“We are contacting every person in the District who has been impacted and will help residents enroll in real health insurance through DC Health Link -- coverage that actually pays medical claims, provides access to necessary medical care and gives people financial security,” said Mila Kofman, JD, Executive Director of the DC Health Benefit Exchange Authority. “District residents should know that real health insurance for people who purchase coverage on their own is only available through DC Health Link. In other words, if you live in DC and are buying health insurance outside of DC Health Link, you could get stuck with fake or junk coverage that won’t cover you when you are sick.”
In November 2018, the Federal Trade Commission (FTC) sued Simple Health, LLC, et al. alleging that the operation “misled people to think they were buying comprehensive health insurance that would cover preexisting medical conditions, prescription drugs, primary and specialty care treatment, inpatient and emergency hospital care, surgical procedures, and medical and laboratory testing.” According to the FTC, “consumers who enrolled reported paying as much as $500 per month for what was actually a medical discount program or extremely limited benefit program that did not deliver the promised benefits and effectively left consumers uninsured.” A federal judge issued a preliminary injunction in May 2019, prohibiting the Florida-based operation from selling to new customers. Further court action is expected.
District residents who purchased junk health insurance plans through Simple Health, LLC and related companies will receive a federal notice from the Centers for Medicare and Medicaid Services (CMS) notifying them of the lawsuit and their options for coverage through DC Health Link, the District’s state-based health insurance marketplace. Consumers will need to decide whether to stay enrolled in this discount program or terminate that coverage. If they choose to stay enrolled, the CMS notice states: “…remember that what you’re paying for is not comprehensive health insurance. If you get sick or have to go to the hospital, you may have to pay almost all of the bills yourself.”
DC Health Link will also reach out to these residents to help them get enrolled in a DC Health Link health insurance plan that covers all essential health benefits and for which financial help may be available depending on people’s incomes. The deadline for District residents who purchased junk plans through Simple Health Plans, LLC and related companies to enroll in coverage through DC Health Link is August 30, 2019.
* According to the FTC, the defendants were also conducting business as Health Benefits Center, Simple Health, Simple Health Plans, Simple Insurance, Simple Insurance Plans, Simple Auto, Simple Home, Simple Home Plans, Simple Care, Simple Life, National Dental Savings, and Health Insurance Services.