**Exhibit 21.1**

**Listof 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        | %                     |       |
| Heritage Health  Systems, Inc.                                        |       | Delaware     |       |                             | 100        | %                     |       |
| Marquette  National Life Insurance Company                                 |       | Texas        |       |                             | 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 Financial Corp. Statutory Trust I                      |       | Connecticut  |       |                             | 100        | %                     |       |
| Universal  American Financial Corp. Statutory Trust II                     |       | Connecticut  |       |                             | 100        | %                     |       |
| Universal  American Financial Corp. Statutory Trust III                    |       | Delaware     |       |                             | 100        | %                     |       |
| Universal American  Financial Corp. Statutory Trust IV                     |       | Connecticut  |       |                             | 100        | %                     |       |
| Universal  American Financial Corp. Statutory Trust V                      |       | Delaware     |       |                             | 100        | %                     |       |
| Universal  American Financial Services, Inc.                          |       | Delaware     |       |                             | 100        | %                     |       |
| WorldNet Services Corp.                                                    |       | Florida      |       |                             | 100        | %                     |       |

 

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