Tennessee CO-OP Community Health Alliance Voluntarily Enters Runoff

Wednesday, October 14, 2015 | 10:33am

NASHVILLE – Community Health Alliance (CHA) has voluntarily entered state-approved runoff and will not offer insurance coverage in 2016.

The runoff decision came after careful analysis of the company’s current and future financial condition and lengthy discussions involving the Centers for Medicare & Medicaid Services, the Tennessee Department of Commerce & Insurance (TDCI) and CHA. Created as a Consumer Operated and Oriented Plan (CO-OP) under the Affordable Care Act, CHA has approximately 27,000 enrollees.

Runoff is when a business winds down its existing business and pays all related policy claims while ceasing to take on new customers.

CHA policyholders will keep their insurance coverage through Dec. 31, 2015 so long as they continue to pay premiums. To continue insurance coverage in 2016, consumers must re-enroll in a new healthcare plan during the next Open Enrollment period beginning Nov. 1.  CHA consumers have until Dec. 31, 2015 to enroll in a new healthcare plan in order to have coverage effective Jan. 1, 2016. 

 “This was not a decision that the Department took lightly, but it was the right decision,” TDCI Commissioner Julie Mix McPeak said. “With thousands of Tennesseans’ coverage hanging in the balance, CHA’s financial success could not be guaranteed. Ultimately, the risk of CHA's potential failure in 2016 was too great and would have caused substantial detrimental effects on the market as a whole if it were to collapse.”

CHA’s enrollment of new customers on the Federally Facilitated Marketplace (FFM) was frozen in January. This summer, CHA received TDCI’s approval for new rates and had planned to offer coverage on the FFM in 2016.

However, recent guidance about a federal program designed to assist health insurance carriers as well as disclosures about the company raised concerns about its future.

Tennessee still has four carriers on the FFM offering insurance coverage for 2016 and allowing Tennessee consumers to select a range of insurance plans, depending on their location.

Frequently Asked Questions (FAQs):

If I bought insurance through CHA, what will happen to my coverage? The coverage you bought will remain in effect through December 31, 2015.

Can I continue to buy insurance through CHA? No. You need to find new coverage to begin January 1, 2016. Open enrollment begins November 1 and runs through January 31, 2016. CHA consumers have until Dec. 31, 2015 to enroll in a new healthcare plan in order to have coverage effective Jan. 1, 2016. 

What does the dissolution of CHA mean to providers? Providers will be paid for claims incurred through December 31, 2015.

Where else can I enroll for insurance in the Federally Facilitated Marketplace? Visit www.healthcare.gov for access to insurers participating in the FFM or call 1-800-318-2596. There will be up to four carrier options on the FFM, depending on your geographic location.

Will this change my premium? No. Premiums will not change through the 2015 plan year. Your premium may change when you purchase coverage from another company for 2016 coverage.

Should I keep paying my premium? Yes. You must pay your premium through the end of 2015 to have coverage.

Can I still see my regular doctor and have prescriptions filled at the same pharmacy? Yes. The provider network should remain in place through 2015. Once you shop for new coverage for 2016, check provider directories for the other companies to ensure your doctors and preferred facilities are members of those networks.

Can my doctor refuse to see me because of the situation? No. Contracts between CHA and providers should remain in force during the runoff.

Who should I contact at TDCI if I have questions? TDCI Director of Consumer Insurance Services Vickie Trice can be reached at (615) 741-2218 or 1-800-342-4029 or by email at cis.complaints@tn.gov. Consumers may also contact Community Health Alliance.