The Oregon Department of Consumer and Business Services, Division of Financial Regulation has file a petition with Marion County Circuit Court to place Oregon’s Health CO-OP in receivership in order to protect policyholders. The CO-OP lost $18.4 million in 2015, mostly driven by medical claims for individual policies.
Oregon’s Health CO-OP’s board of directors voted last week to consent to the receivership order.
As the receiver, the state intends to liquidate the troubled company’s assets and help connect policyholders with new health plans.
“We understand changing plans in the middle of the year will be difficult for Oregonians, but this action was necessary given the sudden deterioration of the company’s financial position,” said Patrick Allen, DCBS director. “We will be working hard over the next few weeks to reach Oregon’s Health CO-OP policyholders to ensure they are aware of this change and to help them pick a new plan that best meets their needs.”
Oregon’s Health CO-OP is a nonprofit consumer operated and oriented health insurer (CO-OP) formed under the Affordable Care Act. The CO-OP lost $18.4 million in 2015, mostly driven by medical claims for individual policies. Last week, the Centers for Medicare and Medicaid Services (CMS) announced that the CO-OP owes about $900,000 to the federal risk adjustment program. The CO-OP was expecting to receive about $5 million from the program.
“Unfortunately, as a startup, Oregon’s Health CO-OP is not in a position to sustain these losses while meeting its obligations to policyholders,” Allen said. “We are working closely with the company on an orderly wind-down of its business.”
As of March 31, 2016, Oregon’s Health CO-OP has 20,600 health insurance policyholders in Oregon: 11,800 in the individual market and 8,800 in the small and large group markets.
For all of Oregon’s Health CO-OP policyholders, plans will end July 31.
Starting Monday, July 11, individual policyholders can enroll through a special enrollment period and choose a new plan that will take effect Monday, Aug. 1. Consumers should enroll by Sunday, July 31 to ensure their new insurance coverage is active on Aug. 1. They can enroll through HealthCare.gov to access financial help or enroll directly through an insurance company or broker.
Consumers must pay the premium to their new insurer for the plans to take effect.
Businesses that provide Oregon’s Health CO-OP plans to their employees will need to work with their insurance broker and take immediate action to find a new plan with an Aug. 1 effective date.
Individuals and businesses can choose a new plan from an insurer that offers 2016 plans in their county. However, several insurers are discontinuing coverage in certain counties for 2017, so consumers who choose an insurer that is exiting their county in 2017 will not be able to stay with that insurer next year. To find coverage options for your county in 2016 and 2017, visit dfr.oregon.gov.
“Today’s news heightens our concern about limited options for consumers, particularly in rural areas of the state,” Allen said. “In the coming months, we will be working with stakeholders to develop both short-term and long-term solutions to make it more feasible for insurers to offer individual plans throughout the state.”
For help with this change, consumers can call the Oregon Health Insurance Marketplace at 855-268-3767 (toll-free) or email info.marketplace@oregon.gov. More information and questions and answers are available on dfr.oregon.gov.
