The financial performance of Community Health Options stayed roughly on track in August for the Affordable Care Act insurer to meet its planned budget for the year.

According to a report by the Bureau of Insurance, paid claims in August were 3.9 percent higher than the plan anticipated for August, but paid claims for the first eight months of the year remained at 1 percent lower than anticipated. The results for 2016 business and operations through the first eight months of 2016 “were generally consistent with its plan.”

A year after becoming the only health insurance cooperative in the country to make money, the Lewiston-based insurance cooperative posted a $31 million loss in 2015, prompting it to set aside another $43 million in reserves to cover potential losses in 2016. Managers said at the time that customers accessed more medical care than expected, and that soaring costs for things such as prescription medications contributed to the shortfall. The organization had paid about $117 million in claims in 2014 and $250 million in 2015.

Last year’s performance drew increased oversight from Maine’s insurance superintendent, who has required CHO to file monthly updates to make sure the co-op’s finances are stabilizing.

So far, there have been no major financial surprises for the insurer in 2016, according to the August report.

“The (Bureau of Insurance) will continue to closely monitor (Community Health Options’) cash position but the variance from plan in August is not a source of particular concern,” it says.


The bureau noted that the budget plan attempts to reflect the seasonality of incurred claims over the course of the year, since claimants must satisfy their deductibles earlier in the year, requiring higher payouts by the insurance cooperative later in the year.

Total incurred claims were 0.3 percent below what was planned for August, and 0.6 percent below the anticipated number for the first eight months of the year, the report says.

Membership at the end of August was 4.4 percent lower than anticipated but about the same as at the end of 2015, it says. Roughly 76 percent of the membership consisted of individual insurance plans, with virtually all the rest being small group insurance plans.

CHO has about 65,000 customers in Maine and 11,000 in New Hampshire. In early September it was given permission to withdraw from the New Hampshire market in 2017, which will allow it to focus on its primary market in Maine and build up reserves, according to Eric Cioppa, Maine’s insurance superintendent.

August premiums were 4.8 percent lower than anticipated in the plan, and year-to-date premiums were 3 percent lower.

Total expenses were 11 percent less than anticipated for August, and 4.6 percent less than planned for the first eight months of the year.

The insurer’s net loss in August was 3.6 less than the plan anticipated, but its net loss for the first eight months of the year was 4.1 worse than was planned.

Drawdown from a reserve fund created at the beginning of the year to cover anticipated losses was 3.6 percent less than expected, and the year-to-date drawdown was 5.5 percent less than expected.


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