WIN Association Resource Page from the Texas Department of Insurance

W.I.N. Association Resource Page

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On April 3, 2009, the Travis County District Court entered a Default Order of Liquidation and Permanent Injunction against W.I.N. Association, Healthshare America LLC, Chamberhealth USA, and Healthshare Marketing LLC (“Companies”) finding the Companies to be insolvent.

The Commissioner has been named the Liquidator

The Agreed Liquidation Order names Mike Geeslin, Texas Commissioner of Insurance, as the Liquidator of the Companies. Members of the Liquidator’s staff are currently on-site to monitor the companies’ operations and ensure that the Liquidator maintains control over the assets and operations.

Permanent Injunction and Automatic Stay

The entry of the Agreed Order of Liquidation and Permanent Injunction triggered an automatic stay under Chapter 443 of the Texas Insurance Code. Pursuant to the automatic stay, certain actions against the Companies, such as lawsuits, are prohibited.

February and March Electronic Fund Transfers

In February and March, some consumers’ bank accounts or credit cards were inadvertently charged, via Automatic Payment Draft / Electronic Fund Transfers (“EFT”), for their monthly premium payments. The Receiver’s representatives have worked with the merchant processing company, RBSLynk (also known as RBS WorldPay), to correct this problem, and RBSLynk has assured the Receiver that EFTs will not take place again.

If you were affected by these EFTs, please contact your bank or credit card company to contest the February and March charges and request that the money be refunded. RBSLynk has assured the Receiver that they will not contest the refunds.

Additional Background Information

Wellness International Network (a.k.a. W.I.N. Association, formerly known as Healthshare America and Chamberhealth USA) has engaged in the unauthorized business of insurance by soliciting, marketing, selling, administering, executing and issuing health insurance plans to individuals and small businesses without any authority to act as an insurer.

The Texas Department of Insurance has issued an Emergency Cease & Desist Order against the Companies for selling unlicensed insurance coverage, collecting premiums and failing to pay medical claims. W.I.N. Association covered approximately 400 people in the United States, including 42 people in the State of Texas, and 57 in the State of Georgia.

In addition to the Texas Insurance Commissioner and the State of Texas, Utah and Oklahoma have also taken action against W.I.N. Association.

Frequently Asked Questions

Q. Who will pay medical claims that should have been paid by W.I.N. Association?
A: Currently, there are hundreds of thousands of dollars of unpaid medical bills that should have been paid by W.I.N. Association. Until assets are collected, it is difficult to project how much of the outstanding medical claims will be paid. However, based on the information currently available, it is unlikely that any significant portion of claims will be paid.

Q. Can my doctor go after me to pay unpaid medical bills?
A: The Liquidator is unsure how much, if any, of outstanding medical claims will be paid. By law, providers are not prohibited from seeking to collect money from patients covered by the W.I.N. Association Plans. Thus, ultimately the consumers themselves do remain liable for payment.

Q. Will I be treated fairly even though I do not live in Texas and a Texas Receiver handling the Liquidation of these Companies?
A: Yes. The Texas Department of Insurance and the Liquidator will treat all individuals covered by W.I.N. Association Plans equally, without regard to state of residency. Texas residents will not be given preference, and all similarly situated claimants will be treated equally as required by Chapter 443 of the Texas Insurance Code (the Insurer Receivership Act).

Q. Has coverage through W.I.N. Association been terminated?
A: As of April 24, 2009, coverage has not been terminated. The Receivership court will determine the termination date for policies issued by W.I.N., but it is unlikely that coverage would extend beyond early June.

We strongly recommend that consumers not wait to receive the official notice of termination of coverage to look for other coverage. Consumers should seek to find other coverage as soon as possible.

Q. How do I prove that I had health insurance through W.I.N. Association?
A: Insurers and employers are required to issue certificates of creditable coverage so you can prove your coverage history and protect your rights. Whether you are joining a new group health plan, buying coverage on your own, or applying to your state's high-risk pool, it helps to have a certificate of creditable coverage.

The Liquidator for W.I.N. Association plans to issue certificates of creditable coverage. A certificate will be sent to individuals covered by W.I.N. Association plans. The certificate of creditable coverage will show the type of creditable coverage you had (group or non-group) and the length of time you were covered (including the termination date of your coverage with W.I.N. Association). As of April 24, 2009, the Liquidator has not yet issued any certificates. You can also ask your employer for a certificate of creditable coverage if the coverage you had through W.I.N. Association was job-based.

Remember that you do not need a certificate of creditable coverage to demonstrate that you had prior coverage. If you have old medical cards, pay stubs that show withholdings for health coverage, medical bills that have been paid by W.I.N. Association, or other evidence that you were covered by W.I.N. Association, your new group health plan, individual health insurance policy, or a state HIPAA program must accept evidence of prior coverage if a certificate is not available.

Q. Where can I go for more information?
A: For more information, contact the Texas Department of Insurance Consumer Protection Hotline at 1-800-252-3439.

If you live in Utah, contact M. Gale Lemmon, Assistant Attorney General at 801-538-3872. The Utah Department of Insurance ordered this illegal entity to cease and desist any and all insurance business in the State of Utah on March 7, 2008.

If you live in Oklahoma, the Insurance Department ordered this entity to cease and desist from all activities relating to doing insurance business on February 19, 2008. For more information, contact the Oklahoma Department of Insurance at 405-521-2828 and ask for John Mahoney.

Consumers may also contact their state's Department of Insurance.

Contact TDI

For answers to general insurance questions or for information on filing an insurance-related complaint, visit our website or call the Consumer Help Linebetween 8 a.m. and 5 p.m., Central time, Monday-Friday

1-800-252-3439
463-6515 in Austin
www.tdi.state.tx.us

Shopping for Coverage

When shopping for coverage, visit www.TexasHealthOptions.com to learn about your options and to help you locate agents and companies selling insurance in your area.
Be sure you understand the full extent of the coverage that is included in any health plan you’re considering. If you have more than one option, choose the plan with the highest level of coverage you can afford. The higher a plan’s deductibles, copays, and coinsurance, the more you can usually save on premiums. However, you’ll also have to pay more out of pocket for claims.
Consider factors other than cost. A carrier’s financial rating and history of consumer complaints are other important considerations. Also ake sure your carrier is licensed by TDI. You can learn a company’s financial rating from an independent rating organization, its complaints history, and its license status by calling TDI’s Consumer Help Line or by viewing company profiles on our website

1-800-252-3439
463-6515 in Austin
www.tdi.state.tx.us
Ask your friends, family, and physician for health plan recommendations. Be sure to ask these questions before buying a health plan:
- Will the plan allow you to visit your choice of physicians and hospitals?
- Are there limits on medications, referrals to specialists, or treatments and surgeries?
- Are there benefit limits per person, family, illness, treatment, and/or hospital stay?
- What is the procedure for out-of-network emergency care?
- Does the plan have annual or lifetime maximums?

Helpful Publications

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Insurance Fraud Toll-Free Hotline - 1-888-327-8818

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Online Fraud Reporting for Insurance Companies
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File an Insurance Complaint

Read about TDI's consumer complaints process in the Helping You With Your Insurance Complaint publication. You may also e-mail, mail, or fax your complaint along with copies of your supporting documents to

Texas Department of Insurance
Consumer Protection Program (MC 111-1A)
P.O. Box 149091
Austin, TX 78714-9091
Fax: 512-475-1771
E-mail: ConsumerProtection@tdi.state.tx.us

For more information contact:

Last updated: 04/24/2009