January 23, 2015

Once the liquidation order is entered, the Iowa Life & Health Insurance Guaranty Association and the Nebraska Life & Health Insurance Guaranty Association subject to the limitations referenced below, will pay all eligible healthcare claims including any claims for services provided prior to liquidation which have not been paid due to CoOportunity Health's cash flow problems.

 

The Insurance Commissioner of Iowa and the Insurance Director of Nebraska want providers to know:

• You should continue to provide healthcare services without interruption to CoOportunity Health members.
• You will be paid for covered services delivered to CoOportunity Health members. Claims are being processed as usual but payments are not being made as timely as they were previously. All claims processed and unpaid prior to the date of liquidation, likely February 28, will be paid by the guaranty associations as soon as possible in March after the liquidation order is entered.
• You should continue to submit claims for services as usual.

Under Iowa and Nebraska law, the guaranty associations pay a maximum of $500,000 per member on medical and pharmacy claims. Based on a review of claims, a very small number of CoOportunity Health members may be negatively affected by this limit. 

 

Policyholders Encouraged to Enroll in Other Coverage

When the order to liquidate the company takes effect, CoOportunity Health will no longer qualify as a Qualified Health Plan (QHP). This means that members currently receiving tax credits will be ineligible for assistance if they remain with CoOportunity Health. Specifically:
 

• Members who currently have a cost sharing plan will have higher deductibles and out-of-pocket maximums in liquidation with CoOportunity Health policies
• Members who receive the Advanced Premium Tax Credit (APTC) to assist with their premiums will be responsible for the entire cost of their CoOportunity Health policy premium in liquidation                                                                 

CoOportunity Health is actively reaching out to brokers, groups and individual members to encourage switching to other carriers. The Iowa and Nebraska guaranty associations will be terminating individual and group coverage as soon as allowed by applicable law if the coverage is not replaced before such termination.

 

Checking Eligibility

During this time of transition, it's important to check each CoOportunity Health member's eligibility using one of these options: 
 

• Use the CoOportunity Health secure Provider website to find answers all day, every day - no waiting.
• Log on 24/7 and enter the ID number, or find an ID number using the patient's name and birth date.
• Contact CoOportunity Health's Member Services for help.
• Follow prompts when you dial 1.888.324.2064, available 24/7. You'll need to enter the patient's ID number and birth date.
• Use the Contact Us tool to direct your question to the correct area. The Contact Us tool includes phone numbers, website resources, and an online form that requests information needed to research your question.
• Call Member Services at 1.888.324.2064 between 7 a.m. and 6 p.m., Monday through Friday.