Colorado Health Insurance (CO)

Colorado (CO)
Individual Health InsuranceRegulations

Learn more about Colorado Individual Health Insurance

When it comes to insurance, health insurance has always precededother types of insurance. As an earning member of your family, itbecomes your prerogative to protect your family against sickness orinjuries. An appropriate health insurance can save you from huge medicalbills and promise well-being of your family's health. It is advisable toassess your budget and family's health care needs, before purchasinghealth coverage. If you live in Colorado, you can choose from variousoptions of health insurance. The Colorado Division of Insurance controlsthe regulations under which the Alaska health insurers can sell privatehealth insurance to individuals and families.

Colorado does not require its individual health insurancepolicies to be guaranteed issue, which means that the insurancecompanies can medically underwrite any application for insurance anddecline the application for pre-existing medical conditions or pasthealth history. All individual policies and the cost of owning it willvary according to the specific design plan marketed by each healthinsurance carriers. Colorado does, however, require all health plans tooffer coverage of certain benefits which include, but are not limitedto, mammograms, prostate cancer screening, vaccinations and diabetestreatment. There is a 12 month exclusionary period allowable forpre-existing conditions with a 12 month look-back clause. During theapplication process, the health insurance company may deny coveragebased on the health information provided in your health insuranceapplication; offer to provide health insurance with certain limitationson pre-existing health conditions; or approve your application for fullcoverage as submitted. Premium rates will vary depending upon the age ofthe applicant, gender, health status and geographical area. If yourapplication is accepted, the insurance policy is required to recognizecreditable coverage from a prior health insurance policy and apply thisto the 12 month pre-existing exclusionary period, as long as there is nowaiver written into the policy that address that specific pre-existingmedical condition. If you get declined for an individual policy due tomedical conditions, and do not qualify for a group policy, Coloradoprovides medical coverage through its CoverColorado plan.

Colorado (CO)

In Colorado, a small employer group is defined as any companywith 1-50 employees. Insurance companies offering a small group productare required to provide guaranteed issue to its members, that is acceptany qualified group for coverage, regardless of the health status of anyemployee participating in that group. Upon commencement of youremployment, your employer may impose a waiting period upon you beforeyou become eligible to join the employer sponsored health insuranceplan. Once you have been determined eligible to join the plan, issuanceof health insurance coverage is guaranteed and may not be denied oraltered in any way due to your health status. Furthermore, your grouphealth insurance can never be cancelled, even if you become ill and youremployer cannot raise your premiums because of your medical condition.If you have gone without continuous health insurance coverage at anytimewithin the previous six months, a waiting period for coverage ofpre-existing conditions may apply. Typically, for a group health plan,the look-back period for pre-existing conditions is 6 months and theexclusionary period for those medical conditions is 6 months. Healthinsurance premiums are determined by the health status, age, healthhistory, smoking habits of the applicants. Rates may range between +10%or -25% of the insurance company's index rate.

Some HMO companies in Colorado may require a waiting period, alsoreferred to as an HMO affiliation period. The applicant will not be ableto acquire coverage during the HMO affiliation or waiting period norshould they incur any premium charges during this time. The HMOaffiliation or waiting period should never exceed 2 months, except incases of late enrollment.

Colorado COBRA and Continuation Coverage

Any employer with more than 20 employees must abide by federalCOBRA regulations that require the employer to provide the option to adeparting employee to remain on the group health plan for a minimum of18 months. In special cases, some persons may be entitled to 36 monthsof continued COBRA coverage under federal law. Under COBRA you areentitled to the same benefits that you had under your employer's groupplan and the benefits might include drug, dental, and vision care. Thecosts for COBRA coverage range from 102% to 150% of group health rates.The COBRA recipient is responsible for paying the insurance premiumsthat the employer was paying for the coverage along with 2%administrative costs. The COBRA participant has 60 days from the date ofthe employment termination notice or the loss of coverage (whichever islater) to choose COBRA coverage. If the health insurer raises thepremium on your employer's group plan, you will also be subject to thosehigher rates. Conversion may be available at the conclusion of COBRAcontinuation coverage and you can get health coverage through basichealth plan or the high risk pool of CoverColorado.

Colorado mini-COBRA regulations impose these same restrictions onsmall employers of less than 20 employees. Individuals or theirdependents must have 6 months of continuous coverage under the grouppolicy to be eligible and have 30 days from termination date to acceptcoverage under Colorado continuation laws.

For those persons who have exhausted their COBRA benefits,guaranteed issue coverage under federal HIPAA regulations is available through the state's high risk pool, CoverColorado. More information andlinks to this program are located in the additional resources sectionbelow.

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