The Maine Bureau of Insurance on Monday warned state residents to be wary of purchasing “self-funded” individual health plans.
“These plans do not provide comprehensive medical coverage and can leave consumers with large, unpaid medical bills,” Bob Carey, the bureau’s superintendent, said in a written statement. “Mainers should proceed with caution before signing up and paying a monthly premium.”
Carey said that the bureau already has received complaints from Maine people who have had medical claims denied by the so-called self-funded health plans.
The licensed insurance companies in Maine offering major medical individual health plans are Anthem, Harvard Pilgrim/Point32, UnitedHealthcare, Community Health Options and Taro Health. All major medical plans can be purchased through www.coverme.gov, directly from the insurance company or a licensed agent.
Some of the groups marketing self-funded plans that are not major medical insurance include Affiliated Workers Alliance, Consumer Data Partners, Employers Business Alliance, Innovative Partners, Socios Buenos, Strategic Limited Partners and The Vitamin Patch.
According to the Bureau of Insurance news release, “some of these self-funded plans only cover preventive services such as a yearly check-up or annual health screening. Other plans place limits on the number of services, like doctor visits, that will be covered. There are even some self-funded plans that restrict this already limited coverage by not covering preventive services if they are provided in a hospital facility.”
Carey said that “while the monthly premium for these self-funded health plans may be lower than a major medical plan, consumers may face very high out-of-pocket costs from uncovered medical expenses. A health plan that covers only preventive services will not cover visits to your doctor beyond an annual physical, won’t cover drugs to treat chronic health conditions and won’t cover a hospital stay. These medical services can cost tens of thousands of dollars.”
Those concerned about the type of health plan purchased should call the Maine Bureau of Insurance at 207-624-8475.
Consumer guides about how to spot red flags when purchasing health insurance are available on the bureau’s website.
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