ASAP
HHS Issues Final Rule Implementing CO-OP Program Under Affordable Care Act
Generally, a “qualified nonprofit health insurance issuer” eligible to participate in the CO-OP program is an organization that is organized under state law as a private, nonprofit, member corporation, conducts activities primarily related to the issuance of CO-OP qualified health plans in the individual and small group markets in each state, and meets other requirements outlined in section 1322(c) of the health care reform law. Notably, issuers that existed prior to July 16, 2009 cannot participate in the CO-OP program, as the purpose is to create new consumer-governed, private, nonprofit health insurance issuers. Similarly excluded are: (1) holding companies that control pre-existing issuers, foundations established by pre-existing issuers, and trade associations that are comprised of pre-existing issuers and whose purpose is to represent the interests of the health insurance industry; (2) organizations sponsored by a pre-existing issuer; (3) organizations that receive more than 25% of their total funding (excluding any loans received from the CO-OP program) from pre-existing issuers; and (4) instrumentalities of state or local governments. The law does permit CO-OPs to use experienced managers and health care organizations to manage the functions they have to perform in providing health insurance.
This rule takes effect 60 days after its publication in the Federal Register, which is scheduled for December 13, 2011.
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