Colorado Health Insurance Guide
Colorado Health Insurance Information, Health Organizations and Resources and access to online health insurance Quotes
As a Colorado resident you can choose from many health insurance plans for individuals and groups provided by private insurance carriers, as well as Colorado State-funded affordable health insurance for eligible individuals and families, and federal programs such as Medicaid and COBRA.
Colorado is not a guarantee issue state. That means private insurance companies are not required to sell health insurance to individuals who do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose a 12-month exclusionary period for any pre-existing conditions, which includes a 12-month look-back discovery period. Colorado is a guaranteed renewal. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area.
If your Colorado health insurance is provided through your employer’s group plan, your coverage cannot be denied, limited or subject to higher premiums because of your health.
Colorado Mandated Health Benefits
Colorado laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism treatment
- Autism
- Birth centers/midwives
- Cervical cancer/HPV screening and vaccination
- Cleft palate
- Dental anesthesia
- Diabetic supplies and self management
- Early intervention services
- Emergency services
- Home health care
- Hospice care
- Mammography
- Maternity and maternity stay
- General mental health
- Orthotics/prosthetics
- PKU/formula
- Prostate cancer screening
- Well child care
- Coverage for newborn under parent's policy
- Coverage for adopted and non-custodial children under parent's policy
- Coverage for continuation and handicapped dependents under parent's policy
- Coverage for dependent students under their parent’s policy
- Coverage for domestic partners
Types Health Insurance Plans Available in Colorado
The following major medical health insurance plans are generally available in Colorado. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Colorado
CoverColorado - In compliance with regulations, Colorado guarantees acceptance into ColoradoCover, the state's high-risk health insurance pool, for HIPPA eligible consumers who are turned down by private insurers.
Child Health Plan Plus – CHP+ offers free or reduced price health coverage for resident children 18 or younger and to pregnant women 19 and older whose families earn goo much to qualify for Medicaid but who cannot afford private insurance. The program is open to citizens and to registered aliens who have lived in the state at least 5 years. Coverage begins the day your application and other required documents are received, although a child must wait 3 months from the termination date of any group health insurance plan if the employer paid 50% or more of the premium. Covered services include well-child check-ups, immunization, office visits, hospitalization, prescription drugs, lab and x-rays, dental care, eye glasses and hearing aids. Plans depend on the county you live in, and you must choose from an HMO or Colorado’s managed care network. Premiums are based on household income and size of family. An annual enrollment fee and modest co-pays may also be required.
Women’s Wellness Connection - WWC provides free breast and cervical cancer screening for qualified women. If cancer is diagnosed through WWC, women may be eligible for medical care through Colorado’s Medicaid program.
Regulatory Agency
The Colorado Division of Insurance regulates the sales of private health insurance to individuals and families.
Get access to Colorado health insurance quotes from http://www.einsurance.com/health-insurance/.
Department of Regulatory Agencies (DORA)
1560 Braodway, Suite 850
Denver, CO 80202
(303) 894-7499 – Phone
(303) 894-7455 – Fax
http://www.dora.state.co.us/insurance/contact.htm
CoverColorado
Quote page (they do not do quotes over the phone)
https://www.covercolorado.org/default.asp?contentID=677
Enrollment Office (303) 863-1960
Main Page
https://www.covercolorado.org/default.asp
Child Health Plan Plus (CHP+)
PO Box 929
Denver, CO 80201
(800) 359-1991
http://www.cchp.org/
Women’s Wellness Connection (WWC)
4300 Cherry Creek Drive South, PSD-WWC-A-5
Denver, CO 80246-1530
http://www.cdphe.state.co.us/pp/cwcci/index.html and
http://www.womenswellnessconnection.org/
(303) 692-2581 – Phone
(303) 691-7900 – Fax
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/