Your Rights under Colorado Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Colorado Health Insurance:
In Colorado, your access to individual health insurance options is somewhat dependent on your health status. However, once you have health insurance, it cannot be cancelled because you get sick. Most health insurance is guaranteed renewable as long as you pay your premium.
The Colorado Medicaid program offers free health coverage and other assistance for qualifying families, children, pregnant women, elderly, and disabled individuals. The Child Health Plan Plus program offers free or reduced price health coverage for children who do not qualify for Medicaid.
Under Colorado law, newborns, adopted children, and children placed for adoption are automatically covered under the parents’ individual health plan for the first 31 days.
Under Colorado law, your unmarried, disabled child may remain covered under your individual health plan into adulthood.
Colorado does require all health plans to cover certain benefits – such as mammograms, prostate cancer screening, and diabetes treatment.
Some insurance companies sell temporary health insurance policies.
A conversion policy is an individual policy you buy from the company that insured your employer’s group plan. Conversion policies cannot impose a new pre-existing condition exclusion period. However, you may have to satisfy any unfinished portion of any pre-existing condition exclusion period from your former health plan.
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. CoverColorado is also considered a qualified health plan for individuals eligible for health coverage tax credit (HCTC). Colorado Uninsurable Health Insurance Plan at http://www.covercolorado.org. For more help call (800) 672-8447 or (303) 863-1960.
You may also be able to buy insurance from CoverColorado if you have had difficulty obtaining affordable health insurance from private companies because of your health condition.
You can buy coverage from CoverColorado if you are uninsurable. CoverColorado coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, and limited mental health care services. However, CoverColorado does not offer family coverage.
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.
Premiums will vary based on the plan you chose. CoverColorado charges different based on the enrollees age, gender, smoking status, and geographic are they live in.
Eligibility for Medicaid is based on the household income. Medicaid eligible individuals in Colorado include infants, children, pregnant women, and parents if your family income meets the Medicaid income standards.
The Child Health Plan Plus Program offers free or low-cost health insurance for low-income children who are not eligible for Medicaid. When you sign your child up for CHP+, he or she will be enrolled for one year, even if your income changes.
Some women diagnosed with breast or cervical cancer may be eligible for medical care through Medicaid. The Colorado Women’s Cancer Control Initiative (CWCCI), part of the National Breast and Cervical Cancer Early Detection Program, provides women a qualified woman with full healthcare benefits through Medicaid at no cost or for a nominal copayment. Women screened through this program and diagnosed with breast or cervical cancer may be eligible for free health coverage through Medicaid, which extends throughout the duration of treatment. To be eligible for screening through the program, you must be between the ages of 40 and 64 and be a Colorado resident.
The Federal Health Coverage Tax Credit, under which you can either claim the tax credit at the end of the year on your tax return or you can elect to have the money paid directly to your qualified health plan each month by the Internal Revenue Service. To be eligible for the tax credit, you must be receiving Trade Adjustment Assistance benefits, you also must be at least 55 years old.
The Colorado Uninsurable Health Insurance Plan is called CoverColorado. For more information on CoverColorado visit http://www.covercolorado.org or call (800) 672-8447 or try (303) 863-1960.
For more information visit the Colorado Division of Insurance at www.dora.state.co.us/insurance
Group Health Insurance:
Employers are not required provided health benefits for their employees, so if you change jobs, you may find that your new employer does not offer you health coverage.
Group health plans that impose pre-existing condition exclusion periods must give you credit for any previous continuous creditable coverage that you’ve had.
As a small employer, you can be charged more because someone in your group is seriously ill. Premiums can also vary based on the age and family size of covered employees, and where the business is located. You can also be charged more if there are smokers in your group. Insurers can require that a minimum percentage of your eligible employees sign up for coverage.
If you are self-employed and buy your own health insurance, you are eligible to deduct 100% of the cost of your premium from your federal income tax.
If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. If so, you can buy an individual health insurance policy from the state high-risk pool, CoverColorado. However, if you are healthy, you may be able to buy individual health insurance. CoverColorado is generally for people who are considered uninsurable.
If you lose your group health insurance and meet other qualifications, you may be eligible to buy a conversion policy. Two standardized policies, a basic health plan and a standard health plan, must be offered to you.
If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your group health coverage for a limited time.
You must be given a special opportunity to sign up for your group health plan if certain changes happen to your family.
Under Colorado law, an unmarried, disabled child may remain under your fully insured group plan into adulthood.
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