Louisiana Regulators Take Over Health Insurance CO-OP

September 2, 2015

The 19th Judicial District Court granted an Order of Rehabilitation and Injunctive Relief giving Insurance Commissioner Jim Donelon possession and control of the Louisiana Health Cooperative Inc. (LAHC, aka CO-OP), the Louisiana Department of Insurance announced.

The CO-OP is a health maintenance organization (HMO) formed under the provisions of the Affordable Care Act as a non-profit health insurance company. It had previously announced it would wind down operations at the end of this year and not offer coverage in 2016.

Donelon said the department is “convinced that the CO-OP, with the support of the Centers for Medicare and Medicaid Services (CMS), will have the ability to pay claims owed to health care providers and I am confident that we can more efficiently and successfully wind down affairs in a timely and equitable fashion.”

Because CO-OP policies remain in effect through Dec. 31, 2015, the LDI sought the Order of Rehabilitation in an effort to ensure uninterrupted healthcare for policyholders and the timely payment of claims to providers.

Policyholders should continue to pay premiums in the same manner, schedule doctor appointments and be assured that their policies will be honored. No one’s health insurance policy will be canceled.

All individual market (non-employer sponsored) insurance policies end on Dec. 31, 2015. CO-OP policyholders will need to enroll in new coverage that will be effective on Jan. 1, 2016. The open enrollment period for health insurance coverage for the 2016 calendar year runs from Nov. 1, 2015, through Jan. 31, 2016.

The LDI will work with providers to ensure they are paid in a timely manner. Financial examiners with the LDI believe the CO-OP, with the support of the CMS, will have the ability to pay all claims.

The Order states that the Commissioner is entitled to enforce, for the benefit of policyholders, contract performance by any party who had contracted with the LAHC. Providers are required by their contracts to continue treating policyholders.

Source: Louisiana Department of Insurance

Topics Louisiana Colorado Policyholder

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