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Insurance Commissioner Seeks Liquidation of CoOportunity Health; Help Clients Find Other Coverage Immediately (January 29, 2015)

 

The Iowa Insurance Commissioner has asked the court to place CoOportunity Health into liquidation. A petition for liquidation was filed on January 29. A hearing will then occur in February and an order to liquidate the company is anticipated to take effect on February 28, 2015. Outlined below, by market segment, is what it means to be in liquidation.

Individual Segment - Marketplace Purchasers

Individual Segment - Off-Marketplace Purchasers

Group Segment - Non-SHOP Purchasers

Group Segment - SHOP Marketplace Purchasers

Communications by Segment


Please help your individual and group clients immediately find different coverage now Taking action now is especially important to your individual clients as Open Enrollment ends on Sunday, February 15, 2015.

The Iowa Insurance Division and Nebraska Department of Insurance have posted updated FAQs on their websites as well as the January 29 announcement by the Iowa Insurance Commissioner and a copy of the petition.


Individual Segment – - Marketplace Purchasers

Eligible pharmacy and medical claims in liquidation will be paid by the Iowa and Nebraska guaranty associations, subject to the limitations referenced below. This includes all claims for services prior to liquidation which have not been paid due to CoOportunity Health's cash flow problems.

Advance Premium Tax Credits Discontinued

Once CoOportunity Health goes into liquidation, it will lose its Qualified Health Plan (QHP) status. This means that effective the date of liquidation, policyholders will no longer receive advance premium tax credits (APTCs) and they will be responsible for paying their entire premium if they retain their CoOportunity Health policy.

In addition, in liquidation, the Cost Share Reduction (CSR) plans will no longer be valid and policyholders will be responsible for paying the deductible and out-of-pocket maximum for a Silver plan rather than the reduced deductible and out-of-pocket amounts.

$500,000 Claims Limit

Under the applicable guaranty association laws, there is a $500,000 per member limit on eligible medical and pharmacy claims; this $500,000 limit does not include member cost share. Any medical and pharmacy claims that exceed the $500,000 guaranty association payment limit may be submitted to CoOportunity Health, but CoOportunity Health may not have sufficient assets to pay all amounts over $500,000, so individuals could be billed for those amounts.

Open Enrollment Period Continues Through February 15

The annual Open Enrollment Period continues through Sunday, February 15. The new coverage will start on March 1 if enrollment in a new policy occurs by February 15 and the policyholders can continue to receive their tax credits and Cost Share Reduction plans, if applicable. To avoid a gap in coverage, policyholders should continue to pay their CoOportunity Health premiums until the new coverage goes into effect.

Deductible and Out-of-Pocket Maximums

Because the policyholder's annual deductible and out-of-pocket maximum may not carry over to a new carrier, the quicker a member moves to another carrier, the less out-of-pocket costs the member will incur under his or her CoOportunity Health coverage.

Special Enrollment Period

A Special Enrollment Period (SEP) will be opened between February 16 and April 30 to enroll in new coverage. During this SEP, policyholders can enroll in other coverage on the Marketplace and receive APTCs, based on their income and family size, once the new coverage starts. Enrollment during the Special Enrollment Period needs to occur by calling the Marketplace call center at 1.800.318.2596. Enrollment cannot be done online at HealthCare.gov after February 15.

To avoid a gap in tax credits and cost share reduction plans, please enroll your clients in other coverage by February 15, 2015. Otherwise, the client will be responsible for the full premium cost until new Qualified Health Plan coverage starts.

Notify CoOportunity Health When Other Coverage Occurs

Ask your Marketplace clients to notify CoOportunity Health when ending coverage by calling 1.888.827.0181. Hours are 8 a.m. to 5 p.m. Monday through Friday. This will ensure our records are up-to-date. You can also notify CoOportunity Health on behalf of your clients.

Coverage Issues

Both the Iowa Insurance Division and the Nebraska Department of Insurance are strongly encouraging policyholders to immediately choose other coverage because of the loss of tax credits and coverage limits after liquidation. Policyholders are responsible for full premium payments or their coverage will be cancelled. In addition, if not replaced earlier, under applicable law, the Iowa and Nebraska guaranty associations will terminate CoOportunity Health later this year.


Individual Segment – Off-Marketplace Purchasers

Eligibile pharmacy and medical claims in liquidation will be paid by the Iowa and Nebraska guaranty associations. This includes all claims for services prior to liquidation which have not been paid due to CoOportunity Healthxs cash flow problems.

$500,000 Claims Limit

Under the applicable guaranty association laws, there is a $500,000 per member limit on eligible medical and pharmacy claims; this $500,000 limit does not include member cost share. Any medical and pharmacy claims that exceed the $500,000 guaranty association payment limit may be submitted to CoOportunity Health, but CoOportunity Health may not have sufficient assets to pay all amounts over $500,000, so individuals could be billed for those amounts.

Open Enrollment Period Continues Through February 15

The annual Open Enrollment Period continues through Sunday, February 15. The new coverage will start on March 1 if enrollment in a new policy occurs by February 15. To avoid a gap in coverage, policyholders should continue to pay their CoOportunity Health premiums until the new coverage goes into effect.

Deductible and Out-of-Pocket Maximums

Because the policyholder's annual deductible and out-of-pocket maximum may not carry over to a new carrier, the quicker a member moves to another carrier, the less out-of-pocket costs the member will incur under his or her CoOportunity Health coverage.

Coverage Issues

Both the Iowa Insurance Division and the Nebraska Department of Insurance are strongly encouraging policyholders to immediately choose other coverage because of coverage limits under the Iowa and Nebraska guaranty association laws. Members are responsible for premium payments or their coverage will be cancelled. In addition, if not replaced earlier, under applicable law, the Iowa and Nebraska guaranty associations will terminate CoOportunity Health individual policies later this year.


Group Segment – Non-SHOP Purchasers

If not replaced earlier, under applicable law, the Iowa and Nebraska Guaranty Associations will continue group insurance for only between 30 and 45 days from the date of liquidation, which is expected at the end of February. Please immediately find alternative coverage for your groups to avoid a gap in coverage.

$500,000 Claims Limit

Under the applicable guaranty association laws, there is a $500,000 per member limit on eligible medical and pharmacy claims; this $500,000 limit does not include member cost share. Any medical and pharmacy claims that exceed the $500,000 guaranty association payment limit may be submitted to CoOportunity Health, but CoOportunity Health may not have sufficient assets to pay all amounts over $500,000, so individuals could be billed for those amounts.

Coverage Termination Notice

CoOportunity Health coverage will be terminated within 45 days of the liquidation order, which is expected at the end of February. A notice will be sent to groups notifying them when their CoOportunity Health coverage will be terminated. Groups are strongly encouraged to look for other coverage options now to avoid any gap in coverage.

Deductible Credit Reports

CoOportunity Health is not providing deductible credit reports. If a new carrier will honor deductible credit, the following steps should be followed to provide documentation:

Group Segment – SHOP Marketplace Purchasers

If not replaced earlier, under applicable laws, the Iowa and Nebraska Guaranty Associations will continue group insurance for only between 30 and 45 days from the date of liquidation, which is expected at the end of February. Please immediately find alternative SHOP coverage for your groups to avoid a gap in coverage.

$500,000 Claims Limit

Under the applicable guaranty association laws, there is a $500,000 per member limit on eligible medical and pharmacy claims; this $500,000 limit does not include member cost share. Any medical and pharmacy claims that exceed the $500,000 guaranty association payment limit may be submitted to CoOportunity Health, but CoOportunity Health may not have sufficient assets to pay all amounts over $500,000, so individuals could be billed for those amounts.

Coverage Termination Notice

CoOportunity Health coverage will be terminated within 45 days of the liquidation order, which is expected at the end of February. A notice will be sent to SHOP groups notifying them when their CoOportunity Health coverage will be terminated. Groups are strongly encouraged to look for other coverage options now to avoid any gap in coverage.

Nebraska SHOP Groups

In Nebraska, businesses in areas of the state with other SHOP insurance carriers are encouraged to switch to other SHOP carriers to maintain eligibility for the Small Business Health Insurance tax credit.

Iowa SHOP Groups

In Iowa, businesses in the areas of the state without other SHOP insurance carriers will be able to maintain eligibility for the Small Business Health Insurance tax credit if they switch to other carriers and meet all other eligibility requirements in 2015. Please see the IRS Guidance - Small Business Tax Credit Transitional Relief for additional information.

SHOP Help

Questions about SHOP (Small Business Health Options Program) can be directed to the call center for SHOP Marketplace, which is part of www.HealthCare.gov , at 1.800.706.7893, TTY 1.800.706.7915, Mon-Fri, 8 a.m. to 6 p.m. (CT).

Deductible Credit Reports

CoOportunity Health is not providing deductible credit reports. If a new carrier will honor deductible credit, the following steps should be followed to provide documentation:

Websites for Up-to-Date Communications

For updates on CoOportunity Health, visit the CoOportunity Health, Iowa Insurance Division or Nebraska Department of Insurance websites.

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