Oregon sues insurer for millions over health plan exit

A state regulator says the insurer never got a required boost to capital levels – and that its health plan is insolvent

Oregon sues insurer for millions over health plan exit

Life & Health

By Ryan Smith

An Oregon regulator is suing Zoom Health Plan for $3 million over the insurer’s exit from the state’s insurance marketplace.

The Oregon Department of Consumer and Business Services (DCBS), which is overseeing the company’s exit, is suing to recover $3 million from a company affiliated with the insurer, according to The Lund Report. Zoom Management told regulators in 2016 that it had paid $3 million to bolster Zoom Health Plan’s capital levels. However, the DCBS claims the company never made the payment.

“This funding is critical for Zoom Health Plan to meet its obligations to policyholders,” DCBS director Patrick Allen said in a statement.

Zoom Health Plan claimed in its annual financial report that its capital and surplus levels at the end of last year were $2,873,168, according to The Lund Report. But without the $3 million payment, DCBS claims Zoom was actually in the hole by $126,832 – which meant that the health plan was insolvent.

Join more than six hundred insurance companies and brokers who have grown revenue and reduced costs. Download our free white paper to learn how Docusign can help you improve your customer experience.

Zoom spokesman Len Bergstein told the publication that the company had “$9 million in the bank, but the company’s available cash and the health plan’s capital are two different numbers.” Bergstein blamed Zoom Health Plan’s impending exit largely on the uncertainty the insurance industry has felt since President Donald Trump took office.

“We lost some money the first couple years; however we thought that in the context of the ACA and likely reforms that might occur under the administration that would be elected in 2016, there was hope that the stability of the system and the flexibility of the system could allow an innovative company like us to survive with both a delivery system and an insurer,” Bergstein told The Lund Report. “That didn’t happen. The person everybody expected didn’t get elected. The person who did get elected was unable, even in the beginning, to provide stability, and Congress was unable to repeal and replace. … For a young, cash-short company with a thousand bodies insured or so, this is not the marketplace for us to be. Too risky.”

Related stories:
West Coast carriers get competitive under Obamacare
Trump team looks for Obamacare fixes while seeking its repeal

Keep up with the latest news and events

Join our mailing list, it’s free!