Real people in Maine, answering every call
Where care meets community
In a year where healthcare costs affected all carriers, Members and businesses stayed with Community Health Options, citing our care teams. These clinicians, nurses, pharmacists and claims experts do more than coordinate care — they are personal advocates helping Members navigate some of the most stressful moments of their lives. From helping a rural Member discover that diabetes supplies may be available at no cost, to closing network gaps for Members who couldn't find in-network providers, to connecting cancer patients with lodging and transportation resources for out-of-state treatment, these teams collaborate to remove barriers and find solutions.
Making prescriptions more accessible—and more affordable
The Pharmacy team is saving millions in costs while making it easier for our Members to get the medications they need.
The extra mile is our everyday.
For many Members, the Pharmacy Team becomes the difference between getting—and affording— medication or going without, all while working to constrain rising prescription costs. In 2025, the team expanded its Infusion Site of Care program by increasing Member incentive payments and adding medications. Separately, the team also moved Members from expensive specialty brand-name drugs to biosimilars. These biosimilars offer the same treatments and health outcomes as brand names, but at much lower prices, reducing costs for Members and groups across our health plans.
Day-to-day support defines the team—tracking down out-of-stock medications for a transplant patient, redirecting time-sensitive fertility prescriptions to pharmacies that can fill them, clearing system barriers, and reaching out to let Members with chronic conditions know about the Chronic Illness Support Program, all so they can access their benefits when they need them most.
On the last night of Open Enrollment, after hours, a small business account rep called the pharmacy team. A Member with diabetes couldn't afford both his premiums and the Dexcom monitor he needed for his insulin pump — so he planned to cancel coverage. The team found him a plan with a Chronic Illness Support Program that offered a compatible monitor at no out-of-pocket cost. The pharmacist called, explained the program, and he enrolled just before the deadline.
Virtual care, real results with Firefly
Facing increasingly limited access to local primary care providers, Community Health Options partnered with Firefly Health to offer virtual primary care to Members aged 18 and over. Each participant gets a virtual team—including a doctor, nurse practitioner, behavioral health specialist and health guide—who work together to manage care virtually and provide referrals for in-person care when necessary. For people struggling to find a provider or fitting appointments into a busy schedule, an option like Firefly Health provides convenient and efficient access to primary care anytime, anywhere.
The ongoing impact of
better access
Members cite convenience and responsiveness from Firefly Health providers, as the program continued to grow in 2025, providing important access to primary care.
When a 54-year-old woman moved to Maine, she needed a new PCP for asthma, cholesterol, menopause, and anxiety. Through Firefly Health, prescription refills happen in the app, a rash was resolved over chat, and specialist referrals were coordinated with ease. She came to Firefly first — saving time, reducing care coordination headaches, and potentially saving $80,000 annually on medications by using generics.
Reducing the risk of diabetes
Health happens in communities — and so does change. Our Wellness Grants support Maine nonprofits tackling diabetes prevention through nutrition, fitness and medication access programs that meet people where they are.
| Assets | |
| Bonds | $49,603,856 |
| Cash, cash equivalents, and short-term investments | $5,843,334 |
| Subtotals, cash and invested assets | $55,447,190 |
| Investment income due and accrued | $304,774 |
| Premiums receivable | $1,347,309 |
| Accrued retrospective premiums and contracts subject to redetermination | $2,510,000 |
| Amounts recoverable from reinsurers | $8,656,061 |
| Amounts receivable relating to uninsured plans | $620,754 |
| Healthcare and other amounts receivable | $5,134,112 |
| Total Assets | $74,020,198 |
| Liabilities | |
| Unpaid claims and claims adjustment expenses | $34,985,425 |
| Accrued medical incentive pool & bonus amounts | $862,960 |
| Aggregate health policy reserves | $6,734,418 |
| Premiums received in advance | $3,981,819 |
| General expenses due or accrued | $4,520,232 |
| Ceded reinsurance premiums payable | $694,954 |
| Amounts withheld or retained for the account of others | $3,967 |
| Liability for amounts held in uninsured plans | $136,596 |
| Other Liabilities | $66,895 |
| Total Liabilities | $51,987,266 |
| Capital and Surplus | |
| Surplus notes | $132,316,124 |
| Unassigned deficit | ($110,283,192) |
| Total Capital and Surplus | $22,032,932 |
| Total Liabilities, Capital and Surplus | $74,020,198 |