WINhealth chooses not to participate in 2016 individual market


WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program.


NEWS RELEASE: WINhealth chooses not to participate in 2016 individual market

October 8, 2015

 

CHEYENNE, WYO – As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program.

According to the Centers for Medicare and Medicaid Services (CMS), “The goal of the risk corridor program is to support the Marketplaces by providing insurers with additional protection against uncertainty in claims costs during the first three years of the Marketplace. The temporary risk corridor program provides payments to insurance companies depending on how closely the premiums they charge cover their consumers’ medical costs. Issuers whose premiums exceed claims and other costs by more than a certain amount pay into the program, and insurers whose claims exceed premiums by a certain amount receive payments for their shortfall.”

This recent development from CMS came as a surprise to WINhealth. The financial impact of the federal government’s decision on WINhealth amounts to approximately $4.4M. The ambiguity of federal government repayments, both in timeline and amount, have created an environment of uncertainty and increased risk in the individual environment. For this reason, WINhealth has chosen not to participate in the individual market for 2016.

WINhealth’s President & Chief Executive Officer, Stephen Goldstone, stated “The federal government’s decision to significantly reduce the reimbursement we would receive under the risk corridor program came as a complete surprise to WINhealth. This combined with the continuous delays in repayment has caught WINhealth flat-footed with no choice but to turn down participating in the exchange for 2016.”

Current WINhealth individual members will continue to have coverage through December 31, 2015, so long as they continue to pay their monthly premiums. Open enrollment begins November 1, 2015. All individual members will need to choose a plan through a new insurance carrier between November 1, 2015 and December 15, 2015 for a plan that starts on January 1, 2016. Current WINhealth individual members can look at their options through the federal exchange by visiting healthcare.gov. Should WINhealth members have any questions about their current plan, they should contact WINhealth directly or their broker/agent.  Should members have any questions regarding Open Enrollment, they should contact healthcare.gov or Enroll Wyoming.

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