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Introducing CoOportunity Health

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CoOportunity Health is Iowa and Nebraska’s first and only not-for-profit CO-OP, a Consumer Operated and Oriented Plan, offering health insurance to individuals and employers. Founded in 2012, CoOportunity Health is one of 24 organizations across the United States with the purpose of providing new competitive options for individuals, families and employer groups.

As a CO-OP, members of the health plan govern the organization, elect its board of directors, and are involved actively in the Plan’s programs. CoOportunity Health retains no profits; any financial gains must be returned to members in the form of lower premiums or enhanced benefits.

Founded by experienced professionals with backgrounds in healthcare, insurance regulation, health plan administration and management, CoOportunity Health has formed strategic business alliances with best-in-class provider and administrative services partners, Midlands Choice and HealthPartners, to deliver an exceptional member, employer group and provider experience.

CoOportunity Health Products

CoOportunity Health offers health insurance plan solutions for individuals, small businesses and large employers (fully insured or self-funded options). CoOportunity participates on the new Health Insurance Marketplace/Exchange and the SHOP Exchange (for small businesses) in Iowa and Nebraska, and on the open market.

CoOportunity Health’s portfolio of plans in Iowa and Nebraska includes CoOportunity Premier, a PPO plan design with Midlands Choice broad network of providers that includes 100 percent of hospitals and 97 percent of practitioners in Iowa and Nebraska as well as providers in bordering states. CoOportunity Health also has teamed up with University of Iowa Health Alliance member organizations plus other select providers to introduce two unique plans in Iowa. CoOportunity Choice UI Health Alliance is a tiered-benefit design plan that provides consumer savings when the Choice Tier 1 provider network is used for services. CoOportunity Preferred UI Health Alliance is a select network plan that offers significant cost savings in exchange for obtaining services from an exclusive provider panel.

CoOportunity Health is excited to collaborate with providers to offer a new health insurance solution that will meet the needs of the changing health insurance landscape. It is their goal to bring you new patients who may have been uninsured or underinsured in the past as well as more comprehensive and affordable plans to your existing patients.  Their plan features include the following attributes:

  • Covers the 10 essential health benefits
  • No out-of-pocket costs for preventive services
  • Rewards for healthy living (when patient receives a physical exam and completes the online Health Assessment, they receive a $100 gift card)
  • Limits on cost sharing and deductibles
  • No lifetime dollar limits on essential health benefits
  • Tobacco surcharge
  • No denials of coverage because of pre-existing conditions
  • No medical underwriting or riders

Beginning January 1, 2014, CoOportunity Health will be participating in the Iowa Marketplace Choice Plan (IMCP aka Medicaid Expansion). This plan provides commercial health insurance coverage to individuals that fall between 100 to 138 percent of the Federal Poverty Level. Providers treating IMCP patients covered by CoOportunity Health will now be reimbursed at commercial rates for the services provided to these patients, another important benefit of participating with CoOportunity Health. This does not apply to providers in the state of Nebraska. Nebraska is not participating in a Medicaid Expansion program.

Communications about CoOportunity Health

CoOportunity Health is gearing up to start communicating with providers about their organization and how to do business with them. Beginning in September, providers will receive email provider alerts about CoOportunity Health. Providers will continue to receive a steady stream of communications as they prepare for a January 1, 2014 start date for their products.  Look for information about:

  • Electronic claims processing (EDI) and claims flow
  • Plan identification cards
  • Policies and procedures
  • Website eTools
  • Education programs and webinars

If you have additional members of your team who would like to receive this information, please encourage them to sign up for the Midlands Choice Provider e-Newsletter.

Provider Website Coming Soon

Be sure to check out the CoOportunity Health website, CoOportunityhealth.com. EDI clearinghouse information will be available on the website by September 1. In addition, you’ll be able to become a registered user starting in mid-December.

Detailed product information will be available on October 1 when CoOportunity Health can start enrolling for a January 1, 2014 effective date. The provider directory, drug formulary and pharmacy directory will also be available on October 1.