Auditor James Brown Issues Warning to Montana Consumers About Utilizing “Self-Funded,” Limited Partner Health Plans

HELENA, Mont. — The Office of the Montana State Auditor, Commissioner of Securities and Insurance (CSI), advises consumers to carefully review health insurance coverage offered through “self-funded,” limited partner plans.

These plans may not be 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 responsible for unpaid medical bills. Individual health plans that comply with the ACA are only available through a licensed insurance agent and www.healthcare.gov.

Montana consumers should exercise caution before enrolling in a limited partner plan. CSI has already received numerous complaints from Montanans who believed they had purchased quality health insurance through a limited partner plan but were later denied coverage for medical expenses.

Companies may offer plans that refer to consumers as “limited partners” or “employees” to avoid Montana consumer-protection regulations. Many limited partner plans only cover preventive care, like 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.

If a deal looks too good to be true, it probably is. 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 health insurance plan seeming abnormally cheap or referencing a “stop-loss” insurer;
– 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, CSI encourages consumers to request the agent’s full name and National Producer Number. Consumers can verify the agent’s licensure status by visiting csimt.gov and selecting the “Montana Insurance License Search” link on the homepage.

Organizations and health plans that have been identified by other state regulators as having marketed limited partner coverage include:

– Affiliated Workers Alliance
– Consumer Data Partners, LP
– Data Miner, LP
– Employers Business Alliance, LLC
– Innovative Partners, LP
– LifeX Research Corp
– Outreach Data Partners, LP
– Population Science Management
– Quick Health LLC
– Socio Buenos, LP
– Strategic Limited Partners
– The Vitamin Patch, LLC

Montana consumers can contact the Insurance Consumer Service (ICS) Bureau at the Office of Securities and Insurance before enrolling in a plan if they have any questions or concerns. ICS can be reached at 800-332-6148 or 406-444-2040.

The ICS team has experienced employees who can help determine whether a plan is approved for the ACA marketplace, whether the company is licensed to do business in Montana, and whether any complaints have been received about the company.

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840 Helena Avenue, Helena, Montana 59601
(main fax) 406.444.3413  I  (securities fax) 406.444.5558
(insurance consumer services fax) 406.444.1980  I  (legal fax) 406.444.3499
(phone) 800.332.6148 or 406.444.2040  I  (email) [email protected]  I  (web) www.csimt.gov