Moda Health Under Supervision

We received this press release on January 28th from the Oregon Department of Consumer and Business Services regarding Moda Health. We’ll be sure to keep you updated as we get more information. A few frequently asked questions are shared at the end of the press release. If you have further questions, give us a call and we’ll do our best to answer them.

State places Oregon health insurer under supervision

January 28, 2016

(Salem) – The Oregon Department of Consumer and Business Services, Division of Financial Regulation announced today that it has issued an order of supervision to Moda Health Plan, Inc., because of concerns over its financial condition. At the same time, the department will begin working with Moda to transfer its individual market plans to another carrier.

An order of supervision allows the department to have a representative on site and in control of all financial decisions to ensure that consumers are protected. The order prohibits Moda from issuing new policies or renewing current policies in the individual market, and from adding new groups. The order also requires the company to obtain sufficient capital and present a business plan to DCBS that clearly demonstrates that it can operate in sound financial condition going forward. The supervision order is available at .

The department took this action because of Moda’s excessive operating losses and inadequate capital and surplus. Capital and surplus is the amount a company’s assets exceed its liabilities. The required minimum increases as the company assumes more insurance risk.

“Our primary goal is to ensure consumers are protected,” said Patrick Allen, director of the Department of Consumer and Business Services. “We will continue to work closely with the company to find a sustainable path going forward while minimizing risk to consumers.”

The order became effective late yesterday; however, Moda’s insurance policies may still appear on HealthCare.gov through the end of open enrollment, Sunday, Jan. 31. DCBS advises consumers still shopping for plans to choose a carrier other than Moda. In the event that Oregonians already enrolled with Moda need to switch plans, there will be a special enrollment period. In the meantime, Moda policyholders can continue to access medical services and get their claims paid.

DCBS, which also runs the Oregon Health Insurance Marketplace, will keep Moda customers apprised of new developments and actions they may need to take.

As of Sept. 30, 2015, Moda enrolled a total of about 244,000 Oregonians in the commercial market, including 95,000 in the individual market, 16,000 in the small group market, and 129,000 in the large group market. Moda also has members in the associations and trusts market.

Eastern Oregon CCO, which serves Oregon Medicaid members and is owned by Moda, serves 48,000 Medicaid members. No one on Medicaid is losing coverage.

The Oregon Health Authority is also working with the Public Employees’ Benefit Board and Oregon Educators Benefit Board partners to minimize any potential impacts to their members. There are 1,100 PEBB members and 42,000 OEBB members enrolled in Moda health plans.

Consumers with questions should call the DCBS Division of Financial Regulation’s consumer advocates at 1-888-877-4894 (toll-free). Staff will be available to answer calls until 8 p.m. More information can be found on the division’s website.

The Division of Financial Regulation is part of the Department of Consumer and Business Services, Oregon’s largest business regulatory and consumer protection agency. Visit  and.

Questions and Answers about Moda Health Plans

Note: These questions and answers will be updated as we receive more information. Please check regularly for updates.

What action did the state take regarding Moda Health Plans?

The Department of Consumer and Business Services, Division of Financial Regulation issued an order of immediate supervision to Moda Health Plan Inc. The order of supervision allows the department to have a representative on site and in control of all financial decisions to ensure that consumers are protected. The order prohibits Moda from issuing new policies or renewing current policies. The order also requires the company to obtain sufficient capital and present a business plan to DCBS that clearly demonstrates that it can operate in sound financial condition going forward. The supervision order is posted on the department’s website:

Why did the state take this action?

The department took this action to protect consumers. Moda is experiencing significant financial difficulties, including excessive operating losses and inadequate capital and surplus.  Capital and surplus is the amount a company’s assets exceed its liabilities. The required minimum increases as the company assumes more insurance risk.

What are the next steps?

The department will closely monitor and work with Moda to ensure the company can continue to serve its current customers and pay claims. DCBS also will facilitate a plan to transfer Moda’s individual policyholders to another carrier.

What if I have a Moda health insurance plan?

Oregonians with Moda policies can continue to access health care services. Through its supervision, DCBS will ensure claims are paid and consumers are protected.

Should I continue to pay my premium?

Yes. If you pay your premium, it will help ensure continuity in coverage as the department works with Moda on next steps.

Can I still see my doctor and have prescriptions filled at my pharmacy?

We are working with Moda to ensure that its contracts with providers remain in place. DCBS will do its best to minimize disruptions, but they are possible.

I had a Moda plan in 2015 but changed to a new carrier in 2016. Will my 2015 claims be paid?

Yes. With DCBS on site supervising Moda’s activities, the department will ensure claims are paid.

I am still shopping for coverage – can I sign up for a Moda plan?

No. The supervision order prohibits Moda from issuing new policies or renewing policies.

I have a Moda plan through my employer. What does this mean for me?

This order does not affect any policies you get through your job. You should continue to pay your premium, and more information will be provided about any service changes.

Will my Moda dental plan be affected?

No. The company that administers Moda’s dental plans is different than the company that is subject to this order.

Could I potentially lose my premium subsidy or other financial assistance?

Any financial assistance you receive to help pay for your insurance plan is not affected by this order. However, if you have selected Moda for 2016, but decide to select another carrier or plan, the amount of your subsidy may change.

Can I change plans now?

You can change plans during open enrollment, which lasts until Jan. 31, 2016. Outside of open enrollment, you can switch only if you lose coverage or have a life change, such as getting married or having a baby. If Moda is unable to continue to provide individual health coverage, you will have an opportunity to switch to a new carrier during a special enrollment period.

Oregon has a highly competitive market with many options for consumers. There are still a number of carriers offering individual insurance on and off HealthCare.gov and many carriers offering small group coverage. Individuals and businesses have access to a wide selection of plans.

Are other companies struggling?

Many Oregon health insurers experienced losses in 2014 and 2015, as it was challenging to predict claims costs for the first two years of the Affordable Care Act. Lower-than-expected payments from the federal risk corridor payments have also affected some Oregon insurers.

One insurer, Health Republic, chose to exit the market in 2015 because of financial difficulties. Health Republic was a nonprofit Consumer Operated and Oriented Plan (CO-OP), created by the Affordable Care Act.

The remaining Oregon health insurers are currently meeting regulatory standards for solvency, and the department continues to monitor their financial health.

Can my doctor refuse to see me because of Moda’s financial condition?

We are working with Moda to ensure that its contracts with providers remain in place. DCBS will do its best to minimize disruptions, but they are possible.

Who can I contact for more information?

Contact Oregon Division of Financial Regulation advocates at 888-877-4894 (toll-free).

Oregon Health Insurance Marketplace

1-855-268-3767