Colorado (CO)
Individual Health InsuranceRegulations

Learn more about Colorado Individual Health Insurance

When it comes to insurance, health insurance has always preceded other types of insurance. As an earning member of your family, it becomes your prerogative to protect your family against sickness or injuries. An appropriate health insurance can save you from huge medical bills and promise well-being of your family’s health. It is advisable to assess your budget and family’s health care needs, before purchasing health coverage. If you live in Colorado, you can choose from various options of health insurance. The Colorado Division of Insurance controls the regulations under which the Alaska health insurers can sell private health insurance to individuals and families.

Colorado does not require its individual health insurance policies to be guaranteed issue, which means that the insurance companies can medically underwrite any application for insurance and decline the application for pre-existing medical conditions or past health history. All individual policies and the cost of owning it will vary according to the specific design plan marketed by each health insurance carriers. Colorado does, however, require all health plans to offer coverage of certain benefits which include, but are not limited to, mammograms, prostate cancer screening, vaccinations and diabetes treatment. There is a 12 month exclusionary period allowable for pre-existing conditions with a 12 month look-back clause. During the application process, the health insurance company may deny coverage based on the health information provided in your health insurance application; offer to provide health insurance with certain limitations on pre-existing health conditions; or approve your application for full coverage as submitted. Premium rates will vary depending upon the age of the applicant, gender, health status and geographical area. If your application is accepted, the insurance policy is required to recognize creditable coverage from a prior health insurance policy and apply this to the 12 month pre-existing exclusionary period, as long as there is no waiver written into the policy that address that specific pre-existing medical condition. If you get declined for an individual policy due to medical conditions, and do not qualify for a group policy, Colorado provides medical coverage through its CoverColorado plan.

Colorado (CO)
Small Group Health InsuranceRegulations

In Colorado, a small employer group is defined as any company with 1-50 employees. Insurance companies offering a small group product are required to provide guaranteed issue to its members, that is accept any qualified group for coverage, regardless of the health status of any employee participating in that group. Upon commencement of your employment, your employer may impose a waiting period upon you before you become eligible to join the employer sponsored health insurance plan. Once you have been determined eligible to join the plan, issuance of health insurance coverage is guaranteed and may not be denied or altered in any way due to your health status. Furthermore, your group health insurance can never be cancelled, even if you become ill and your employer cannot raise your premiums because of your medical condition. If you have gone without continuous health insurance coverage at anytime within the previous six months, a waiting period for coverage of pre-existing conditions may apply. Typically, for a group health plan, the look-back period for pre-existing conditions is 6 months and the exclusionary period for those medical conditions is 6 months. Health insurance premiums are determined by the health status, age, health history, 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, also referred to as an HMO affiliation period. The applicant will not be able to acquire coverage during the HMO affiliation or waiting period nor should they incur any premium charges during this time. The HMO affiliation or waiting period should never exceed 2 months, except in cases of late enrollment.

Colorado COBRA and Continuation Coverage

Any employer with more than 20 employees must abide by federal COBRA regulations that require the employer to provide the option to a departing employee to remain on the group health plan for a minimum of 18 months. In special cases, some persons may be entitled to 36 months of continued COBRA coverage under federal law. Under COBRA you are entitled to the same benefits that you had under your employer's group plan and the benefits might include drug, dental, and vision care. The costs for COBRA coverage range from 102% to 150% of group health rates. The COBRA recipient is responsible for paying the insurance premiums that the employer was paying for the coverage along with 2% administrative costs. The COBRA participant has 60 days from the date of the employment termination notice or the loss of coverage (whichever is later) to choose COBRA coverage. If the health insurer raises the premium on your employer’s group plan, you will also be subject to those higher rates. Conversion may be available at the conclusion of COBRA continuation coverage and you can get health coverage through basic health plan or the high risk pool of CoverColorado.

Colorado mini-COBRA regulations impose these same restrictions on small employers of less than 20 employees. 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.

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 and links to this program are located in the additional resources section below.