BE CAREFUL BEFORE BUYING ‘SELF-FUNDED, LIMITED PARTNER’ HEALTH PLANS

Connecticut Insurance Commissioner Andrew N. Mais cautions Connecticut residents to be aware of salespeople offering “self-funded” health plans to individual consumers. The latest pitch involves so-called self-funded health coverage that makes people “limited partners” or “part owners” of an employer group that is offering these plans.

Consumers lack state protection, can have high, unpaid medical bills

These plans do not provide comprehensive medical coverage and can leave consumers with large, unpaid medical bills. These plans are not ACA compliant and are not approved by the Department. They claim ERISA exemption and therefore, fall outside of the Connecticut Department’s authority. That means if something happens, the Department cannot protect you as we would consumers buying fully insured plans.

Be careful. Proceed with caution before signing up and paying a monthly premium.

Some of the groups marketing self-funded coverage in Connecticut include:

• Affiliated Workers Alliance
• Consumer Data Partners, LP
• Employers Business Alliance, LLC
• Innovative Partners, LPSocios Buenos, LP
• Strategic Limited Partners
• The Vitamin Patch, LLC

Plans have limited coverage and benefits

These groups do not offer major medical plans. Major medical plans cover a full range of medical services, including preventive care, office visits, inpatient and outpatient services, prescription drugs, and emergency care.

Unlike major medical plans, 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.

How to know if you have one these plans:

To determine if you have purchased coverage through one of these groups, look at the documents that were emailed after you enrolled in the plan and look at the insurance card they may have sent you. The group may not even send a physical card, so consumers should check their email for an ID card.

Anyone with questions can contact the Connecticut Insurance Department by email at insurance@ct.gov or by calling 860-297-3900.

Additional Resources:

• List of licensed carriers selling ACA-compliant plans in Connecticut.
• Access Health CT - The Connecticut State Health Insurance Exchange.

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For help with all your insurance issues:

• Email us at insurance@ct.gov.
• Ask a question or file a complaint online.
• Call the Consumer Helpline at 800-203-3447 or 860-297-3900.
• Sign up for e-alerts to get the latest news, warnings and rate changes that may affect your premium.
• Download consumer FAQs on health, homeowner and auto coverage.
• Use the Department’s Speakers Bureau for public events.
• Visit our Website and follow the Department on Facebook, Instagram, Twitter, LinkedIn, or YouTube.