ZOOM Health Plan Agrees to Honor Co-Pays from CO-OP Members

After the Department of Consumer and Business Services issued an Order against ZOOM Health Plan on Wednesday for refusing to accept the maximum co-payments paid by Oregon Health CO-OP members, the matter appears to have been amicably resolved.

In an article published today by the Portland Business Journal, CEO Dave Sanders said, “Yesterday our lawyers met with theirs and talked about appeal process and our conclusion is it’s not worth it for anybody so moving forward,” Sanders said. “We will proceed as they’re asking us to do.”

Following the announcement that the CO-OP would be shutting down on August 1, Laura Cali, Oregon's Insurance Commissioner, sent a memorandum of understanding to all the insurers, asking them to accept the individual members of the CO-OP and agree to accept the maximum out-of-pocket amounts that these members had already paid. Cali set a July 25 deadline.

On July 27, Patrick Allen, director of the department, told The Lund Report that ZOOM had not accepted the requirement to honor the co-payments and, as such, was not in  compliance with the Insurance Code.

In an earlier article that appeared in The Lund Report, we said ZOOM was in violation of the Insurance Code and that statement was inaccurate. We apologize for the error.

Before the Order was sent to ZOOM, T.K. Keen, deputy administrator of the Division of Financial Regulation, told The Lund Report this was an “open investigation” and that his agency was consulting with the Department of Justice. “All carriers agreed to assume the members of the CO-OP. We don‘t want consumers who’ve paid money toward their deductible to lose it.”

ZOOM Health Plan is part of ZOOM+ and has been actively selling insurance in the Oregon marketplace to individuals and small employers.

Oregon's Health CO-OP has about 22,000 health insurance policyholders: 12,000 in the individual market and 10,000 in the small and large group markets.

Diane can be reached at [email protected].