IRG/AIM Health Solutions

AIM is an Association and the marketing company for these plans. AMLI American Medical and Life Insurance Company is the licensed insurance company. The program is a unique opportunity to provide a guaranteed issue HIPAA qualified defined benefit plan to the national marketplace. It fills a void for those who cannot get major medical in the standard markets and offers an alternative, although limited, to the high-risk/high-premium pool coverage offered in most states.


I received this email today from the TDI (with the 4 page letter to AIM attached to it):

RE: Your inquiry received July 29, 2008
Advertising Unit received August 7, 2008
File ID: 36416
Complaint ID: 836351

Thank you for making the subject material available to us. We have reviewed the advertisements for compliance with our Advertising rules. On August 26, 2008, we sent a letter (a copy is attached) to the Association of Independent Managers indicating the objections we had to the advertisements that you submitted to us. After also reviewing their website, we sent a letter on August 29, 2008 to the Association of Independent Managers indicating the objections we had to their website. We have not received a response to either of our letters.

As we indicated in our attached letter, we found no record of the Association of Independent Managers or the Insurance Resource Group as being licensed with the Texas Department of Insurance to do insurance business in Texas. We also found no record that they are registered with the Texas Department of Licensing and Regulation to solicit a discount health care program in Texas.

Since we have received no response from the above-referenced entities, we will be referring this matter to our Enforcement Division for consideration and appropriate action.

We do appreciate that you took the time to send this matter to us for our review. We are closing our complaint file at this time. We rely on agents like you to help us gather information which will enable us to regulate insurance advertising effectively. If you have any additional information or comments, please feel to contact me.


Janice Mosher
Insurance Specialist
Consumer Protection/Advertising Unit
Texas Dept. of Insurance
[email protected]
 
AIM is an Association and the marketing company for these plans. AMLI American Medical and Life Insurance Company is the licensed insurance company. The program is a unique opportunity to provide a guaranteed issue HIPAA qualified defined benefit plan to the national marketplace. It fills a void for those who cannot get major medical in the standard markets and offers an alternative, although limited, to the high-risk/high-premium pool coverage offered in most states.

Rick, we've heard all this crap before. It's old news/excuses.

This is your second post. What is your interest in all this?
 
I doubt you would know a HIPAA qualified plan if it bit you in the butt.

I don't know who you are or what your experience is, but I run an agency, have more than fifteen years experience and market in several states. We primarily sell our clients face to face and have relationships with families and businesses that span years...not just renewals. I ran into the AIM product, which is underwritten by AMLI, more than a year ago. Individual major medical medical insurance is not guaranteed issue in most states, so a health plan that is guaranteed makes sense to have in our portfolio -even if it is a defined or limited benefit plan. We have done due diligence on the underwriting company with the state in which they are licensed and all states where we are licensed. Currently no complaints have been filed against AMLI that were reported to us.

I suggest that you do your research more thoroughly, before you make accusations. Don't sell this plan to your clients, instead keep referring business to the high risk pool or let those people join the legion of 47 million uninsured.
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Rick, we've heard all this crap before. It's old news/excuses.

This is your second post. What is your interest in all this?
I have done a lot of research and due diligence on the AMLI company and do not think that licensed agents should throw around misinformation. I happened upon this thread on another round of research on the parent company and marketing company.

If you have an axe to grind, do a little research and call Bob Ostrander at AMLI and he will answer you questions.
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I'd like to know this, as well as what makes a plan a major medical or limited benefit plan....

Any links would be greatly appreciated.

Major Medical has a lifetime maximum or annual maximum for any illness unless excluded or limited. You can access all of that maximum for anything.

Limited or Defined benefit pays a set amount per procedure, regardless of the cost.

A good insurance agent can dive you advice on both of those.
 
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I suggest that you do your research more thoroughly, before you make accusations. Don't sell this plan to your clients, instead keep referring business to the high risk pool or let those people join the legion of 47 million uninsured.

You may also wish to do a little more thorough research.

If you read through the entire two-year old thread, you'll find the "due diligence" has been done by many - just as experienced as you or I.

There have been some very serious issues and inconsistencies raised, sited, and confirmed (including claims issues).

Sell it at your own peril.

PS-For fifteen years in the business, I'm surprised you don't know that it's NOT the issuing company/TPA that gets to decide whether it's creditable coverage or not. They can CLAIM anything they want - whether it's true or not is another story...
 
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I don't know who you are or what your experience is, but I run an agency, have more than fifteen years experience and market in several states. We primarily sell our clients face to face and have relationships with families and businesses that span years...not just renewals. I ran into the AIM product, which is underwritten by AMLI, more than a year ago. Individual major medical medical insurance is not guaranteed issue in most states, so a health plan that is guaranteed makes sense to have in our portfolio -even if it is a defined or limited benefit plan. We have done due diligence on the underwriting company with the state in which they are licensed and all states where we are licensed. Currently no complaints have been filed against AMLI that were reported to us.

I suggest that you do your research more thoroughly, before you make accusations. Don't sell this plan to your clients, instead keep referring business to the high risk pool or let those people join the legion of 47 million uninsured.
- - - - - - - - - - - - - - - - - -

I have done a lot of research and due diligence on the AMLI company and do not think that licensed agents should throw around misinformation. I happened upon this thread on another round of research on the parent company and marketing company.

If you have an axe to grind, do a little research and call Bob Ostrander at AMLI and he will answer you questions.
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Major Medical has a lifetime maximum or annual maximum for any illness unless excluded or limited. You can access all of that maximum for anything.

Limited or Defined benefit pays a set amount per procedure, regardless of the cost.

A good insurance agent can dive you advice on both of those.

For the 15th time - can you point out where AMLI is found on the AIM website or brochures and whether or not you think that not stating the underwriting carrier is compliant?
 
For the 15th time - can you point out where AMLI is found on the AIM website or brochures and whether or not you think that not stating the underwriting carrier is compliant?

Carrier compliance is a states issue and varies from state to state. The NAIC guidelines recommend identification of carrier, but those guidelines are just that. Some states require only that the carrier information be included prominently in the policy. The insured has the right to refuse the policy once they receive and review it.
If you are serious about the product...do your own due diligence with AMLI the same way that I did. If not, stop talking smack and act like a professional. An agents job is to give people the proper advice about the products they represent. Due diligence is not a reading a thread in a blog or a forum. Due diligence is a call to the DOI, a call to the VP of sales or the compliance officer at a carrier if you have a question. The complaint against AIM with the TX DOI was forwarded to AIM's National Marketing Director by me on Wednesday.
By the way, Marketing organizations are not required to be licensed in every state unless they actually sell the product directly to the consumer. The insurance company must be licensed and if you check, you will find AMLI licensed in all states where the product is offered. There was a comment about not being offered in some states, but that refers to policy add-ons underwritten by other carriers that can be packaged with the AIM Health Solutions or HealthMax plans or purchased as stand alone products. The individual agents, or call centers who sell the product must hold valid LA & H licenses in the states where they sell the product and must be appointed by AMLI prior to selling the product. Now that you have all this information, you should make a decision to represent the product or not...your choice. I choose to carry E&O with high limits which covers my clients if I make a mistake. Additionally, I made sure that AMLI was an admitted company in the states where I do business, so there is no exposure to my clients should the insurance company become insolvent. Their claims will be paid.
This is how a professional insurance agent operates.
 
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