Community Health Options has experienced higher than expected claims for the first 9 months of 2016.
Many prior reports indicated Maine Community Health Options as a strong performer financially.
Medical Loss Ratio 89%
For the 1st three quarters of 2015 Community Health Options has been spending 89% of it's premium revenues on medical expenses and claims. Most small co-ops target a medical loss ratio of 85%.
At this point we do not believe there is any reason for worry for following (4) reasons:
1. The insurer has re-assured us that the problem lies in their INDIVIDUAL market products- and that their GROUP HEALTH INSURANCE division is healthy. The individual market is a difficult arena for insurers and Community Health is not the only insurer to withdraw. Large insurers like Aetna and United Healthcare have withdrawn or plan to withdraw from several INDIVIDUAL state marketplaces as well.
This action will NOT affect their group health insurance clients, or current individual members or recent Community Health enrollees.
2. Co-Op health insurers have strict oversight by BOTH State and Federal Agencies
State of NH Insurance Dept. and Department of Health and Human Services oversight and funding requirements are designed to protect consumers. Community Health is in communication with State Insurance Departments for BOTH NH and ME.
3. In the past 20 years several insurers hit difficult times.
Many of these insurers are still around, and thriving. Insures like Harvard Pilgrim, TUFTS and Blue Cross have all hit difficult times. As for the insurers that are NOT still around- their departures have been planned and often take 12 to 18 months.
4. IN NH there is a Life & Health Insurance Guaranty Association that is designed to provide protection to consumers in the event of a liquidation of an insurance company. (At this point we believe we are no where near this happening- but want you to be aware of this protection.)
We are happy to conduct off- anniversary market reviews for any Community Health Options client who feels uncomfortable. We will continue to monitor the status of Community Health Options and share with you new information as it becomes available.
NY Times Article Community Health STOPS Individual Health Insurance Enrollment
Union Leader- Insurance Carrier to Drop out of State Exchange
Press Release from Community Health Options December 9, 2015
Press release from NH Insurance Department December 9, 2015 Community Health Options