Ahhh…the marketplace…pushing, shoving, spinning, clarifying, puffery and many other special words come tumbling out with bad news. For those who want to paint a happy face on the recent Washington Insurance Commissioner (OIC) disapproval of large group health plans for several associations/trusts insured through Moda, let’s sort through the options in the “No Spin Zone.”

  1. Moda can demand a hearing contesting the disapproval of its filings as noted by the OIC Deputy Commissioner for Legal Affairs.
  2. Moda can sue the Insurance Commissioner contesting the agency’s interpretation of law.
  3. Moda can offer association member employers any OIC approved ACA metal plan, e.g., silver community rated small group plan.
  4. Moda can start over and file new plans for associations and try to reconfigure associations to satisfy OIC criteria for treatment as a large group, bona fide association plan.
  5. Moda can request a letter from the Department of Labor that the Commissioner is wrong and the associations really are bona fide.

Here’s what won’t happen until Moda successfully sues the Insurance Commissioner:

  1. Moda cannot sell disapproved health plans.
  2. Moda cannot advise association members that the association is bona fide without also advising that the OIC has disagreed with this classification – the pesky truth in advertising thing.
  3. Moda cannot underwrite association member small employers in a manner that differs from the ACA community rating standards.
  4. Moda must transition association member employers to ACA compliant plans as directed by the OIC unless the OIC is overruled by a higher power.

What does this mean for competing health plans that have been approved by the OIC? Easy.

Insurance producers will offer small employers losing their large group association plan coverage an alternative that does not depend upon successful litigation.

Since this is NFL playoff season, I’ll reduce this article to a football analogy – none of my employer clients want to buy a health plan dependent on a “future draft pick.” They want a winning team now.

For those who want to pore over the meaning of the OIC action and the minutiae of the disapprovals, here’s the list of plans filed by Moda since February 2014 on behalf of associations/trusts. I have highlighted the date of filing, the association and the disapproval action.

Happy reading and go Seahawks.