Zoom Issues Statement, Says No Health Plan Rebates Were Due

A spokesman is calling statements from a former Zoom Health Plan employee "inaccurate and inflammatory," and says the company complied with medical loss ratio rules.

In response to allegations made by a former Zoom Health Plan employee, and concerns raised by several of the insurance company's former members, Zoom spokesman Len Bergstein issued the following statement on Thursday:

Recent articles, containing inaccurate and inflammatory statements from anonymous sources may have raised concerns about the Zoom Health Plan voluntary exit from the insurance market and the subject of medical loss ratio [“MLR”] rebates. Zoom is confident that the health plan correctly determined —  consistent with the Affordable Care Act rules — that no MLR rebates were due in 2015. If any business member of the Zoom Health Plan has concerns that they were entitled to a rebate for 2015 that they did not receive, they should contact Len Bergstein at lbergstein@zoomcare.com for a complete explanation.

In addition, rebates for the 2016 plan year will be calculated later this year and Zoom is confident that if any rebates are owed for that plan year, the Deputy Receiver appointed by the Oregon Department of Consumer and Business Services to run the health plan will have sufficient funds to pay them.

 

Federal investigators recently served at least one subpoena at the offices of Zoom Health, as part of an ongoing investigation. A former employee has alleged that the insurance company owes rebates to its customers under an Affordable Care Act provision that requires insurers to spend at least 80 percent of premiums on claims or health system improvements.
 

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