Exhibit 21.1

List of Subsidiaries

|Name                                                             |  | State of Incorporation |  | Percentage Owned |  
|---------------------------------------------------------------- |  | ---------------------- |  | ---------------- | -
|American Exchange Life Insurance Company                         |  | Texas                  |  | 100              | %
|American Pioneer Life Insurance Company                          |  | Florida                |  | 100              | %
|American Progressive Life & Health Insurance Company of New York |  | New York               |  | 100              | %
|American Pioneer Health Plans, Inc.                              |  | Florida                |  | 100              | %
|Ameriplus Preferred Care, Inc.                                   |  | Florida                |  | 100              | %
|CHCS Canada, Inc.                                                |  | Canada                 |  | 100              | %
|CHCS Services, Inc.                                              |  | Florida                |  | 100              | %
|Constitution Life Insurance Company                              |  | Texas                  |  | 100              | %
|Global Health, Inc                                               |  | Oklahoma               |  | 100              | %
|Harmony Health, Inc.                                             |  | Oklahoma               |  | 100              | %
|Heritage Health Systems, Inc.                                    |  | Delaware               |  | 100              | %
|Marquette National Life Insurance Company                        |  | Texas                  |  | 100              | %
|MemberHealth, LLC                                                |  | Delaware               |  | 100              | %
|Part D Management Services, LLC                                  |  | Delaware               |  | 50               | %
|Pennsylvania Life Insurance Company                              |  | Pennsylvania           |  | 100              | %
|Pyramid Life Insurance Company                                   |  | Kansas                 |  | 100              | %
|SelectCare HealthPlans, Inc.                                     |  | Texas                  |  | 100              | %
|SelectCare of Maine, Inc.                                        |  | Maine                  |  | 100              | %
|SelectCare of Oklahoma, Inc.                                     |  | Oklahoma               |  | 100              | %
|SelectCare of Texas, LLC                                         |  | Georgia                |  | 100              | %
|Union Bankers Insurance Company                                  |  | Texas                  |  | 100              | %
|Universal American Corp. Statutory Trust II                      |  | Connecticut            |  | 100              | %
|Universal American Corp. Statutory Trust III                     |  | Delaware               |  | 100              | %
|Universal American Corp. Statutory Trust IV                      |  | Connecticut            |  | 100              | %
|Universal American Corp. Statutory Trust V                       |  | Delaware               |  | 100              | %
|Universal American Corp. Statutory Trust VI                      |  | Delaware               |  | 100              | %
|Universal American Financial Services, Inc.                      |  | Delaware               |  | 100              | %
|Worlco Management Services, Inc.                                 |  | New York               |  | 100              | %
|Worlco Management Services, Inc.                                 |  | Pennsylvania           |  | 100              | %
|WorldNet Services Corp.                                          |  | Florida                |  | 100              | %

---



QuickLinks