Unlicensed Health Plans
Unlicensed Health Plans
An unexpected illness or injury is tragic enough when you are insured. But imagine lying in the hospital and learning that your insurer took your money without ever intending to protect you in return. Now you face huge medical bills and, if you can’t pay, grave damage to your credit.
This scenario can happen to anyone if they do not verify their insurer is licensed by the State of Florida before they purchase coverage. Always check with the department by calling our Consumer Helpline or verify licensure on our Verify Before You Buy page. Be sure to obtain the full name of the insurer. If the name does not match exactly as shown with the department, it may not be a legitimate company.
Licensed companies are subject to regular monitoring and oversight that can help the department identify potential problems and prevent large losses. If a licensed company is liquidated, the state has a guaranty fund to cover unpaid claims. There is no safety net when an insurer operates without a license and quits paying claims and/or goes out of business. You can be left solely responsible for paying the medical bills or worse if your provider refuses to continue treating you during a major illness.
Agents who sell unlicensed health plans can face felony charges as well as be subject to disciplinary action, including license revocation. Under Florida law, if an unlicensed insurer fails to pay claims, the agent who sold the coverage may be held responsible. Agents should always verify a company’s licensure and obtain the required company appointment prior to selling their products.
Remember, if it sounds too good to be true, it usually is.
My medical bills are not being paid and I think I may be a victim of an unlicensed health plan. What should I do?
Contact the Department’s Consumer Helpline at 1-877-693-5236 so our staff can review your plan information. We may need you to send us copies of your plan documents to confirm if the company is licensed.
My insurer’s name is very close, but not identical, to the name shown as licensed on the department’s website. Can it still be okay?
The name of the company should match the name on our website exactly. Some unlicensed companies will create a name similar to a legitimate company to make it appear that it is properly licensed. Contact our Department’s Consumer Helpline at 1-877-693-5236 so our staff can review your plan information. We may need you to send us copies of your plan documents to confirm if the company is licensed.
Can the agent who sold me an unlicensed health plan be held responsible for paying my outstanding claims?
Possibly, but first an investigation needs to take place to establish an agent’s responsibility. This process can take an indeterminate amount of time and your medical providers may seek payment from you during this period.
My agent proposed health insurance coverage for me through a union even though I am self-employed. Is this plan legitimate?
You must belong to a union to have access to their group health plan. As the member of a union, it should be acting as a collective bargaining unit to represent employees in negotiations with an employer. If the union membership lacks this basic purpose, the legitimacy of the union is in question. Contact the Department’s Consumer Helpline at 1-877-693-5236 so our staff can review your plan. We may need you to send us copies of your plan documents to confirm if the plan is legitimate.
I joined a Health Care Sharing Ministry (HCSM) for my coverage but they are not paying my medical bills. Can your office assist me?
HCSMs can operate in the State of Florida without a license if they meet the requirements to be exempt from licensure as outlined in s. 624.1265, Florida Statutes. If your plan is exempt from our department’s regulation, our office will not be able to assist you. However, you can contact the Department of Agriculture and Consumer Services at 1-800-435-7352 or visit their website at https://www.freshfromflorida.com/Contact-Us/File-a-Complaint or the Florida Attorney General’s office at 1-866-966-7226 or visit their website at http://www.myfloridalegal.com/ to find out if either of these agencies may be of assistance.
Verify Before You Buy: Health Plans
Download this flyer for tips on how to protect yourself while shopping for health plans.