Claims were down but losses were up at Community Health Options in October, the Maine Bureau of Insurance said this week.

The bureau has been monitoring the cooperative health insurer this year after it racked up $31 million in losses in 2015 and set aside $43 million in reserves to cover anticipated losses for 2016.

The Lewiston-based insurer – which has more than 80,000 customers, mostly in Maine – had been the only bright spot among the insurance cooperatives that sprung up in the wake of the Affordable Care Act. It turned a $7 million profit in 2014, but then saw losses snowball last year as new customers signed up and accessed health care under the insurance cooperative, some for the first time in years. As the customers saw doctors and treated medical issues that some had previously ignored, they met annual deductible limits and the bills went to CHO for full payment, leading to increasing losses as the year went on.

The Bureau of Insurance had considered putting the cooperative into receivership in order to trim the ranks of customers and cut losses, but federal officials blocked that effort, saying the ACA required insurers to renew policies for customers. Instead, the bureau worked on a financial plan with CHO and said it would monitor the insurer’s finances on a monthly basis.

In its report for October, the bureau said claims were 12 percent lower than CHO’s financial plan, but the net loss for the month was 31.3 percent worse than forecast. For the year to date, the bureau said, net losses are 6.9 percent worse than what CHO planned for, but the drawdown from the reserve fund was slightly better than the plan.

The bureau also said CHO has done a good job of controlling its costs, with expenses 10.7 percent below what the plan anticipated for October and year-to-date expenses 1.9 percent lower than the plan.

CHO’s bonds, cash, cash equivalents and short-term investments also were lower than expected in October. The bureau said that was largely because CHO paid claims faster and had lower-than-expected premium income as it stabilized its customer base.

The bureau said CHO’s year-to-date financial performance has been “generally consistent with its plan, and October’s results were in line with the company’s most recent fourth-quarter projections.”

CHO’s finances are also likely to be affected by a lawsuit it has filed against the federal government, seeking $23 million from a pool created to help insurers cope with unexpected financial issues during the first few years of the ACA. A federal judge last week ruled that the lawsuit could continue, despite a federal government request for a delay.

 


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