Community Health Options Floundering

One of the health care organizations on the Exchange in NH is struggling to balance its financial obligations due to its larger-than-planned insurance risk and its rapid growth in membership since 2014. Community Health Options (CHO) began operating in Maine in 2014 and expanded in 2015 to sell plans in NH. It now covers 12,730 people in NH and 71,539 in Maine.

The Maine Bureau of Insurance, in conjunction with the NH Insurance Department, will be monitoring and posting monthly financial updates on the fiscal health of Community Health Options (CHO).

Since October of 2015, the Maine Bureau has raised concerns about CHO’s capital position. This past December, CHO stopped selling new 2016 individual health insurance plans both through NH’s federally facilitated exchange and directly from the company. Because of higher-than-expected 2015 enrollment and claims costs, CHO’s 2016 premium rates turned out to be too low to cover its anticipated 2016 losses.

The Maine Bureau notes that CHO’s management and employees have worked to reduce 2016 expenses and other costs and, with their consulting actuaries, have prepared a detailed 2016 monthly plan, which will be the basis of the Maine Bureau’s monthly monitoring going forward.

“The New Hampshire Insurance Department has been working closely with the Maine Bureau –  which has primary regulatory oversight over CHO – and the federal government to monitor CHO’s operations and financial results, and it will continue to do so,” says Roger Sevigny, NH insurance commissioner.  

If the Maine Bureau determines that CHO will not be able to meet its financial obligations on an ongoing basis, affected consumers will be entitled to a special enrollment period during which they could select new coverage.

“One of the Insurance Department’s top priorities is to ensure the financial health and stability of the companies that provide insurance to New Hampshire residents,” says Sevigny. “Our other top priority is to ensure that Granite State consumers are treated fairly and according to the law by their insurance companies. We will continue to monitor Community Health Options’ financial situation, and our Consumer Services division is available to help anyone who has questions or concerns about their coverage.”

To read a statement issued by the Maine Bureau, click here.