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  #21  
Old 01-02-2015, 06:40 PM
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So if you were getting APTC on one of their plans, would you have to pay that back? Or would you just stop receiving it going forward and your premium would spike up?
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  #22  
Old 01-02-2015, 06:47 PM
cincinnatikid cincinnatikid is offline
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So if you were getting APTC on one of their plans, would you have to pay that back? Or would you just stop receiving it going forward and your premium would spike up?
My guess is that it would be like a discontinuation of the QHP; current members would be able to move to another plan or stay on their existing plan as on off-exchange non-QHP (no premium or cost-sharing credits) under the state guaranty fund.
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  #23  
Old 01-02-2015, 07:13 PM
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Quite the dilemma with the deductible credits. It is plausible they don't want to make it easy for employers to switch mid year to keep cash coming in. But it isn't clear how long the cash flow can last and then claims don't get paid. Why make it harder for folks to switch to a company with stability?
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  #24  
Old 01-09-2015, 11:40 AM
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IOWA CO-OP

http://www.lifehealthpro.com/2015/01..._LID=164548916

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Iowa insurance regulators say they think the liquidation of a health insurer might affect an enrollee's ability to buy new major medical coverage.

Officials at the Iowa Division of Insurance talk about their concerns in a new batch of guidance for agents and brokers. The officials wrote the guidance in response to questions about CoOportunity Health, a troubled Consumer Operated and Oriented Plan (CO-OP) that covers about 100,000 people in Iowa and Nebraska.

......

Officials have noted that the CO-OP could enter liquidation. If the CO-OP enters liquidation, guaranty funds in Iowa and Nebraska would provide up to $500,000 in protection per individual.

Officials say in a new set of answers to questions about CoOportunity that the $500,000 guaranty fund protection would apply to the contracted rates the carrier uses to pay claims to providers, not the providers' billed charges.

The $500,000 limit does not include any amounts patients pay through cost-sharing arrangements, officials say.

"Any medical and pharmacy claims in excess of $500,000 would be the member's responsibility," officials say.

.....
If CoOportunity enters liquidation, and an enrollee sticks with the CO-OP until after the end of the open enrollment period, "policyholders may not be able to choose another carrier until the open enrollment period in the fall of 2015," officials say, in boldface type.
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  #25  
Old 01-09-2015, 01:07 PM
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Not sure who these quoted 'officials' are, but the part about not being able to choose a new plan until the Fall of 2015 is completely inaccurate. Under section 155.1080, the Exchange is required to provide notice to all enrollees (amongst others) upon the decertification of a QHP (recently issued IID guidance recognizes that liquidation would result in a change of benefits that would trigger a decertification). This notice is the triggering event for a Special Enrollment Period, which would give the impacted individuals 60 days to choose a new QHP.
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  #26  
Old 01-09-2015, 02:01 PM
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now, LifeHealthPro could have gotten it wrong, but let's look at the document being referred to:

http://www.iid.state.ia.us/node/9953683

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Should CoOportunity Health move into liquidation status, it is important to understand that if an individual chooses to maintain CoOportunity Health coverage rather than move to another carrier by February 15, the limitations outlined above apply and policyholders may not be able to choose another carrier until the Open Enrollment Period in the fall of 2015.
That is on the official site.

I do not know ACA regs well enough to say, but if this is incorrect, then somebody needs to contact the Iowa Insurance Division and get it straightened out.
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  #27  
Old 01-09-2015, 02:53 PM
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Originally Posted by cincinnatikid View Post
Not sure who these quoted 'officials' are, but the part about not being able to choose a new plan until the Fall of 2015 is completely inaccurate. Under section 155.1080, the Exchange is required to provide notice to all enrollees (amongst others) upon the decertification of a QHP (recently issued IID guidance recognizes that liquidation would result in a change of benefits that would trigger a decertification). This notice is the triggering event for a Special Enrollment Period, which would give the impacted individuals 60 days to choose a new QHP.
The way I read the statement was if the CoOp enters liquidation and the member doesn't do anything during the 60 day window of the Special Enrollment Period, then they would be stuck until the next open enrollment session. The use of "open enrollment period" does cause confusion though.
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  #28  
Old 01-12-2015, 12:37 PM
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My 'rents (retired, year or so away from Medicare) have/had Coopertunity. Last year they had 3 options (BCBS, Coventry, Coopertunity) on the exchange and they said they could get a platinum from them cheaper than the bronze from BCBS or Coventry.

Of course they signed up again in November for 2015. They said that the 2015 rates increased, but were still considerably cheaper than the others. They switched to Coventry last week starting coverage 2/1, but weren't happy with the increased premium. I told them to think of it as an introductory offer like you hear from cable companies (1st year really cheap, then goes up).

I assume that they used consultants for the pricing, but holy crap were they wrong. I think that someone needs a ABCD review of what they were doing...
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  #29  
Old 01-12-2015, 01:02 PM
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Last year they had 3 options (BCBS, Coventry, Coopertunity) on the exchange and they said they could get a platinum from them cheaper than the bronze from BCBS or Coventry.
how did this not raise any suspicions from the DOI?
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  #30  
Old 01-12-2015, 01:18 PM
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how did this not raise any suspicions from the DOI?
I did 100's of rate filings earlier in my career. Not once was I questioned with a concern about rates being too low.
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