Obamacare COOP Evergreen Health to cease issuing new policies, renewals in Maryland

Evergreen Health Cooperative Inc. will not be issuing or renewing individual health benefit policies, both on and off the state’s health insurance exchange, Maryland Health Connection, according to a statement from the Maryland Insurance Administration.

“After many months of working closely with Evergreen management, leadership at the Centers for Medicare and Medicaid Services and outside investors to find a workable solution, we have run out of time to meet the deadline for a January 1 effective date. We remain committed to a viable, competitive insurance industry in Maryland,” said Commissioner Al Redmer, Jr.

Evergreen is a start-up health maintenance organization (HMO) organized as a not-for-profit Consumer Operated and Oriented Plan (“CO-OP”) under President Barack Obama‘s signature health insurance legislation, the Affordable Care Act. Evergreen was licensed by the Maryland Insurance Administration on March 28, 2013. CO-OPs were sponsored by Centers for Medicare and Medicaid Services (“CMS”) to increase competition among insurance companies.

This means that Evergreen Health plans are not available on Maryland Health Connection for the 2017 plan year (for policies effective January 1, 2017).

Last week, Evergreen Health announced that it named Dustin Plantholt as its Chief Sales Officer. Plantholt was the Vice President of Employee Benefits at PSA Insurance & Financial Services.

Click here to read stories of Evergreen’s often troubled history.

In a separate statement, Evergreen Health CEO Dr. Peter Beilenson said: “Our conversion from a non-profit co-op to a for-profit company is moving forward.  We have a very strong group of investors and are working closely with federal and state regulators to craft a deal that will close sometime in the first half of 2017.  Right now, we continue to sell to small and large groups. When the conversion is done, Evergreen will be in a much stronger financial position than we have ever been and, as a result, even better able than before to provide the high-quality, affordable services that our members have come to expect from us.”

According to the Maryland Insurance Administration’s statement, the most recent news means the following to individual policyholders:

1. Evergreen will be unable to offer or bind any new individual policies during Open Enrollment for the 2017 plan year (for policies effective January 1, 2017). Likewise, Evergreen also will be unable to renew any individual policies during Open Enrollment for the 2017 plan year.
2. Current Evergreen enrollees for 2016 who purchased policies on Maryland Health Connection will be renewed into the most similar plan available in their area effective January 1, 2017, to avoid a gap in coverage. It is important to make a decision and choose an alternative plan by December 15, 2016, to ensure coverage effective January 1. If they wish to choose an alternative plan, they need to contact Maryland Health Connection. Individual policies currently in effect will remain in effect until December 31, 2016.
3. Current Evergreen enrollees for 2016 who did NOT purchase their policy on Maryland Health Connection (for example through Evergreen’s website) will need to obtain insurance for 2017 from an alternative insurer. It is important to make a decision and choose an alternative plan by December 15, 2016, to ensure coverage effective January 1, 2017.

If you have recently submitted an application to Evergreen for the 2017 plan year and have already paid for January 2017 coverage, a refund will be issued in the manner the payment was received. Additionally, you will need to purchase coverage for 2017 from an alternative insurer. It is important to make a decision and choose an alternative plan by December 15, 2016 to ensure coverage effective January 1, 2017.

What this means for group policyholders:

This does not impact group policies. Group policies currently in effect will remain in effect until the policy renewal date. Group policyholders should continue to pay the premiums on their in-force policies to ensure continued coverage.

 Where Consumers Can Get Assistance:

Contact Information for Maryland Health Connection:

Go to MarylandHealthConnection.gov/help for information on how to enroll online, search for free, in-person help from a local insurance broker or consumer assistance organization, or enroll by phone. The Maryland Health Connection can be reached at 1-855-642-8572 (TTY: 1-855-642-8573).You can also download a free mobile app (Enroll MHC) to browse available plans and find local enrollment help.

Evergreen policyholders may also obtain information online at https://www.evergreenmd.org or Member Services at 855-978-3282.