Ev­er­green Health plans listed but not for sale

In­surer awaits ap­proval for con­ver­sion to for-profit

Baltimore Sun - - NEWS - By Sarah Gantz sarah.gantz@balt­sun.com twit­ter.com/sarah­gantz

Mary­lan­ders hop­ing to buy health in­sur­ance from Ev­er­green Health through the state’s on­line in­sur­ance ex­change, which opened Tues­day, will have to wait.

In a bid to stay in busi­ness, Ev­er­green an­nounced plans in Oc­to­ber to be ac­quired by a group of in­vestors and con­vert from a non­profit to a for-profit in­surer. It won’t be al­lowed to sell health plans through the ex­change un­less and un­til the Cen­ters for Medi­care and Med­i­caid Ser­vices ap­proves the pro­posal, Matt Jablow, an Ev­er­green spokesman, con­firmed Tues­day.

Ev­er­green plans and pric­ing con­tinue to be listed on the Mary­land Health Con­nec- tion in hopes the re­view will be con­cluded soon, said An­drew Rat­ner, an ex­change spokesman.

But users who try to en­roll in an Ev­er­green plan will be blocked and re­ceive a pop-up mes­sage that reads:

“Ev­er­green plans are not avail­able at this time. Mary­land Health Con­nec­tion ex­pects to know soon if Ev­er­green plans will be­come avail­able be­fore open en­roll­ment for 2017 ends. It is im­por­tant to choose a plan by Dec. 15 to en­sure Jan. 1 cov­er­age. If you choose a plan now with a dif­fer­ent car­rier, you may still switch to Ev­er­green if those plans be­come avail­able prior to the end of open en­roll­ment on Jan. 31.”

Peo­ple can buy in­di­vid­ual health plans di­rectly from Ev­er­green, but only plans pur­chased through the ex­change are el­i­gi­ble for in­come-based sub­si­dies.

Ev­er­green is one of 23 con­sumer- ori­ented-and- op­er­ated health plans founded un­der the fed­eral Af­ford­able Care Act. Led by for­mer Bal­ti­more City Health Com­mis­sioner Peter Beilen­son, the Bal­ti­more-based in­surer is one of a hand­ful of the co-ops still in busi­ness, and its bid to con­vert to a for-profit in­surer is an at­tempt to stay afloat.

Other co-ops closed or are in the process of wind­ing down, un­able to at­tract enough mem­bers, draw enough premium rev­enue and with­stand the weight of new and costly reg­u­la­tory hur­dles cre­ated un­der the health re­form law.

Ev­er­green sought a buyer af­ter be­ing crip­pled by new in­sur­ance rules that re­quired it to make a “risk-ad­just­ment pay­ment” that amounted to $24 mil­lion in 2015 — more than a quar­ter of its $85 mil­lion rev­enue that year.

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