Planes de Salud sin Licencia

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. Asegúrese de obtener el nombre completo de la aseguradora. Si el nombre no coincide exactamente con el nombre que figura en los registros del departamento, es posible que no sea una compañía legítima.

Las compañías con licencia están sujetas a controles y supervisión regulares que pueden ayudar al departamento a identificar posibles problemas y prevenir pérdidas importantes. Si una compañía con licencia se liquida, el estado tiene un fondo de garantía para cubrir las reclamaciones pendientes. No existen mecanismos de protección cuando una aseguradora opera sin licencia y deja de pagar reclamaciones o cierra sus puertas. Puede terminar siendo el único responsable de pagar las facturas médicas o en una situación peor si su proveedor se niega a seguir brindándole tratamiento durante una enfermedad grave.

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.

Recuerde: si suena demasiado bueno para ser verdad, probablemente así sea.

No se están pagando mis facturas médicas y creo que tengo un plan de salud sin licencia. ¿Qué debo hacer?

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.

¿Se puede responsabilizar al agente que me vendió un plan de salud sin licencia por el pago de mis reclamaciones pendientes?

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.

Mi agente me propuso una cobertura de seguro de salud a través de un sindicato a pesar de que trabajo en forma independiente. ¿Este plan es legítimo?

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.

Me uní a un Ministerio de Cuidados de Salud con Costos Compartidos (HCSM) para obtener mi cobertura, pero no están pagando mis facturas médicas. ¿Su oficina puede brindarme asistencia?

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.fdacs.gov/Contact-Us/File-a-Complaint or the Florida Attorney General’s office at 1-866-966-7226 or visit their website at  https://www.myfloridalegal.com/ para averiguar si alguna de estas agencias puede brindarle asistencia.

Verifique Antes de Comprar: Planes de Salud

Descargue este volante para obtener consejos sobre cómo protegerse al comprar planes de salud.