SCC cautions Virginians regarding short term, limited benefit health insurance policies

Thinking about changing health insurance plans or purchasing new coverage? The State Corporation Commission’s (SCC) Bureau of Insurance warns Virginians not to fall victim to high-pressure telemarketers selling short-term or limited benefit health insurance policies.

These types of policies are not compliant with the federal Affordable Care Act (ACA), despite some company promises, and consumers who purchase these policies may also be required to pay a fee assessed through their federal income taxes if the only health insurance coverage they have is a short-term or limited benefit policy.

“Protect yourself physically and financially by arming yourself with knowledge,” said Virginia Insurance Commissioner Jacqueline K. Cunningham. “Understand enrollment periods, what ACA-compliant plans must cover, and where to turn for legitimate information about ACA-compliant coverage,” she said.

Consumers should keep in mind that these types of policies are not subject to ACA rules, such as the requirement that policies provide at least the 10 categories of essential health benefits including hospitalization, ambulatory services, emergency services, maternity and newborn care, mental health and substance use disorder services, prescription drugs, lab tests, chronic disease management, pediatric services and rehabilitative and habilitative services. Additionally, these types of policies are not prohibited from denying eligibility for coverage or excluding services because of pre-existing conditions and applying dollar limits on benefits.

The Bureau offers consumers the following tips in the event they receive a call from anyone attempting to sell health insurance over the phone:

• The open enrollment period for the 2016 health insurance marketplace under the ACA ended January 31, 2016. The next open enrollment period will run November 1, 2016, through January 31, 2017.
• There are no special or state enrollment periods for individual health insurance. Anyone offering to sell individual health insurance plans through an “enrollment period” outside of the open enrollment period is not selling an ACA-compliant policy.
• The only official website for the federal Marketplace is www.healthcare.gov. Here you can find information regarding the Affordable Care Act, qualified health plans and comparisons of Marketplace plans. Be wary of other similar sounding names or websites.
• Check the Bureau of Insurance website at www.scc.virginia.gov/boi/pubs/hbp_indv.pdf for a list of carriers that have received approval to offer ACA-compliant health benefit plans to individuals on and off the federal Marketplace in Virginia for 2016.
• No one offering ACA-compliant health care coverage will ask you if you have a pre- existing condition.
• Be wary of telemarketers from the “national enrollment center,” “national healthcare center,” or other official-sounding name. The federal government will not call to sell you health insurance.
• Do not provide anyone your Social Security number, bank account details or health information. If a caller pressures you to provide this information, hang up.
• Never agree to any request to send money over the phone.
• When purchasing insurance through an agent, make sure that person is a licensed agent and ask for his or her license number. If he or she refuses, hang up.
• If you receive a sales call from someone selling health insurance, ask the caller for written information about the policy, including premiums. If he or she refuses, hang up.

Consumers who have questions about these types of sales calls may contact the Consumer Services Section of the Virginia Bureau of Insurance’s Life and Health Division at 1-800-552-7945. For more information about the Virginia Bureau of Insurance, visit www.scc.virginia.gov/boi.