Complaint Review: United American Insurance Company - Atlanta Georgia

I found the information from the Florida Dept of Financial Affairs. While a health insurance company must adhere to certain rules Florida requires them to sell in this state, they do not have to adhere to all the laws the State of Florida requires of health insurance companies governed by the state. In addition, Florida requires the health insurance companies not governed by Florida to place a disclosure in their policies that they are governed by the laws of another state. It is on their website health guide, pages 5 & 6. I do not mean to cause anyone harm, I was only letting people know what I learned (which you did state). Also, my insurance company was Golden Rule (United Healthcare) and they did have the governed by the state of _____ in their policy. I double checked when I read the Dept of Financial Affairs website (I cannot remember the state right now, but it wasn't Florida). I know they were not merely a discount company.

I found the information from the Florida Dept of Financial Affairs. While a health insurance company must adhere to certain rules Florida requires them to sell in this state, they do not have to adhere to all the laws the State of Florida requires of health insurance companies governed by the state. In addition, Florida requires the health insurance companies not governed by Florida to place a disclosure in their policies that they are governed by the laws of another state. It is on their website health guide, pages 5 & 6. I do not mean to cause anyone harm, I was only letting people know what I learned (which you did state). Also, my insurance company was Golden Rule (United Healthcare) and they did have the governed by the state of _____ in their policy. I double checked when I read the Dept of Financial Affairs website (I cannot remember the state right now, but it wasn't Florida). I know they were not merely a discount company.

Nikki-- You evidently are not a licensed insurance representative. I am...in 4 states. I am NOT an agent for UA. Your comments are totally inaccurate. Your statement that companies don't have to follow the rules of your state just because they are based in another is completely, utterly, false. What's worse is you are dropping this misinformation on different areas of this site (assurant complaints). Number one: a company who is headquartered in one state and sells insurance in another certainly DOES have to meet all the regulations of the state it is selling in. This is one of the questions on the licensing exam. Number two: Consider your statement: "Insurance companies that are not governed by Florida laws do not have to comply with the Florida laws regarding their converage, even though they are allowed to sell health insurance in Florida." This is so incorrect it's not even funny. If a company SELLS in Florida (or any other state for that matter), they must comply with EVERY REGULATION in the state of Florida--or any other state. This is why some companies only sell in (for example) 30 states--their product does not meet the regulations of those other states. Number three: "There is a clause in their policy that states they are governed by the laws of the state of _____." WRONG! It sounds to me you had a DISCOUNT PLAN which is NOT insurance, it is NOT sold by licensed agents, and therefore may be subject to laws of the state that the company is HQ'd in. I am not an agent for UA, but I am an agent for World Insurance (type their name in and see how many complaints--zero) and Assurant Health, just to name a few. Assurant does have a few complaints on this site, but they are from people who did not understand their policy provisions. I have been selling Assurant for nearly one year and I have had two people drop off (one got group coverage, the other switched to BCBS for their new HSA, even though the deductible was higher it was lower monthly). None of my customers have complained to me about their insurance. The reason I bring up Assurant is that I have a policy ready to deliver. It does NOT have the "governed by the laws of Michigan" (where I am), or ANY state for that matter. It does state: "CONFORMITY OF STATE STATUES - if this plan is in conflict with any laws of the state where it is issued, this plan is changed to meet the minimum requirement of such laws." So much for your "covered by another state regulations" statement. To anyone reading this: understand individual coverage is night and day different than group coverage. You will have higher deductibles and lower coverages. You will have policy limits. All companies do. Why? Because groups let them spread the risk over a larger pool. Individual insurance is just you. To summarize: Nikki, if you don't know what you are talking about, don't give out the information. I don't think you did this with malice, you were simply uninformed.

I just found out this bit of interesting advice for anyone wanting to purchase personal health insurance. I made a mistake in choosing my health insurance company. Many insurance companies are licensed to sell insurance in your state, but are governed by the laws of another state. Only a few are actually governed by your own state's regulations. The companies that are governed by a different state are usually governed by the state that has the least rules they have to follow. There is a clause in their policy that states they are governed by the laws of the state of _____. When purchasing insurance, I basically made sure all my doctors were in the insurance company's network and that was good enough for me. I was wrong. If you are planning to purchase personal health insurance, check with your state to find out the companies that are governed by your state's laws and call them first. For example, Florida has very strict regulations regarding the companies they govern. Rules regarding pre-existing conditions, caps on the costs, wellness visits, mammograms, etc. Even on high deductible plans, insurance companies governed by Florida must pay for certain things, cover pre-existing conditions, etc., even if you did not yet meet your deductible. Insurance companies that are not governed by Florida laws do not have to comply with the Florida laws regarding their converage, even though they are allowed to sell health insurance in Florida. Contact the dept that handles the insurance regulation in your state (in Fla it is the Dept of Financial Services) and find out who is governed by your state's laws before you purchase insurance.

Usually on a major med policy, the deductible is required first for major services (usually waived for preventative care) and then there may be a cost-sharing or "co-insurance" where you and the carrier each pay a percentage of the costs (70/30, 80/20 something like that). Major med policies have a "out of pocket annual maximum" which is the calendar year maximum you would pay for covered expenses on your end before the carrier would cover any remaining costs at 100%. If the agent was referring to the coinsurance when he said you were wrong, then he should have explained this to you. If he said you were wrong indicating that you would be on the hook for some percentage of costs with no limit with participating providers (the OOP max should be listed in the materials you have from that carrier) then he is guilt of "twisting" which is illegal and such conduct can result in fines and suspension of license. Dave