Bulletin – July 12, 2016
From the Desk of Mark Gurda, Jeff Greenberg, Mark Zisook, Brent Caldwell and the staff at Castle Group Health Inc. : Northbrook, IL Tel: 847-559-8100.
The Federal Government denied the suspension of the $31mm payment to the federal risk adjustment program. As a result, the State of Illinois has petitioned the court to take over Land of Lincoln health due to financial instability.The State will continue to operate the company on a temporary basis while making arrangements for the orderly shut down of the company. This shut down could last the rest of the year or the company could be closed as early as September 1, 2016.
Land of Lincoln will continue to pay policy claims while the director of insurance works with the state to create an open enrollment period.
All members should continue to pay premiums and the carrier, with the backing of the State insurance pool will pay claims. We will send out additional information as it becomes available.
What you need to do and know:
No action is required on your part at this time.
Land of Lincoln will continue to operate normally and pay claims under the supervision of the State of Illinois.
Continue to pay premiums to maintain coverage.
There is, at this time, no open enrollment event.
If and when the carrier is shut down, there will be an open enrollment event allowing you to elect new coverage.
Copy of the Petition On Behalf of Land of Lincoln Mutual Health Insurance Company
CHICAGO – Anne Melissa Dowling, Acting Director of the Illinois Department of Insurance, has requested the Illinois Attorney General petition the Circuit Court of Cook County, Illinois, for an Order of Rehabilitation for Land of Lincoln Mutual Health Insurance Company (LLH).
The Director’s decision is based on LLH’s current financial position after the federal Centers for Medicare and Medicaid Services (CMS) did not allow the suspension of LLH’s federal Risk Adjustment Program liability. This is despite LLH being owed an outstanding payment of approximately $70M as
part of the related federal Risk Corridor Program.
If the Cook County Circuit Court enters an Order of Rehabilitation, LLH will temporarily continue to operate under the Director’s supervision. LLH will continue paying policyholder claims, while the Director works with CMS to establish a 60 day Special Enrollment Period for LLH’s policyholders to obtain new health care policies, and prepares the company for liquidation.
An Order of Rehabilitation neither cancels the policies issued by LLH nor its contracts with health care providers. In order to maintain their health coverage, LLH policyholders must continue to pay their premiums. Providers must continue to honor their contracts for service to LLH policyholders, and
vendors must work with Director Dowling to continue to provide necessary services to LLH.
LLH policyholders that wish to keep their federal health care subsidies will need to visit the federal health insurance exchange at healthcare.gov or call 1-800-318-2596 as soon as possible, after CMS establishes a Special Enrollment Period for LLH customers, in order to replace their LLH policy with a policy offered by another insurance company on the exchange.
LLH is a start-up mutual health insurer organized as a Consumer Operated and Oriented Plan (“CO-OP”) under the Affordable Care Act and was licensed under the Illinois Insurance Code by the IDOI in April 2013. CO-OPs were sponsored by CMS to increase competition among insurance companies and thereby lower prices for consumers. LLH currently provides health insurance to approximately 49,000 Illinois residents.