CoverColorado

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Colorado has a high-risk pool program, called CoverColorado that offers insurance for people with health conditions who are unable to buy private health insurance coverage and for people who are HIPAA eligible. CoverColorado is also considered a qualified health plan for individuals eligible for the health coverage tax credit (HCTC). (see Financial Assistance)

When can I get coverage from CoverColorado?

· If you are HIPAA eligible, you can purchase an individual health insurance policy from CoverColorado.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible in Colorado, you are guaranteed the right to buy an individual health insurance from CoverColorado and are exempted from pre-existing condition exclusion periods. To be HIPAA eligible, you must meet all of the following:

· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan. (Note that in Colorado, coverage under student health insurance is considered group coverage.)

· You also must have used up any COBRA or state continuation coverage for which you were eligible.

· You must not be eligible for Medicare, Medicaid or a group health plan.

· You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)

· You must apply for CoverColorado within 90 days of losing your prior coverage. (In other states, you must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.)

HIPAA eligibility ends when you enroll in CoverColorado or an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

· If you are eligible for the HCTC, you can purchase an individual health insurance policy from CoverColorado.

· If you are not HIPAA eligible, you can buy coverage from CoverColorado if you are “uninsurable.” You are considered uninsurable if you: 1) have been turned down for coverage within the past 6 months because of previous medical conditions; 2) have had your health insurance involuntarily terminated within the past 60 days for reasons other than non-payment of a premium; 3) are unable to find private health insurance coverage that is less expensive than CoverColorado health insurance; 4) are uninsured and have a diagnosis of one of several medical conditions including cancer, diabetes, or HIV/AIDS or transferring from a high risk pool in another state.

In addition, to buy coverage from CoverColorado you must be have been a Colorado resident for at least 6 months and not be eligible for Medicare, Medicaid, or any other health insurance coverage. The residency requirement is waived for those transferring from another state’s high risk insurance pool and for HIPAA eligible individuals.

· CoverColorado does not offer family coverage. Each individual member of the family must qualify for coverage independently.

What will CoverColorado cover?

· CoverColorado coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, and limited mental health care services.

· CoverColorado offers you a choice of eight plans, each with a different deductible. All CoverColorado plans have a preferred provider (PPO) network of doctors and hospitals in your area. Generally for most services, depending on the plan, you will be charged between 20% and 30% coinsurance for care from a network provider and 50% coinsurance for care from an out-of-network provider. All plans have a lifetime cap of $1,000,000 on covered benefits.

What about coverage for my pre-existing condition?

· If you are HIPAA eligible or eligible for the Health Coverage Tax Credit (HCTC), you will not have a pre-existing condition exclusion when you enroll in CoverColorado. Elimination riders are not permitted on CoverColorado plans.

· If you are not HIPAA eligible, you may have a pre-existing condition exclusions period. If you have not been insured in the 90 days prior to applying for CoverColorado, expenses related to any pre-existing medical condition will not be covered for the first six months that you are enrolled. In CoverColorado, a pre-existing condition is one for which you actually received a diagnosis, medical advice, or treatment in the 6 months prior to enrollment. CoverColorado can impose a pre-existing condition exclusions on pregnancy.

CoverColorado will credit prior continuous coverage toward your pre-existing condition exclusion if you apply for CoverColorado coverage within 90 days of losing your prior coverage.

What can I be charged for CoverColorado coverage?

· Premiums will vary based on the plan you choose. In addition, CoverColorado charges enrollees different rates based on their age, gender, smoking status, and the geographic area they live in. CoverColorado can charge rates up to 50% higher than premiums charged to healthy people for similar coverage by private health insurers.

For example, the monthly premium for a 24-year-old, non-smoking male in Denver ranges from $71.66 to $180.49, depending on which deductible is selected. By contrast, the monthly premium for a 64-year-old, non-smoking male in Denver ranges from $375.87 to $946.84, depending on the deductible selected.

· A premium discount is available to some lower income enrollees. To be eligible, your income must be less than $50,000 and you must meet an asset test. If you qualify, depending on your income, your CoverColorado premium will be reduced up to 30 percent. Contact CoverColorado for more information.

· If you are eligible for HCTC, you can enroll in MHIP and the federal government will pay 80% of your premium each month. You should call the HCTC customer contact center toll free at (866) 628-4282 Monday through Friday, 7 am to 7 pm central time. The customer contact center can provide you registration material and help you fill them out so you can take advantage of the tax credit. (see Financial Assistance)

How long does CoverColorado coverage last?

· CoverColorado policies are renewable as long as you pay your premiums, continue to reside in Colorado, and meet other eligibility requirements.If you fail to pay the premium or you voluntarily leave the CoverColorado program, you will not be eligible to re-apply until 12 months after the termination date.