Insurance fraud costs consumers—businesses included--an additional $1,500 per year in increased premiums. In fact, it can inflate premiums by as much as 30 percent -- National Insurance Crime BureauSmall-business owners often have trouble obtaining affordable health insurance coverage for themselves and their employees. Where SBOs are in need, dishonest predators will invariably come out of
woodwork to take unfair advantage, which is one reason why health insurance fraud is a growing problem in this country.
Illegal Health Insurance Schemes
Health insurance fraud usually involves group health plans sold to employers for their employees.
Posing as legitimate-sounding but phony unions or trade groups, or falsely claiming
backing of big insurers, fraudulent insurers prey on employers who are badly in need of health insurance by, for example, offering low-cost health care coverage—as much as 50% or more below
going rate. Some even say they’ll issue coverage regardless of health conditions, and with little or no underwriting.
Companies and individuals behind these schemes are seldom licensed in
states in which they do business, and they operate by recruiting unwary local agents to sell these fraudulent products to trusting clients. By putting out false information, undercutting rates and competing unfairly with licensed carriers, unauthorized insurance scams are bilking their customers, and constitute a serious financial hazard to
general public.
Here’s
set up…
Legitimate v. Illegitimate “MEWAs”
Under federal law, self-insured or fully insured “Multiple Employer Welfare Arrangements”--MEWAs—are plans created by two or more employers to furnish employee benefits, such as health insurance. However, unscrupulous entrepreneurs have found MEWAs to be a handy way to market worthless health care benefits to employers for their employees. Here’s how…
While legitimate MEWAs permit individual employers to self-insure health coverage for their own employees, any plan providing coverage to more than one unrelated employer, must be licensed by
state. Yet dishonest promoters present MEWAs to employers as employee benefit plans covered by
Employee Retirement Income Security Act (ERISA), which (they say) exempts them from expensive state licensure, reserve, and other regulatory requirements and allows them to offer health care and other coverage at such low rates.
It just ain’t so, and states cannot allow health care coverage to become a con game played on
unsuspecting by
unscrupulous. Yet many of these phony insurers are domiciled outside
United States, further complicating
false information illegitimate MEWA promoters give employers, and their almost inevitable failure to pay claims.
Other Causes for Concern
The primary legal issue involving unauthorized insurers is
erroneous claim that they’re free from state insurance regulation, but other issues are cause for concern. These include:
• Inadequate financial backing, and
lack of a federal guaranty fund covering unpaid claims.
• Financial impact on
businesses that have fallen for this fraudulent scheme, and
future insurability of MEWA-covered employee.
• Widespread illegal activity by promoters claiming to be insurance companies, and
long-term affect this has on public confidence in state regulation of
insurance business.