Press Release: Meritus Health Placed Under Supervision

Media Contact:

Andy Tobin, Director of Insurance

(602) 364-3475

 

Meritus Health Placed Under Supervision

 
Two Arizona health insurance companies have been placed under supervision by the Arizona Director of Insurance, Andy Tobin.  Director Tobin filed an Order for Supervision on October 30, 2015, to place Meritus Health Partners and Meritus Mutual Health Partners into supervision.  Meritus declined to consent to the Order for Supervision.  The Meritus companies’ ability to write new policies or renew existing policies is suspended.  The Centers for Medicare and Medicaid Services has removed the Meritus plans from the Marketplace.  Director Tobin, appointed as Supervisor under Arizona law, will oversee the two companies.

Under Supervision, both Meritus companies will honor their individual and group health insurance plans through the end of 2015.  As part of the Order for Supervision, Meritus may not issue new policies or renew existing policies.  Current Meritus policyholders should seek new coverage for 2016 when Open Enrollment begins November 1, 2015.  An affected policyholder may contact the Marketplace to inquire about a Special Enrollment Period, if the policyholder needs more time to select a non-Meritus plan.  Currently, there are expected to be eight companies on the Exchange in Arizona representing roughly 120 individual plans, and three companies offering approximately 15 small group plans.  There are additional plans available off the Marketplace, as well.

“The Governor’s number one priority is protecting Arizona citizens and I intend to do just that,” said Director Tobin.  “We will work to make policyholders’ transition as seamless as possible.  Policyholders will be able to select a new plan from companies available on the Marketplace when Open Enrollment begins November 1, 2015.”  

The Meritus companies were incorporated on December 7, 2012, as nonprofit corporations for the purpose of becoming Consumer Operated and Oriented Health Plans (Co-Ops).  Meritus received start-up and solvency loans from the Centers for Medicare and Medicaid Services under the Affordable Care Act in the aggregate of approximately $93.3 million.  The Meritus companies were two of twenty-three healthcare Co-Ops that were formed around the country. The Meritus entities have yet to make a profit and have lost over $78 million since their inception. 

"It's disappointing that the Meritus CEO and Board of Directors declined to consent to this order," Tobin said. "However, with Open Enrollment beginning this weekend and many Meritus policyholders subject to automatic re-enrollment, it was vital that the Department step-in and protect Arizona citizens."

Meritus has both Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) products that provide coverage for approximately 59,000 Arizona residents, mostly in Maricopa, Pima and Pinal Counties. 

Affected consumers are urged to contact, the “Marketplace” at 1-800-318-2596, work with their agents/brokers, or request help from a local assister https://localhelp.healthcare.gov.  If you have questions about insurance claims, continuation of coverage, health care appeals, or other issues specific to your insurance coverage, contact the Arizona Department of Insurance Consumer Affairs Division at 602-364-2499 (metro Phoenix) or 800-325-2548 (outside Phoenix).

 
About the Arizona Department of Insurance

The Arizona Department of Insurance, an agency of the State of Arizona, is responsible for the education and protection of insurance consumers and for oversight of the insurance industry in the state.

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Arizona Sample Notice of Continuation Coverage (Mini-COBRA)

Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event.  The law requires a small employer (with an average of at least 1 but fewer than 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrolee's qualifying event.  Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website.  A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements.  On January 23, 2019, the Department uploaded a new version of the form.

Health Insurance Telemarketers Annoy; Pose Fraud Risks

Phoenix, AZ—The Arizona Department of Insurance (ADOI) wants to make citizens aware of scams involving aggressive telemarketers attempting to sell health insurance plans and, in some cases, attempting to gain personal and financial information possibly for criminal purposes.

The ADOI has received complaints from people who received multiple phone calls, robocalls, and text messages claiming to be from the National Health Enrollment Center, the Healthcare Enrollment Center and from Healthcare.gov. Some people report that they were contacted multiple times a day, sometimes from different phone numbers, despite requests to be placed on the companies' do-not-call lists. Additionally, some people report having been asked to provide health insurance enrollment information, including such information as address, date of birth, social security number, and personal health information that, in the wrong hands, could be used in identity theft or other fraud schemes.

Arizona citizens who have received persistent phone calls or text messages from these or other callers attempting to sell them health insurance are encouraged to file a complaint with:

Federal Trade Commission (FTC)

Arizona Department of Insurance Consumer Protection Division

  • Visit https://insurance.az.gov/consumers
  • Or call the ADOI’s Consumer Protection Hotline at 602-364-2499, or 1-800-325-2548 if calling within Arizona but outside Maricopa County.

We can all take steps to avoid becoming victims of fraud.

  • Never provide someone who calls you with your bank account number, your social security number, your credit card number, or your personal health information. If you are asked to provide this information, hang up.
  • Research the insurance agent and insurance company you are considering using by finding their license information through the ADOI’s License Search webpage (https://insurance.az.gov/license-search), and use contact information in the license record to contact them. Be skeptical and do research.
  • For information about insurance available from Health Insurance Marketplace, visit the Healthcare.gov website or call Healthcare.gov directly at 1-800-318-2596. The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

The Arizona Department of Insurance is a state agency dedicated to protecting Arizona citizens and businesses by promoting a safe, strong, innovative and competitive insurance marketplace.

Regulatory Bulletin 2019-01

Use of Credits and Premium Rebates in the Health Insurance Market