CoOportunity Health

What CoOportunity Health does

CoOportunity Health is a Consumer Operated and Oriented Plan (CO-OP) health insurer established under the Affordable Care Act and domiciled in West Des Moines, Iowa, operating across Iowa and Nebraska. The carrier sells individual and family Qualified Health Plans through the federal HealthCare.gov Marketplace and supplements that direct marketplace channel with an inside-sales enrollment hotline, an appointed broker/agent network spanning 13 Managing General Agencies in Iowa and 10 in Nebraska, and a Navigator/Certified Application Counselor assisters program. It segments customers horizontally into individual and family plans (primary segment, with income-based subsidy eligibility), small employer groups of 1-50, mid-market employer groups of 51-100, and large employer groups of 101+ served through both fully insured and self-funded arrangements. Plan portfolio includes CoOportunity Premier and Premier HSA PPO plans plus the Choice UI Health Alliance and Preferred UI Health Alliance tiered-network products, with metal-level options from Catastrophic through Platinum.

The technology stack is largely assembled through partnerships rather than built in-house. HealthPartners Administrators, Inc. provides claims processing, medical management, and broader administrative services, and the HealthPartners Medical Directors Committee (which includes CoOportunity's Medical Director) runs the technology and coverage-policy review process. Provider access is delivered through the Midlands Choice Premier PPO network (33,500+ physicians, 339 hospitals, 1,700 facilities across Iowa, Nebraska, and bordering states) plus PHCS and MultiPlan networks for national out-of-area in-network access. Member-facing tools include the eTools secure portal, an online Provider Network Directory, a searchable drug formulary, CareLine 24/7 nurse advice, myMailRx mail-order pharmacy, CareCheck prior authorization, and the Healthy Rewards program ($100 gift card for an annual physical plus fitness and retail discounts); the most differentiated feature is the Three-for-Free benefit, which delivers three free office visits per family member per plan year on Silver, Gold, and Platinum non-HSA plans.

The revenue model is a subscription recurring premium structure: premium payments from individuals, families, and employer groups, with amounts varying by metal level, coverage type, age, and household income and eligibility for federal premium tax credits through the Marketplace. Indirect monetization surfaces include pharmacy benefit management via MediImpact and ASO administrative fees on self-funded large-group arrangements. As a CO-OP, governance is member-elected and surpluses are retained for member benefit rather than distributed to shareholders; no equity investors, parent company, or disclosed funding round appear in the source. Operational quality is underwritten by an NCQA Interim Health Plan Evaluation. Source content reflects 2014-2015 active open-enrollment operations; the company held an "operating" status within that window with no disclosure of subsequent trajectory in the supplied data.

Name

CoOportunity Health

Legal name

CoOportunity Health

Website

https://cooportunityhealth.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

11–50 employees

Short description

CoOportunity Health is a Consumer Operated and Oriented Plan (CO-OP) nonprofit health insurer offering individual, family, and employer group plans in Iowa and Nebraska, distributed through the HealthCare.gov Marketplace, broker/agent networks, and Navigator assisters.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

CO-OP / Nonprofit Individual Market Plans (HLAEABAH)

akta.pro secondary industries

Fully Insured Group Health Plans (Employer-Sponsored) (FSAIAFAA), Managed Care / Network-Based Group Health Plans (Carrier Network Products) (FSAIAFAO), Catastrophic Plans (Under-30/Hardship) (HLAEABAC)

Keywords

• Health insurance plans
• Individual family coverage
• Employer group insurance
• Consumer operated plan
• Marketplace qualified plans

Headquarters

HQ city

Minneapolis

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Supply Chain

Revenue model

1. Health Insurance Premiums: CoOportunity Health generates revenue through premium payments from individuals, families, and employer groups enrolled in their health insurance plans. Premium amounts vary based on plan level (Catastrophic, Bronze, Silver, Gold), coverage type, and member demographics.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

CoOportunity Health sells ACA-qualified individual, family, and employer-group health insurance plans in Iowa and Nebraska, structured as Premier, Premier HSA, Choice UI Health Alliance, and Preferred UI Health Alliance product lines across Catastrophic, Bronze, Silver, Gold, and Platinum metal tiers. Plans are administered through HealthPartners Administrators and delivered via the Midlands Choice Premier network and PHCS/MultiPlan national networks, with member tools including the eTools portal, Three-for-Free office visits, Healthy Rewards, myMailRx, CareLine, CareCheck, and the Provider Network Directory.

Product overview

CoOportunity Health is a health insurance CO-OP (Consumer Operated and Oriented Plan) offering individual, family, and employer group health insurance plans in Iowa and Nebraska. The company operates as a Qualified Health Plan on the Health Insurance Marketplace, with a multi-tier product architecture spanning Premier, Choice UI Health Alliance, and Preferred UI Health Alliance product lines. Plan levels include Catastrophic, Bronze, Silver, and Gold tiers. The product portfolio includes Core PPO plans (Premier, Premier HSA) and UI Health Alliance network plans, complemented by member benefits and tools including Three-for-Free office visits, myMailRx mail order pharmacy, CareLine 24/7 nurse advice, Healthy Rewards program, CareCheck prior authorization, and provider directory search. The company also offers small group (1-50), mid-market (51-100), and large employer (101+) group plans. Plans are administered in partnership with HealthPartners Administrators and utilize PHCS and MultiPlan national provider networks.

Differentiator

Problem solved

Functional benefit

Products and services

• CoOportunity Premier PPO plan design offering broad provider choice and savings for in-network providers. A Qualified Health Plan covering the 10 essential health benefits, utilizing the Midlands Choice Premier network with over 33,500 physicians, 339 hospitals, and 1,700 other healthcare facilities in Iowa, Nebraska and bordering states. Available to individuals and families in Iowa and Nebraska.
• CoOportunity Premier HSA Qualified high-deductible health plan providing broad provider choice and tax savings through health savings account eligibility. Includes free preventive care when using in-network providers and a $10 copay for generics after the deductible is met.
• CoOportunity Preferred UI Health Alliance Health insurance plan design with in-network provider requirements utilizing the UI Health Alliance tiered network for member coverage.
• Small Group 1-50 Plans Health insurance plans for small employer groups with 1-50 employees, available in Silver, Gold and Platinum levels with CoOportunity Premier and UI Health Alliance options.
• Mid-Market Employer Groups 51-100 Plans Health insurance plans for mid-market employer groups with 51-100 employees, available as an optional product feature including the Three-for-Free benefit.
• Large Employer Groups 101+ Plans Fully insured and self-funded health insurance plans for large employer groups with 101+ employees.
• CoOportunity Choice UI Health Alliance Health insurance plan using Tier 1 providers in the UI Health Alliance network for member coverage.

Quantifiable outcome

• 90% of Marketplace members saved on health insurance in 2014 with premium tax credits
• +1 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature2 records

Partnerships

Five partnerships are on record, tiered core.

• HealthPartners Administrators, Inc.coreTechnology or IntegrationCoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services. The HealthPartners Medical Directors Committee, including CoOportunity Health's Medical Director, follows a formal process to analyze new technologies and coverage decisions.
• Midlands Choice Premier NetworkcoreTechnology or IntegrationPPO network providing access to 33,500+ physicians and healthcare professionals, 339 hospitals, and 1,700 other healthcare facilities in Iowa, Nebraska and bordering states for CoOportunity Health Premier plan members.
• PHCS Network and MultiPlan NetworkcoreTechnology or IntegrationNational provider networks used for members traveling or working outside CoOportunity Health's primary service areas, allowing access to in-network providers nationally.
• Iowa Managing General AgenciescoreChannel Partner/ Reseller/ Distributor13 contracted General Agencies in Iowa including Arthur J. Gallagher & Co., Bearance Management Group, Benefit Solutions, Bernie Lowe & Associates, Frank Berlin & Associates, Group Benefits, Holmes Murphy & Associates, KHI Financial Solutions, LaMair-Mulock-Condon, MutualMed, PDCM Insurance, Reynolds & Reynolds, and TrueNorth.
• Nebraska Managing General AgenciescoreChannel Partner/ Reseller/ Distributor10 contracted General Agencies in Nebraska including Benefit Professionals, Boler Wood & Associates, ComPro, Gallagher Grace Mayer, INSPRO, Lincoln Financial Management, Midlands Financial Benefits, OCI Insurance, Preferred Marketing Associates, SilverStone Group, and The Harry A. Koch Co.

Scale indicators3 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Oscar Health: ACA Marketplace-focused individual health insurer with technology-led member experience and concentration in individual market. Comparable as a non-incumbent carrier that built its business around the Health Insurance Marketplace with differentiated consumer benefits.
• Medica: Regional health insurer serving the upper Midwest including Iowa and Nebraska. Comparable as a nonprofit/mutual-style carrier offering ACA Marketplace plans and employer group coverage in the same geographies, competing head-to-head on HealthCare.gov.
• Sanford Health Plan: Provider-affiliated regional health plan in the upper Midwest offering individual, family, and employer plans. Comparable as a regional carrier with integrated provider relationships and Marketplace presence in adjacent Midwestern states.
• Wellmark Blue Cross and Blue Shield: Dominant health insurer in Iowa and South Dakota with significant Nebraska presence. Directly comparable as a regional carrier selling individual, family, and group health plans in the same two-state footprint where CoOportunity competes, with the same provider networks and Marketplace participation.
• Blue Cross and Blue Shield of Nebraska: Dominant Nebraska health insurer offering individual, family, and group plans. Directly comparable as the incumbent carrier competing against CoOportunity in the Nebraska Marketplace with similar product tiers and employer offerings.
• Health Alliance Midwest: Midwest-focused health plan offering individual and group coverage in Iowa and surrounding states. Comparable product portfolio (ACA Marketplace, group plans) and similar regional concentration to CoOportunity.

Broad incumbents

• UnitedHealthcare: Largest U.S. health insurer with broad individual, group, and Medicare offerings across all 50 states including Iowa and Nebraska. Competes with CoOportunity in the same Marketplace and group segments but with vastly greater scale, broader provider networks, and national brand.
• Humana: Major national health insurer with significant individual Marketplace and group presence. Overlaps with CoOportunity in the ACA Marketplace and employer segments but operates at national scale with diversified product portfolio beyond medical insurance.
• Molina Healthcare: Government-program-focused managed care company with Marketplace and Medicaid presence. Comparable as a carrier with significant Marketplace and government-program mix, though heavier tilt to Medicaid than CoOportunity.
• Aetna (CVS Health): National health insurer offering individual, family, and group plans with deep pharmacy integration through CVS. Competes with CoOportunity on Marketplace and employer coverage with broader capabilities and parent-company scale.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xtwitter.com/CoOportunity
• YouTubeyoutube.com/user/CoOportunityHealth
• Facebookfacebook.com/cooportunityhealth
• LinkedInlinkedin.com/company/cooportunity-health
• Pinterestpinterest.com/cooportunity

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about CoOportunity Health