Colorado Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name
CoverColorado
Insurance Regulation Establishing Risk Pool
Colorado Department of Regulatory Agencies
House Bill 01-1319
CoverColorado
CoverColorado was created by the Colorado Legislature to provide medical insurance for eligible Colorado residents who cannot get coverage from private insurers owing to a pre-existing medical condition. The CoverColorado coverage is also available to the HIPAA-eligible individuals or who are eligible under the Health Coverage Tax Credit federal program.
You may be eligible for CoverColorado if you have had at least 18 months of creditable health coverage without a break in coverage for more than 62 days at any time and your most recent creditable coverage was under a group health plan.
Funding
Senate Bill 04-211 altered the funding process for CoverColorado that now directs additional funds to the high risk health insurance program and reduced the assessment that was paid by the insurance carriers. The program is now partial funded by the Unclaimed Property Trust Fund.
Plans Offered
CoverColorado is administered by PacifiCare Health Plan administrators. There is a traditional medical insurance plan available with eight deductible options, ranging from $1,000 to $10,000 along with a $2,000 deductible HDHP plan. CoverColorado offers two different $2,000 Deductible Plans: (1) the traditional plan and (2) a modified plan that qualifies as a High Deductible Health Plan. The High Deductible Health Plan may be paired with an HSA; therefore, it is also called $2,000 Deductible HSA Plan.
Plan Benefits
After you have met your selected plan deductible, your CoverColorado plan will pay 80% of the cost of most covered medical expenses in-network and 60% of covered medical expenses out-of-network. Maximum benefit limits may apply to certain covered expenses, both in and out-of-network. There are no deductibles for pharmacy and preventive care. For other medical services such as doctor visits, x-ray and lab work, etc., an annual deductible is to be met. A newborn child born to a CoverColorado member be covered automatically until the child is 31 days old.
When you have met your annual out-of-pocket limit on the $2,000 Deductible HSA Plan, whether for outpatient prescription drugs or for other medical expenses, or for a combination of outpatient prescription drugs and other medical expenses, you are not required to make any more copayments. The plan would be responsible for paying 100% of your outpatient prescription drug, medicine and medical supply costs.
Maximum Benefit Limits
The maximum payable lifetime benefits per insured CoverColorado member is $1,000,000. Some covered benefits under the plan are subject to annual maximum benefits.
Eligibility
- Must be a resident of Colorado for at least 6 months prior to applying for coverage, unless you are HIPAA eligible or transferring from another stateâs high risk insurance pool, and a U.S. Citizen or has legal alien status
- You have submitted an application for health insurance to an insurer and been declined due to health reasons
- You have been approved for individual health insurance, but the premium is higher than the CoverColorado premium for the $1,000 deductible plan
- You have been approved for individual health insurance, but the insurance company placed a pre-existing condition exclusionary on your policy for greater than 6 months
- Your previous health insurance was involuntarily terminated by the insurance company for a reason other than failure to pay premium
- You have one of the medical conditions listed under the CoverColorado presumptive list of medical condition
- You are not eligible for other health insurance coverage, including individual health insurance, group health insurance, Medicare, Medicaid or government sponsored health insurance
Enrollment Periods
You may submit an application at anytime. Coverage is effective on the 1st of the day following approval of your application. You may change your deductible once per year and any change will be effective on the 1st of the following year. You may only change to a plan with a higher deductible and requests to plans with a lower deductible will not be accepted.
Premium Payments and Premium Calculations
Premiums are based on your deductible selection, your gender, your county of residence, your gender and whether you are a tobacco user. The premium is directly related to your selected deductible and your premium decreases as the deductible increases. The premiums under CoverColorado cannot exceed 125% of this standard risk rate.
Pre-Existing Condition Waiting Periods
Pre-existing conditions are excluded from benefits for the first six months following date of enrollment. If you have been insured, for at least six continuous months, within 90 days of application to CoverColorado, you will not be subject to the 6-month pre-existing waiting period.
Cover Colorado Contact Information
CoverColorado
425 South Cherry St., Suite 160
Glendale, CO 80246
Phone: 877-461-3811
* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.
