Additional resources

UPDATED - Jan. 30, 2017

On Monday, July 11, the Department of Consumer and Business Services placed Oregon’s Health CO-OP in receivership due to the insurer’s deteriorating financial condition. 

All individual and group plans ended July 31, 2016 and most policyholders were able to switch to a new insurer during a special enrollment period that ended Sept. 29, 2016. Policyholders who did not previously enroll, can now shop for a new plan at HealthCare.gov.

Payment letter to providers

Payment letter to members or providers for claims for services prior to July 11, 2016

Questions and answers

What does the receivership mean for policyholders?

All Oregon’s Health CO-OP policyholders must enroll in new plans. 

  • Individuals should call the Oregon Health Insurance Marketplace at 1-855-268-3767 (toll-free) 8 a.m. to 5 p.m. on weekdays.
  • Employers should work with their agents to find a new plan.

Insurers selling individual plans have agreed to honor any money policyholders have paid toward their Oregon’s Health CO-OP deductibles and out-of-pocket maximums so they do not have to start over.

What is the deadline to submit claims to the CO-OP?

The receivership order signed by a Marion County Circuit Court judge states that all claims must be submitted by no later than Oct. 31, 2016. 

What is the claims payment schedule?

Claims with Date of Service from July 11–31 will be paid at 100 percent of contracted rates.

For claims with Date of Service of July 10 and earlier, the Receiver intends to pay a partial payment. Additional payments will potentially be made depending on the money available. Please refer to section II part D 16 of the order​ for more information. 

Can I bill patients if I don’t get paid?

No. Oregon law prohibits providers from billing patients for the insurance company’s portion of the cost of medical care. This law applies to all providers of care, including physicians, hospitals, and pharmacies.

How can I help with communication to Oregon’s Health CO-OP patients?

We hope you can help us reach CO-OP members and inform them of the steps they need to take. You may also help your patients by advising them of what other plans you accept. You can refer patients to an insurer or broker for help. In addition, our staff is available by phone 8 a.m. to 7 p.m. on weekdays and 8 a.m. to 5 p.m. on weekends at 1-855-268-3767 (toll-free). There is more consumer information on our website​.

Will Oregon’s continuity of care requirements apply to this situation?

When members enroll in a new plan, they will not be able to continue to receive coverage on their CO-OP plan for care with a provider after the contract is terminated (July 31, 2016). There is, however, an exception if the patient is hospitalized. For more information, see ORS 750.095 and ORS 743B.225.

Should we be concerned about contracts with other insurers?

The Division of Financial Regulation is closely monitoring the solvency of all Oregon health insurers. Currently, they are all meeting the state’s requirements. Rate increases recently approved for 2017 will help ensure carriers can continue to meet their obligations to policyholders.

How many people does this affect?

As of March 31, 2016, Oregon’s Health CO-OP has 22,000 health insurance policyholders in Oregon: 12,000 in the individual market and 10,000 in the small and large group markets. Most of those members are in the Portland area.​​​​​

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