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
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 6 deductible options, ranging from $1,000 to $10,000. An HDHP plan is also available with a $2,000 deductible.
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.
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, 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 high deductible and requests to plans with a lower deductible will not be accepted.
Premium Payments
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.
Premium Calculations
Monthly premiums are determined by looking at the standard risk premiums available for similar plans offered at standard risk to individuals in Colorado. 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. A waiver of this exclusion will be given is the insured member can provide proof of continuous coverage that terminated no more than 90 days prior to enrollment in CoverColorado.
Cover Colorado Contact Information
CoverColorado
425 S. Cherry St., Suite 160
Glendale, CO 80246
Phone: 877-461-3811
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