planes are available in all 50 states.
They state they are aca compliant plans.
Interesting concept for individuals and wanted to feedback if anyone was aware of these plans and this association.
Would not sell this plan if you put a gun to my head......
This is how I do due diligence......
first we start out by looking at the policy sale's brochure
http://www.croweandassociates.com/w...e-PPO-employers-1-to-9-application-2017-1.pdf......


this is were I look for the insurance company that is backing the fund's....there are none just list's three different ppo networks depending on plan....probably fake....

so next I look for who is collecting the money and who do I have to join to get this plan....the say ENA IS DRAFTING the funds which is owned by I.B.O.T.U. Health & Welfare Fund....which is owned by LOCAL 713, I.B.O.T.U.


So I look at I.B.O.T.U. Health & Welfare Fund......Ibotu Health & Welfare Fund in Garden City, NY - (516) 741-5564
Name:
Ibotu Health & Welfare Fund
Year Founded:
2011
Location Type:
Single
Revenue:
$ 250,000
Employees:
5
Facility Size:
N/A
Peter Hasho
Title: Owner

Kinda like more than 5 people working on my health insurance.... and we find the name Peter Hasho....



So I look at LOCAL 713, I.B.O.T.U. http://www.local713.com/...and there is the name Peter Hasho again.....so it looks like Peter is running the show.....


Peter Hasho
Jersey City Union Boss, Fla. Developer, Indicted for Embezzling Welfare Funds
Jersey City Union Boss, Fla. Developer, Indicted for Embezzling Welfare Funds - National Legal & Policy Center

conspired with each other and others to embezzle more than $350,000 in welfare and union funds through a multi-faceted fraud scheme. The indictment also charges Peter Hasho, 67, of Long Island, President of Local 713 of the International Brotherhood of Trade Unions, located in Albertson, N.Y.
 
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Received information on a self-funded plan offered through Employers Network Association. Was told this can be sold to individuals outside of the employer.
Rates are not aged banded.Some planes are available in all 50 states.
They state they are aca compliant plans.
Interesting concept for individuals and wanted to feedback if anyone was aware of these plans and this association.

I offer this plan to selected clients (I have 7 enrolled to date), so far it has worked well. It's a NY union that exists solely to offer health insurance, regardless of what anyone claims about it being a 'scam' it's been doing this for a long time.

Premiums for the Silver copay for 2017 are $548 per month for an individual, $1022 for couple, $1298 for family.

I've done my due diligence and am satisfied (reviewed multiple annual Form 5500s) as to the viability. There isn't a link to the documents but you can search here: https://www.efast.dol.gov/portal/app/disseminatePublic?execution=e2s2# and use 'International Brotherhood of Trade' in the Sponsor name. They paid out $19M in claims in the last claim year (from the Form 5500, Auditor's Statement):

LOCINTERNATIONAL BROTHERHOOD OF TRADE UNIONS LOCAL 713 HEALTH AND WELFARE FUND
STATEMENTS OF CHANGES IN PLAN BENEFIT OBLIGATIONS
2015 2014
Amounts Currently Payable to or for Participants, Beneficiaries, and Dependents, and Premiums Due to Insurers
Balance at Beginning of Year $ 906,300 $ 5 54,100
Claims Reported and Approved for Payment 19,508,710 7,249,474
Claims Paid (18,670,310) (6,897,274)
Plan's Total Benefit Obligations at End of Year $ 1 ,744,700 $ 906,300



Everyone should make up their own minds about offering this as an alternative to ACA Off Exchange plans-it is fully compliant and uses the Cigna OAP PPO network nationally.

Don't take my word for it or anyone elses, do your due diligence and make your own decision if you think your clients need more options for 2018 and future years.
 
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Don't take my word for it or anyone elses, do your due diligence and make your own decision if you think your clients need more options for 2018 and future years.

Yea....still kinda like my health insurance that has not been sued......

Atlantis Health Plan, Inc. v. LOCAL 713, IBOTU, 258 F. Supp. 2d 284 (S.D.N.Y. 2003) :: Justia

ATLANTIS HEALTH PLAN, INC., Plaintiff,
v.
LOCAL 713, I.B.O.T.U., U.S. Group Medical Administrators, Inc. and U.S. Group Coverages, Inc., Defendants.

Atlantis Health Plan, Inc. ("Atlantis") commenced a civil action in the Supreme Court of New York, County of New York, alleging breach of contract, breach of fiduciary duty, wrongful convergence, and negligence. Atlantis seeks relief in the form of $1,000,000 in insurance premiums it alleges was received by defendants, Local 713, International Brotherhood of Trade Unions ("I.B.O.T.U." or "Local 713"), U.S. Group Medical Administrators, Inc. ("USGMA") and U.S. Group Coverages, Inc. ("USGC") (collectively, "Defendants"), and improperly withheld from Atlantis. Defendants removed the case to federal court, invoking the Court's original jurisdiction under the Employee Retirement Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001-1461. Atlantis filed the instant motion seeking to remand the case to state court and for an award of attorney's fees and costs. For the reasons set forth below, Atlantis's motion is GRANTED in part and DENIED in part.
 
contacted the state insurance department and they have no filling for this plan. Not sure what the exact name would be that they filled under.
If its an association plan do they need to be filled in each state?
They have a plan offered in NJ and NY. These are not easy states to deal with. Would they not of done their due diligence in order to allow them to sell these plans?
 
contacted the state insurance department and they have no filling for this plan. Not sure what the exact name would be that they filled under.
If its an association plan do they need to be filled in each state?
They have a plan offered in NJ and NY. These are not easy states to deal with. Would they not of done their due diligence in order to allow them to sell these plans?

Self funded plans fall under ERISA, which is regulated by Federal law, not state, here is a pretty good overview: https://www.siia.org/i4a/pages/index.cfm?pageID=4546
 
If its an association plan do they need to be filled in each state?

Yes......and they need a contract with a real insurance company to administrate the claims and to re insure if the fund run's dry there is someone to pay claims....I got roped into a deal like this with Employers Mutual scam and they were also playing the ERISA card.... I had to testify for the Texas DOI and pay a fine to keep my Lic.......the day of the trial James invited me to dinner that night.... had decline because I trully thought I would have been whacked.....
Fraudster sentenced for health insurance scam | Business Insurance

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Self funded plans fall under ERISA, which is regulated by Federal law, not state, here is a pretty good overview: https://www.siia.org/i4a/pages/index.cfm?pageID=4546

If you read this it talks about employer's......a business with employees......not members of a association.....which are not employees.....and a true ERISA group plan can not deny anyone......is this plan guaranteed issue.....





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Yes......and they need a contract with a real insurance company to administrate the claims and to re insure if the fund run's dry there is someone to pay claims....I got roped into a deal like this with Employers Mutual scam and they were also playing the ERISA card.... I had to testify for the Texas DOI and pay a fine to keep my Lic.......the day of the trial James invited me to dinner that night.... had decline because I trully thought I would have been whacked.....
Fraudster sentenced for health insurance scam | Business Insurance

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If you read this it talks about employer's......a business with employees......not members of a association.....which are not employees.....





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This plan falls under ERISA for the simple reason that they file an annual Form 5500 and have been doing it for a long time.

They also have a TPA that administers claims (Cook and Associates in New York) and a re-insurance agreement for catastrophic claims.

I have no vested interest in other agents using this or not, just sharing my experience with this specific plan.
 
and a re-insurance agreement for catastrophic claims.


who is the company and have you called to verify they have a current contract......

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They do ask medical questions on the application

and can be declined which a true ERISA plan can not do......

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Ripoff Report | Employers Network Association Complaint Review Nationwide

Employers Network Association (aka, ENA) & Louis Deluca (aka, Louis R. Deluca, III) Accepted $1800/month but failed to make payments for medical services Valhalla Nationwide

I am a New York State resident, small business owner in Manhattan and live in Manhattan with my spouse and two children boys. Helen Altman-Felsher, MBA, a health insurance broker, referred me to a health plans, and I decided on the Cigna “Choice Fund PPO” Network plan (aka, VEBO PPO Plans and ENA Veba Trust). In order to get this health insurance plan, I had to complete and sign enrollment form and worksheet for a company called “Employers Network Association” (ENA). ENA charged me a one-time processing fee of $125 and a monthly premium of $1634 in 2015 and $1833 in 2016
This health insurance plan was managed by Tall Tree Administrators, a third party administrator (TPA). On December 12, 2016 we received a letter stating that, as of 12/1/2016, our insurance carrier and TPA had changed to PHCS and Benefit Plan Administrators, Inc, respectively. We were given NO prior warning about the change, were not asked for our consent, and were not given the option to terminate. We were given no details about the ramifications of these changes and were not even given an identification card or ID number. Even though we have been paying ENA $1833/month for health insurance, none of our claims have been processed since 12/1/2016 (5 months ago). No one from ENA will answer the phone or return emails. Ms. Altman-Felsher has been of no help and washed her hands of this. In fact, she only offered to get me another plan (and to keep receiving commission payments). ENA has set us up with a third party administrator (TPA) called Benefit Plan Administrators (BPA), Inc., who are completely incompetent and who have been repeatedly lying to us about the problems for the past 5 months. We didn’t even had an ID card for the first month and the ID # and group # was changed three times in 2-3 months. The TPA (BPA, Inc.) is stating that they will not pay the claims until they receive the funding. When I did some investigating, I found that: (1) ENA used an unlicensed company (BPA, Inc.) for the administration, (2) ENA is run by Louis Deluca (aka, Louis R. Deluca III), who has been implicated in several insurance fraud cases and accused of previously violating provisions in insurance laws across several states. ENA is also in collaboration with Rod Maynor (CEO of Black Wolf Consulting, Inc.), who is currently being sued for alleged breach of implied covenant of good faith and fair dealing. The plaintiffs allege that the defendant, Mr. Maynor, did not transmit plaintiff's payment to Veritas or to the VEBA trust, failed to provide participants with insurance cards and failed to provide timely information when requested. The case is being tried in Raleigh, WV (Raleigh Circuit Court Case number 17-c-1)

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Louis R. Deluca III)

Florida shuts down phony health insurance policies - tribunedigital-sunsentinel

August 3, 2010|By Bob LaMendola, Sun Sentinel

Florida insurance officials on Tuesday ordered a New York organization to stop selling "bogus" health The organization, best known as AIM or the Association of Independent Managers in Valhalla, N.Y., has sold the policies in numerous states under at least 19 company names, said officials of the Office of Insurance Regulation.

The policies, sold to at least 1,800 Floridians, offer little or no coverage, and the companies are not licensed to sell health insurance in the state, officials said.

Among other names the company has used: CEO Club, Insurance Resource Group, Integrated Insurance Marketing and Star Group. Principals include Louis R. DeLuca III in Connecticut and Gary L. Karns Jr. in Ohio. None of the companies could be located to seek comment.



https://www.linkedin.com/in/louis-de-luca-bb9684a/


Louis De Luca3rd
ENA
UBS Inc.
Greater New York City Area 66 66 connections







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