Colorado Health Insurance (CO)

Colorado (CO)
Individual Health InsuranceRegulations

Learn more about Colorado Individual Health Insurance

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 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 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 opt for one of the following; 1) deny coverage based on the information provided in your health insurance application, 2) offer to provide health insurance with certain limitations on pre-existing health conditions or 3) approve your application for full coverage as submitted. Premium rates will vary depending upon the age of the applicant 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.

Colorado (CO)
Small Group Health InsuranceRegulations

In Colorado, a small employer group is defined as any company with 1-50 employees. Small group health insurance in Colorado is guaranteed issue for groups of 2-50. Groups of 1 only have access to guaranteed issue coverage once a year during an open enrollment period. One man groups are only eligible for this guaranteed issue basic health plan if they have involuntarily lost other health insurance coverage. 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. 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. 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. Health insurance premiums for small groups in Colorado can be adjusted based on smoking, claims and health history, but may not exceed 10% of the published standard rate.

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

Additional Colorado Resources

• CoverColorado
  Provides information regarding Colorado's High Risk Insurance Pool for those Colorado residents unable to obtain health insurance due to their high risk health status.
• Colorado Child Health Plan Plus
  Provides health insurance coverage to Colorado children under the age 18 and under, as well as pregnant women that meet certain income and eligibility guidelines.
• Colorado Medical Assistance Program
  Provides health insurance coverage to low-income families in Colorado and offers programs that include a breast and cervical cancer program, primary and preventive health care, mental health programs and managed care.
• Colorado Senior Health Insurance Assistance Program
  Non-profit organization sponsored by the Colorado Division of Insurance that provides information and assistance about health insurance for residents of Colorado that are on Medicare.

CO Medical Insurance Statistics

Total Population: 4,641,000
With Health Insurance: 3,853,000 / 83%
Without Health Insurance: 788,000 / 17%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Colorado residents without health insurance has not increased since 2004.

Colorado Division of Insurance
Phone: 800-930-3745
Assists consumers in Colorado with important insurance issues, including complaint resolution and education.

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