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Case 0:18-cv-62593-DPG Document 162 Entered on FLSD Docket 06/13/2019 Page 1 of 7

UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF FLORIDA

Case No.: 18-cv-62593-GAYLES

FEDERAL TRADE COMMISSION, 

Plaintiff,

vs. 

SIMPLE HEALTH PLANS LLC, a Florida limited 

liability company, et al., 

Defendants.

 

ORDER AUTHORIZING NOTIFICATION TO EXISTING CUSTOMERS 

THIS MATTER came before the Court on Plaintiff, the Federal Trade Commission’s

(“FTC”) Expedited Motion Authorizing Notification of Existing Customers About Deceptively 

Sold Plans and Opportunity to Obtain Comprehensive Health Insurance (“Motion”) [ECF No. 

144]. The Court, having considered the Motion and the record and finding good cause, grants the 

FTC’s Motion and ORDERS as follows: 

FINDINGS

A. There is good cause to believe that Defendants have deceptively marketed and sold 

limited indemnity plans and non-insurance products such as medical discount or wellness plans 

(collectively, “Products”) as comprehensive health insurance or its equivalent to thousands of 

consumers over the last five years and that these acts or practices violate Section 5(a) of the FTC 

Act, 15 U.S.C. § 45(a), and the Telemarketing Sales Rule (“TSR”), 16 C.F.R. Part 310. There is 

good cause to believe Defendants systematically misrepresented to consumers that the Products 

were health insurance plans that would provide expansive coverage for all of their medical needs 
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and result in low out-of-pocket costs, when in fact Defendants’ Products did not provide this type 

of coverage. 

B. Consumers who were deceptively sold Products by Defendants were billed by, and 

made monthly payments to, Health Insurance Innovations, Inc. (“HII”), the third party 

administrator for the Products, which is not a defendant in this action. Tens of thousands of 

consumers who purchased Products from Defendants prior to the filing of this case currently are 

still being charged on a monthly basis by HII for products provided by independent carriers 

(collectively, “Existing Customers”) that were represented by Defendants to be comprehensive 

health insurance. 

C. There is good cause to believe that due to Defendants’ deceptive sales practices,

many Existing Customers still believe that they purchased comprehensive health insurance or its 

equivalent from Defendants and do not know the true nature of the Products for which they are 

being charged. As a result, there is good cause to believe that Existing Customers are at significant 

risk of incurring substantial medical debt, being unable to obtain necessary medical treatment due 

to the lack of coverage, or being charged on an ongoing basis for the Products without knowing 

their true nature. Consumers should be provided with an opportunity to make an informed decision 

about whether they would like to continue paying for and receiving the Products. 

D. Good cause exists for the entry of this Order requiring that all Existing Customers 

be provided with: 1) notice that the Products they purchased from Defendants are not 

comprehensive health insurance or its equivalent; 2) accurate information about the Products 

purchased and the limited coverage offered by such Products; 3) a simple mechanism to opt-in to 

continue paying for and receiving the Products; 4) notice that the consumers are eligible for a 

special enrollment period offered by the Center for Medicare and Medicaid Services, during which 

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they can apply for comprehensive health insurance plans through the government-sponsored 

marketplace; and 5) instructions for how to access the special enrollment period to apply for a 

plan.

ORDER

IT IS THEREFORE ORDERED that:

E. The Permanent Receiver appointed by the Court, Michael Goldberg (“Receiver”) 

[ECF No. 139, at 23-24], shall oversee the process of providing the notice to Existing Customers 

required by this Order, and shall have the authority to take all steps he deems necessary and 

appropriate for his oversight of the notice process described within. 

F. So that the Receiver may oversee the preparation of the Consumer Notices

described in Paragraph G below, within seven days after entry of this Order, HII shall securely 

provide the Receiver with the names and the contact information (mailing address, email address, 

and any telephone numbers) for every Existing Customer and the Product(s) for which the Existing 

Customer is paying HII. The Receiver shall have the authority to securely provide the names and 

contact information for Existing Customers to the Center for Medicare and Medicaid Services for 

purposes of providing Existing Customers with the special enrollment period referenced in 

Paragraph D. 

G. The process of providing notice to Existing Customers shall be conducted in two

phases, as follows (“Notice Process”): 

1. Within five days after entry of this Order and under the direction of the 

Receiver, HII shall send the first consumer notice to all Existing Customers by

email and U.S. Mail, using the template attached hereto as Consumer Notice, 

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or a substantially similar template that has been approved by the Receiver, 

provided that such template includes the information required in Paragraph D.

2. Fourteen days from the date the first Consumer Notice is sent to Existing

Customers, under the direction of the Receiver, HII shall send the second 

consumer notice to all Existing Customers by email and U.S. Mail, using the 

template attached hereto as Consumer Notice, or a substantially similar 

template that has been approved by the Receiver, provided that such template 

includes the information required in Paragraph D. 

H. HII shall escrow an amount equal to all payments made by Existing Customers and 

received by HII after the entry of this Order until the Notice Process is complete to preserve the 

funds for refunds to Existing Customers who cancel their limited plans, except as provided in 

Paragraph J below. On a monthly basis until all refunds have been paid pursuant to Paragraph J, 

HII shall provide a written report to the Receiver on the amount that has been escrowed under this 

Paragraph.

I. At the conclusion of the Notice Process, on the date specified in the Consumer 

Notices, under the direction of the Receiver, HII shall stop remitting payments to the insurance 

carriers for all Existing Customers who have cancelled those plans. 

J. HII shall issue refunds to all consumers for any payments made to HII that it

received after entry of the Order, including to consumers who have filed claims on the Products in 

the past or have pending claims based on occurrences that took place prior to the entry of this

Order, as follows:

1. For consumers who affirmatively cancel the Products prior to the 

conclusion of the Notice Process, HII shall issue any refunds due to those 

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consumers immediately and need not escrow the consumers’ payments as 

required by Paragraph H; and

2. For consumers who file a claim during the Notice Process based on 

occurrences that took place during the Notice Process, HII, in consultation 

with the Receiver, shall make a case specific determination whether to issue 

a refund to such consumers. 

K. For Existing Customers who maintain their plans, HII shall continue to service their 

accounts uninterrupted. 

L. HII and the Receiver shall track and maintain a record of the results of the Notice 

Process. 

M. HII and the Receiver shall preserve all documents and electronically stored 

information relating to the notice process required by this Order, including, but not limited to, all 

communications with Existing Customers and all records related to the results of the Notice 

Process referenced in Paragraph G above, until the conclusion of this litigation, and shall provide 

copies of such records to any of the parties within five business days of receipt of a written request. 

N. HII shall continue to fully cooperate with and assist the Receiver in connection with 

the Receiver’s performance of his duties pursuant to this Order. 

DONE AND ORDERED in Chambers at Miami, Florida, this Thursday, June 13, 

2019. 

________________________________ 

DARRIN P. GAYLES

 UNITED STATES DISTRICT JUDGE

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I. CONSUMER NOTICE TO SIMPLE HEALTH CUSTOMERS

EMAIL SUBJECT LINE: Important Notice: Your Healthcare Plans May Have Been Sold 

Deceptively. Decision Required

TEXT: 

You’re getting this message because you bought a healthcare plan from Simple Health Plans. 

The Federal Trade Commission (FTC), the nation’s consumer protection agency, has sued 

Simple Health for deceiving its customers.

Simple Health claimed to offer comprehensive health insurance or PPOs that would cover many 

of your medical needs. But Simple Health sold only medical discount memberships, limited 

benefit plans, and other products that provide a small reimbursement or discount for a few 

services. 

That means your Simple Health Plan is not comprehensive health insurance. If you get sick 

or have to go to the hospital, you may have to pay almost all of your medical bills. 

Because of the lawsuit, you have two decisions to make soon. 

DECISION #1: What to do about your Simple Health Plan

You can: 

1. Cancel your plan. Call [number] or visit [URL] to cancel your plan. Health Insurance 

Innovations (HII), the company that bills you monthly, will stop charging you 

immediately.

2. Continue paying for your plan. If you don’t call [number] or visit [URL] by [date 

certain], we will assume you choose to continue your plan. But 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.

DECISION #2: Whether to apply for comprehensive healthcare coverage

You may still be able to buy a health insurance plan through the federal Marketplace, 

www.healthcare.gov. The open enrollment period is over, but the Department of Health 

and Human Services is providing an exception for people who receive this notice. To apply 

for coverage through the Marketplace, you must take these steps by [date certain – 60 days 

from date notice is sent]: 
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 Visit www.healthcare.gov to create an account and fill out an application to see if you are 

eligible to purchase Marketplace coverage.

 If you are eligible to purchase a Marketplace plan, call the Marketplace Call Center at 1-

800-318-2596 (TTY: 1-855-889-4325). Tell the representative you were a Simple Health 

customer who bought a plan based on its representations that you were purchasing a 

comprehensive plan. You can mention the FTC case against Simple Health. The 

representative will help you enroll using a special enrollment period. 

 In the event your eligibility for a special enrollment period cannot be verified at the time 

of your call, the representative will submit a special enrollment period request for you, 

which will take up to two weeks to be reviewed. You will get a letter in the mail saying 

if your request has been approved. If it’s approved, choose a plan by visiting 

www.healthcare.gov or calling the Marketplace Call Center at 1-800-318-2596. The 

deadline for Simple Health customers to get coverage through the Marketplace is 

[date certain – 60 days from date notice sent,] so you must act soon. If you have 

questions, call the Marketplace Call Center.

 If you live in CA, CO, CT, DC, ID, MA, MD, MN, NY, RI, VT, or WA, your state 

operates its own marketplace exchange. Contact your State Exchange directly for help 

with your application: [insert state exchange phone numbers] 

For more information about the FTC’s lawsuit against Simple Health, visit: 

ftc.gov/simplehealthlawsuit. 

Sincerely,

Name

affiliation

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