Income too high, plan expensive, client offered "Association Group PPO" family of 4, $500/mo.

[STIBROKER]

I am interested in a few things about the plan doc you posted..

This plan is currently being sold out of New York....I have been told I can sell it in Texas...the Texas DOI has never heard of it.....so I am pretty sure this is a Unlicensed Health Insurance scam.....

 

[Bobby39]

That is why I said check with your state athorities.

 

[Yagents]

I may be old school, but insurance agents should stick to insurance products

 

[yorkriver1]

Could be a MEWA, set up as union benefits to avoid state DOI compliance/oversight.
https://www.dol.gov/sites/default/f...ource-center/fact-sheets/mewa-enforcement.pdf
This happened in California and other states years ago. Unfortunately I was new and had one client who bought one. The grief this caused both of us was a lifelong lesson in "if it's too good to be true, it probably isn't". I should have known a xeroxed flyer on turquoise paper with almost no details was suspect. I was in my first year as an agent. I now stick with majors and with known reputable wholesalers.
So, I think we could agree that there is a very big difference between ACA coverage at min. $1500+ and what my client is being offered for $500.
Mark Twain said there's a big difference between lightning and a lightning bug.

 

[STIBROKER]

Could be a MEWA, set up as union benefits to avoid state DOI compliance/oversight.

Yea.....but still has to be filed with the state.....I got sucked into selling something like this 20 years ago.....I had to testify for the DOI in court against James Graf to save my lic......

"Anytime you have an insurance need that is not met by the industry, it provides an arena for crooks to get involved," says Robert Brace, partner at Hollister & Brace, a Santa Barbara, Calif.-based law firm, who represented prosecutors against Employers Mutual, an unauthorized health-insurance company that defrauded thousands of health policyholders out of $30 million in unpaid claims. Last February, James Graf, architect of the scam, was sentenced to 25 years in prison and ordered to pay $20 million in restitution."
Top Health-Insurance Scams

Federal prosecutors said the company operated outside of federal and state scrutiny by claiming to be covered by a 1974 act that allows employers, credit unions and others to offer healthcare plans without the approval of the U.S. Department of Labor.

Graf, Hanson and Kokott are accused of collecting more than $14 million in insurance premiums from fall 2000 to December 2001, and misappropriating more than $2.3 million of that money.

Once the Labor Department began investigating the company, Graf told employees to conceal information, Kokott lied to investigators, and Hanson produced fake documents in response to a federal subpoena, according to a statement released by spokesman Thom Mrozek of the U.S. attorney's office.

If convicted, Hanson, the company's director of operations, faces up to 250 years in federal prison and a $7-million fine. Owner Kokott could get 220 years in federal prison and a $6.25-million fine.

Graf, who operated the company, could face up to 160 years in federal prison and a $4.75-million fine.

Employers Mutual LLC has no affiliation with Employers Mutual Insurance Co. of Des Moines.
3 Arrested in Health Insurance Scam

 

[Bobby39]

I may be old school, but insurance agents should stick to insurance products

I may be old school, but insurance agents should stick to insurance products

I respect your statement. I work for families. I help them find the best products. They make their own decisions.

 

[STIBROKER]

I respect your statement. I work for families. I help them find the best products. They make their own decisions.

Yea although legal I would not sell the plans you are selling with a ten foot pole either.......your E&O will not cover you if your client decides to sue you because Aliera does not pay their $1 mil claim and find out they have no case because they did not read the fine print.......

 

[Bobby39]

Yea although legal I would not sell the plans you are selling with a ten foot pole either.......your E&O will not cover you if your client decides to sue you because Aliera does not pay their $1 mil claim and find out they have no case because they did not read the fine print.......

The clients are fully aware of what plans cover and what plans do not cover. At least, they can go and see a doctor.

 

[STIBROKER]

The clients are fully aware of what plans cover and what plans do not cover. At least, they can go and see a doctor.

they can self insure doctor visits cheaper than your plan.....are you telling them they have a $150,000 cap for cancer.....hell if your going to sell a plan with cap's at least sell USHEALTH....they are a insurance company and bound by law to pay claims....unlike your plan....

 

[Bobby39]

they can self insure doctor visits cheaper than your plan.....are you telling them they have a $150,000 cap for cancer.....hell if your going to sell a plan with cap's at least sell USHEALTH....they are a insurance company and bound by law to pay claims....unlike your plan....

they can self insure doctor visits cheaper than your plan.....are you telling them they have a $150,000 cap for cancer.....hell if your going to sell a plan with cap's at least sell USHEALTH....they are a insurance company and bound by law to pay claims....unlike your plan....

I like the idea of self insurance for doctor visits. Here is the information I have on cancer for an ACA compliant plan: "Cancer coverage is provided after 12 months of continuous coverage, if a pre-existing cancer condition did not exist prior to or at the time of application." A client can always buy a self-funded cancer policy. Is USHEALTH in GA? I use these plans as a part of my portfolio if there is "no other option." In GA, the medical facilities ask for cash up front for some surgical procedures. The poor people can not afford $2,000 or $4,000 cash before a surgery. I got an email a few days ago. The agent ask can I help him. I told him he could try an alternative health care plan, but I did not recommend that type of plan. Non-insurance plans are not a substitute for traditional insurance. The non-insurance plan work best as a helper for the traditional insurance policy.