Frequently Asked Questions

The Marion County Circuit Court ordered Zoom Health Plan, Inc. into rehabilitation on April 21, 2017 after finding that the Company was impaired and that further operation of the Company would be hazardous. The Director of the Oregon Department of Consumer and Business Services was appointed as Receiver of Zoom Health Plan, Inc. Zoom Health Plan, Inc. withdrew from the individual and small group insurance markets at the end of 2017. 

 

The receivership does not impact Zoom+ Care, which operates neighborhood clinics throughout the Portland area.

All current individual policies were canceled effective Dec. 31, 2017. Individuals had an opportunity to find a new plan for 2018 when health insurance open enrollment began on Nov. 1, 2017.

Group plans may have expired at different times. Businesses with small group coverage through Zoom Health Plan should call their health insurance agent, and individuals with group coverage should contact their employer with questions.

 

Zoom Health Plan FAQs

I received a Claim Form.  What is it and what do I have to do?

 

ZHP is in receivership and the Court has approved a deadline (Final Bar Date) of July 31, 2018 by which all claims must be filed against the ZHP receivership.  This final bar date applies to both insurance claims and claims for any other financial obligation of ZHP. The Claim Form is required to establish your claim in the receivership if ZHP still owes you money. 

 

Your Claim Form must be properly completed and postmarked no later than July 31, 2018 by 11:59:59 p.m. (Pacific Daylight Time) and mailed to the address on the back of the POC form.   If you are not owed any money by ZHP, you do not have to file the Claim Form.

 

 

What if I already submitted my Claim Form but need to make a change/add additional information?

 

You can send additional information you would like to have considered to the address listed on the back of the Claim Form, Zoom Health Plan, PO Box 40087, Portland, OR 97240.  This information must be postmarked by July 31, 2018.

 

 

If I miss the July 31, 2018 deadline for mailing my Claim Form can I still submit my claim for payment?

 

The court has set a Final Bar Date of July 31, 2018 by which all claims must be filed against the ZHP receivership. If you file a claim after the Final Bar Date, your claim will be a “Late Filed Claim” and will not be considered for payment.  To have your Late Filed Claim considered for payment, you will have to petition the Court to have your claim considered timely filed.

 

 

Where can I find more information about the Court approved Rehabilitation Plan?

 

The court order is posted at http://www.zhporegon.com/court-documents/

 

 

Q&A for Completing the Claim Form

 

 

Is a Claim Form required for each claim or can multiple claims be on one Form?

 

No, a separate Claim Form is not needed for each medical claim.  Providers should attach a detailed itemization of the unpaid claims and submit with one Claim Form.  NOTE:  Do not include the actual medical claims with the form, the medical claims must be submitted via the normal established claim filing procedure. Deadline for submitting claims is July 31, 2018.

 

 

Do I need to submit a W9?

 

If you are a business entity or a self-employed contractor who provided services to ZHP, you must submit a W9. Any payment to you from this Claim Form is contingent upon a current W9 being on file.

 

If you are not a business entity you do not need to submit a W9.

I’m a medical provider who rendered care to a member and have unpaid claims.  Do I use the Claim Form to file my claims?

 

Yes, your Claim Form must be properly completed and postmarked no later than July 31, 2018 by 11:59:59 p.m. (Pacific Daylight Time) and mailed to the address on the back of the Claim Form in order to establish a claim against the receivership.  A detailed itemization of the unpaid claims must be submitted with this form.  Do not include the actual medical claims with this form; the medical claims must be submitted via the normal established claim filing procedure.

 

What qualifies as a detailed itemization of unpaid claims?

 

  1. Copies of the Explanation of Payment (EOP) you have received from ZHP. Indicate the total you believe is owed to you.

 

  1. For claims you have not yet received an EOP from ZHP, provide a list (excel format preferred) indicating the original billed amount, claim # (if known), provider name, policy #, patient name, patient date of birth, date of service & procedure code (CPT).

 

 

What if I have other questions? 

 

For questions not addressed in this FAQ, please send an email to: customersupport@zhporegon.com

In the subject line please indicate “Claim Form”.

 

General Q&A

  • What is receivership?
  • Receivership is a court-ordered proceeding to protect the interests of the policyholders of an insurance company as well as creditors and the general public. When acting as Receiver, the state has increased ability to preserve assets and help ensure policyholder claims and other liabilities are paid.

  • Why did the Court put Zoom Health Plan in receivership?
  • In early April, Zoom Health Plan notified the Division of Financial Regulation that it intended to stop offering health insurance plans at the end of 2017. It is typical for the Division to work closely with insurers if they are winding down operations in order to protect policyholders. After further discussion, the Division and the company came to the agreement that receivership was the best way to wind down the company and make sure policyholders are protected.

  • What if I have other questions?
  • For questions not addressed in this FAQ, please send an email to: customersupport@zhporegon.com

 

Q&A for Zoom Health Plan Members:

  • If I bought insurance through Zoom Health Plan, what will happen to my coverage?
  • The insurance you bought will remain in effect through December 31, 2017. In order to maintain your health insurance coverage you are required to continue to pay your premiums. All individual insurance coverage will expire December 31, 2017.

  • What if I have Zoom coverage through my employer?
  • Group policies may expire at different times. Employees should check with their employer to find out when their plan will change.

  • Can I continue to buy insurance through Zoom Health Plan?
  • No, Zoom Health Plan is no longer selling new or renewal policies. You need to find new health insurance to begin January 1, 2018. Individual open enrollment begins November 1, 2017. You will need to enroll in new coverage by December 15, 2017, to have insurance on January 1, 2018. Businesses should contact their insurance agent to select new insurance coverage.

    Enrollees can, however, add a spouse or dependent to your policy through the end of 2017.

  • How can I enroll in new health insurance for 2018?
  • Open enrollment begins November 1, 2017. You must purchase new coverage by December 15, 2017, to have insurance on January 1, 2018.

    There are many ways to shop for and enroll in new health insurance. You can compare plans and enroll through HealthCare.gov, with the help of an agent, or directly with an insurance company. You also can access HealthCare.gov to see if you qualify for subsidies to help you pay for premiums or other health care costs.

    Businesses with small or large group coverage through Zoom Health Plan should call their insurance agent for help picking new health insurance.

  • Will my claims be paid?
  • Zoom Health Plan has committed to the Division that it intends to pay all claims incurred through December 31, 2017. The Marion County Circuit Court issued a receivership order that allows the Division to act as a Receiver and oversee Zoom Health Plan's business as it winds down and help ensure all claims are paid.

    If you received care from an out-of-network provider you may be balance billed. Balance billing is a term that refers to your provider's ability to bill you for the remaining balance after your insurance pays. If you have questions about balance billing or believe you used an in-network provider and are being balance billed, please contact a Zoom Health Plan representative at (503) 912-9654.

  • Will this change my monthly premium with Zoom Health Plan?
  • No. Premiums will not change through the 2017 plan year. Your premium may change when you purchase new coverage from another company for 2018.

  • Should I keep paying my premium?
  • Yes. You must pay your premium through the end of 2017 to keep your current health insurance.

  • Can I still see my regular doctor and have prescriptions filled at the same pharmacy?
  • Yes. Zoom Health Plan's provider network is not changing. Once you shop for new coverage for 2018, check provider directories for the other companies to ensure your doctors and preferred facilities are members of those networks.

  • Can my doctor refuse to see me because of the situation?
  • No. Contracts between Zoom Health Plan and providers remain in force during the wind-down period.

  • Who can I contact for more information?
  • Contact Zoom Health Plan customer service at (503) 912-9654 or email us at customersupport@zhporegon.com

 

Q&A for Agents:

  • Will I still be paid the commissions owed to me?
  • Yes. Zoom Health Plan has assured the Division that it intends to honor all contractual obligations, including agent contracts, during the wind-down process.

 

Q&A for Providers:

  • Will I be paid for services I have provided?
  • Zoom Health Plan has committed to the Division that it intends to pay all claims incurred through December 31, 2017. The Marion County Circuit Court issued a receivership order that allows it to oversee Zoom Health Plan's business as it winds down and help ensure all claims are paid.

  • Will there be a delay in payments?
  • We do not expect a delay in payments. Zoom and the Division are working closely to ensure a smooth wind-down process with no interruption in services for members or providers.

  • Do we still have to provide care to Zoom Health Plan patients?
  • Yes. Zoom Health Plan has committed to the Division that it intends to pay all claims incurred through December 31, 2017. The Marion County Circuit Court issued a receivership order that allows it to oversee Zoom Health Plan's business as it winds down and help ensure all claims are paid.

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