State Superintendent of Insurance Eric Cioppa has denied Maine Community Health Options’ 11th-hour request to adjust its Affordable Care Act health insurance offerings for 2018.

In a hearing Monday at the state Bureau of Insurance office in Gardiner, Community Health said a series of new, lower-cost ACA insurance “silver” plans proposed by competitor Anthem Blue Cross and Blue Shield threatens to lure away its members unless the nonprofit co-op is allowed to offer a comparable product line.

At the hearing, representatives of Community Health, Maine’s largest ACA insurer with about 40 percent of the market and 35,000 policyholders, said they were not expecting Anthem’s stripped-down silver plans to be accepted by regulators, but that they wanted a chance to make changes to their own offerings just in case.

However, Cioppa said in a written ruling Tuesday that Community Health missed a July 14 deadline to adjust its 2018 rate request. The insurer hoped to make “minor modifications” to two of its silver HMO plans and revive two Preferred Provider Organization, or PPO, plans that it previously had decided to phase out.

ACA insurance plans are ranked bronze, silver, gold or platinum based on the quality of coverage. Community Health President and CEO Kevin Lewis argued that one category of silver plans proposed by Anthem for 2018 is “a bronze-level plan that is masquerading as a silver-level plan.”

The Anthem Silver X 5800 plans would be priced at 8 percent to 12 percent lower than Community Health’s least expensive silver plans, Lewis said.


Cioppa’s ruling against Community Health’s last-minute request did not indicate whether he agrees with the co-op’s argument that the Anthem plans fail to meet silver-tier requirements.

“(Community Health) based the request on its assertion that ‘elements of competitor filings contain benefit design features’ that create impermissible ‘outlier’ features that result in ‘distorted rating plans,’ ” Cioppa said. He said he would review the rate filings by all three Maine ACA insurance providers to ensure they meet the legal requirements.


Cioppa’s responsibilities include ruling on the annual rate requests of Maine’s ACA providers: Community Health, Anthem and Harvard Pilgrim Health Care. He is expected to rule on their 2018 rate requests by mid-August.

Community Health is requesting a 19.7 percent average rate increase for individual plans. Anthem, which has about 28,000 policyholders, is asking for a 21.2 percent increase, and Harvard Pilgrim, which has about 20,000 policyholders, is seeking a 29.2 percent increase.

Anthem defended its proposed Silver X 5800 plans.


“We are confident the plans we filed strictly follow all state and federal regulatory guidelines,” Anthem Vice President Colin Manning told the Portland Press Herald. “As you know, this is a highly competitive market and as such the Bureau of Insurance reviews all filings to ensure they are in compliance and that there is a level playing field for all carriers. We look forward to continuing the regulatory process.”

In order to take full advantage of federal subsidies available under the ACA, eligible residents must purchase silver plans. At a price comparable to bronze plans, the Silver X 5800 plans would likely garner a great deal of interest among Maine residents who are eligible for the subsidies.

However, the coverage offered by the Silver X 5800 plans would be less than all other silver plans available in Maine. In general, a bronze plan is expected to cover 60 percent of medical costs, while the coverage is generally 70 percent for a silver plan, 80 percent for a gold plan and 90 percent for a platinum plan. Silver X 5800 plans would cover about 66 percent of medical costs.


Lewis, the co-op CEO, told the Press Herald on Wednesday that he is confident Cioppa will make the proper ruling on Anthem’s rate request.

“At the same time, we have to use every opportunity to ensure our standing in the market and ongoing competitive stature,” Lewis said. “The process has been made much more confusing and tentative given the numerous federal changes and present-day uncertainty of federal policy.”

J. Craig Anderson can be contacted at 791-6390 or at:

[email protected]

Twitter: jcraiganderson

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