New health insurer prepares to sell policies in Maine, reaches agreement with physicians group

Posted May 15, 2013, at 3:01 p.m.

One of two carriers that will offer policies through Maine’s health insurance exchange has lined up a group of central Maine physicians to treat patients with the new coverage.

Maine Community Health Options, a consumer-run health insurer based in Lewiston, announced this week that it has contracted with the Kennebec Region Health Alliance, a physician group operated by MaineGeneral Medical Center. MCHO plans to add other health providers and hospitals as it assembles a statewide network of preferred providers to serve its future policyholders, according to a press release.

MCHO will offer policies to individuals, families and employers. Enrollment will begin in October, with the policies taking effect in January 2014. MCHO has set a goal of attracting 50,000 members.

The plan would be offered both on its own and through Maine’s exchange, an online marketplace where consumers will be able to shop for health coverage. The exchanges are a key component of President Barack Obama’s health reform law, which aims to widen coverage to 30 million people.

Maine’s exchange will be run by the federal government.

MCHO is a private nonprofit organization known as a “consumer operated and oriented plan” that will be governed by its policyholders, much like a mutual insurance company. It’s one of 24 “co-op” health plans across the country funded under the federal health reform law.

By partnering with MaineGeneral of Augusta and Waterville, Maine’s third-largest health system, MCHO expects to lower health costs by improving access to care, better coordinating patients’ treatment, and supporting community health and wellness efforts, MCHO said in the release.

“We’re very pleased to work with MCHO in this effort aimed at providing a needed option for Maine individuals and companies to buy quality health insurance coverage at reasonable rates,” Barbara Crowley, executive vice president at MaineGeneral Medical Center and its parent, MaineGeneral Health, said in a press release. “With all the changes that are shaping health care today, it is more important than ever that we work together to make health care affordable to all Mainers.”

In March, the Maine nonprofit won a $62 million loan from the federal Centers for Medicare and Medicaid Services to develop the co-op and fund a reserve, or a pool of money dedicated to paying claims.

MCHO is one of two carriers planning to offer policies on Maine’s health exchange during its first year of operation. It joins the much larger commercial insurer Anthem, which has partnered with MaineHealth, the parent system to Maine Medical Center in Portland, to offer a product on Maine’s exchange.

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