ACA Government Co-Ops: Is This Experiment Working In Your State?

[Yagents]

No moonlighting at Co-Ops

Agent says carrier blocked him from joining CO-OP

 

[AllenChicago]

Out of last 10 applicants, 6 have chosen our Land of Lincoln Health Coop over Blue Cross of Illinois. Amazing.
ac

 

[AllenChicago]

12-16-2014

I warned prospects that our Land of Lincoln Health cooperative had only enrolled 3,000 people in all of 2014...and that they would be overwhelmed if too many people chose them. But, the lowest premiums combined with the largest PPO network, caused a good many prospects to ignore my advice and give Land of Lincoln Health a try for 2015.

Sure enough, I'm now getting calls from LOLH applicants complaining that they have not received anything at all from this company.. no e-mail, no phone call, no postal mail...NOTHING.

The first time I called LOLH customer service today to find out what's going on, someone picked up, and hung up the phone real quick. I immediately called again. It rang at least 10 times, then some ro-bo voice said, "We're busy today..call again later to file your claim."


I hope insurer incompetence is still a trigger for a SEP enrollment. I'm starting to get the feeling I may need to use it.

Thanks to forum member KenNguyen for reminding me to relate today's experience with our Land Of Lincoln Health Un-Cooperative.
ac

 

[kennguyen111]

Exactly what I have experienced with LAHC. All of my clients received NOTHING from LAHC. they start to think that I am an incompetent agent...
My reputation is somewhat ruined, because I assured my clients that Invoice and information about their plans will be sent out on Dec 5th.
( I called to many people at this company and they can't give me an answer, and then finally someone in the billing department told me they will send the invoice, plans information on Dec 5th.. and I believed her)
I have clients wanted to enroll everyday but I slow it down now.
why ? don't see the status, not on AOR of some applicants and will be more , ...and may not even get paid as written in the contract.

 

[RayNY]

The co-op is NY is "Health Republic". They expected 30k enrollments for 2014, they ended up getting a few times that in open enrollment, and are at 150k+ now.

The company is good, the plans are good, the network is good, the rates are excellent. Their service is good (at least now, on par or better than competitors) but was certainly lacking for the first part of the year just because they weren't ready for the volume. Everything went out late, if it even got processed.

They've hired staff, tooled up, and expanded to handle the volume and whatever is coming for 2015. They've been much better the past few months, and will do very well if they can keep it up.

All things considered, they had a stellar first year and look like they'll also have a strong second enrollment. With the training wheels off, they could be overtaking the big names pretty soon.

 

[AllenChicago]

thank you for relating your experience ray. I'll be glad when I can say that about ours.

 

[dgoldenz]

Well one just bit the dust...

At the request of Iowa and Nebraska insurance officials, CoOportunity Health is no longer accepting new customers and has been removed from the federal Marketplace. We are working closely with state officials to make sure existing customers remain covered.
• The Affordable Care Act provides for the establishment of nonprofit, member-run health insurance, or Consumer Operated and Oriented Plans (CO-OPs). The law provides for startup loans and long-term solvency funding while these enterprises work to stand up on their own and become stable businesses.
• While states have the primary responsibility oversight of insurance companies, CMS also provides oversight of these startup companies. CO-OPs are required to submit quarterly financial statements that include cash flow data and future business projections, and undergo annual external audits.
• Any start-up business enters a market with the inherent risks of building a business from the ground up. Unfortunately, as with any startup enterprise, not all will succeed.
• We take this news very seriously. Our first priority is to make sure that existing customers remain covered and we are working closely with state officials to make sure existing customers remain covered.
• Current customers enrolled in this plan still have an opportunity to switch plans through open enrollment, which is February 15, 2015.
• CMS continues to closely monitor and evaluate CO-OPs. We have hired a financial management firm and added additional staff to provide ongoing financial monitoring of all CO-OP plans.
• Current customers enrolled in this plan still have an opportunity to switch plans through open enrollment, which is February 15, 2015.
• To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow data, receive site visits by CMS staff, and undergo annual external audits, in order to promote sustainability and capacity to repay loans. This monitoring is concurrent with ongoing financial and operational monitoring by state insurance regulators.
• Co-OP loan applicants underwent a rigorous review process. An objective external review panel of experts conducted an extensive assessment of the requests which included revised business plans, feasibility studies, contingency plans, and pro forma financial statements.
• CMS officials made the final loan award decisions. In making the award decision, CMS took into consideration the reasonableness of the amount of the funding requested, the feasibility of the strategy and business plan proposed, and the impact of the loan on the CO-OP's long-term viability.
• CMS continues to closely monitor and evaluate CO-OPs. We have hired a financial management firm and added additional staff to provide ongoing financial monitoring of all CO-OP plans.

 

[Yagents]

Does this mean that all current Co-Op clients won't have a plan unless they move now to a new carrier? Or, they can keep the Co-Op this year, but no new business?

 

[ctg]

That leaves Coventry as the only carrier to offer plans statewide in Iowa on the exchange. CoOpportunity just wasn't very competitive premium-wise.

 

[unic.consulting]

Does this mean that all current Co-Op clients won't have a plan unless they move now to a new carrier? Or, they can keep the Co-Op this year, but no new business?

More information here:

CoOportunity Health falters, taken over by state

It looks like anyone who applied after Dec. 16th will have to change plans, but anyone before that will be covered if they don't want to change. It sucks because Iowa only has one other company on exchange...same problem NH had last year.