Health Insurance in Colorado

Health Insurance in Colorado
An affordable health insurance policy is a universal necessity, especially if you are the sole earning member of a family. Health insurance from a private insurer can be expensive. You need to assess your finances and the potential risks associated with your family’s health. Approximately 47 million Americans do not have a proper health insurance in place. Majority of these uninsured people are the working families, who are exposed to the risk of crushing medical bills. Those families who are not covered by their employer’s group coverage can avail their state-sponsored low-cost health insurance programs.

Colorado is the 19th healthiest state to live in, according to the America’s Health 2008 Rankings. However, the state has not shown any kind of improvement, as it held the 16th position for two consecutive years of 2006 and 2007. Colorado’s health care system is rather strong, but, the state lawmakers needs to focus on increasing public funding and providing better health care access to the uninsured population. The state of Colorado, having the population of more than four million residents, offers both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Colorado who meet specific eligibility requirements.

The Colorado Division of Insurance Alaska Insurance Department regulates all types of insurance sold in the state including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 16.9% of the population remains uninsured, which is the top priority for the Colorado government. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 38.3% of Colorado residents under the above 200% FPL category continue to live in the state without any kind of health insurance.

Health insurance is an inevitable option; therefore, your best interests remain in taking professional help from a licensed health insurance agent/broker to avail the benefits of appropriate health insurance coverage.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Colorado. These regulations apply to all insurance companies offering individual or family health insurance in Colorado:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
12 months
Look Back Standard
Objective
Mandatory Benefits
Cancer screening for women including breast cancer screening, direct access to OB/GYNs, depression parity
Market Rate Restrictions
NA
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Colorado. These regulations apply to all insurance companies offering small group health insurance in Colorado:

Small Group Size
1-50
Employee Qualifications
Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage
Owner can count as an employee
Guaranteed Issue
Yes
Premium Rating Factors
Adjusted Community Rating
Rate Adjustment Factors
+10% or -25%
Look-Back Period
6 months
Pre-existing condition exclusionary period
6 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Colorado. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Yes
Eligible Group Sizes
2-19 employees
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
18 months
Maximum Premium Increase
100%
State Legislation Reference
Colorado Revised Statutes 10-16-108
Additional Notes
Individuals or their dependents must have 6 months of continuous coverage under the group policy to be eligible and have 30 days from termination date to accept coverage under Colorado continuation laws.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Colorado to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Colorado is summarized in the chart below:

Plan Name
Cover Colorado
Website
https://connectforhealthco.com/
Phone Number
877-461-3811
HIPPA Eligibility Required?
Yes
Available Carriers
PacifiCare
Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Open
Premium Limits
No more than 150% of standard rates
Lifetime Maximum Benefit
1 million
Special Notes
Eligible individuals should :-
Be a resident of Colorado for previous six months
Denied coverage due to a medical condition
Offered coverage at a much higher rate than CoverColorado
Have involuntary loss of health insurance
Have one of the specific conditions listed on the Cover Colorado application.
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Colorado provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Child Health Plan Plus (5CHP+)
Website
https://www.colorado.gov/hcpf/child-health-plan-plus
Phone Number
(5800) 359-1991
Apply Online
Yes
Age Limits
Children age 18 and younger and pregnant women age 19 and over
Insurance Carrier
Colorado Access, Denver Health Medical Plan, Rocky Mountain, Kaiser Permanente
Length of Coverage
12 months
Residency Requirements
Colorado residents, Permanent legal residents who have had an Alien Registration number for at least 5 years, a refugee or asylee
Other Eligibility Requirements
Applicants not eligible for Medicaid.
Applicants who do not have other health insurance
Pre-Existing Condition Exclusions
None
Cost
Annual enrollment fee is $25 for one child, $35 for 2+children. Co pays are $2 – $15 per visit for routine medical care
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Colorado:

Governing Agency
Colorado Medicaid
Website
https://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197364086675
Phone Number
303-866-2993
Federal Poverty Line Income Limits
Pregnant women and children under the age of 6 income at or below 133% of the FPL
Children age 6-18 income at or below 100% of the FPL
Parents income at or below 60% of the FPL
SSI Disabled income at or below 74% of the FPL
Additional Resources

Colorado Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Colorado’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Colorado: At-A-Glance
Provides exclusive health data of Arkansas. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, provides free, up-to-date, and easy-to-use health data on all 50 states.