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Colorado Risk Pool – Health Insurance Provided to the Uninsurable

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FAQ

Acronym or name of the risk pool: CoverColorado.

Regulation establishing risk pool: Colorado Department of Regulatory Agencies. House Bill 01-1319.

Funding: The senate bill 04-211 changed the funding process for CoverColorado. It is now partially funded by the Unclaimed Property Trust Fund. It now directs extra funds to the high risk health insurance programme and lessened the amount paid by the insurance carriers.

Plans offered: The plan is administered by the PacifiCare Health Plan Administrators. A traditional medical insurance plan exists with 6 deductible options. These vary from $1000 to $10000. There is an HDHP plan available for a deductible of $2000.

Plan benefit: After paying for your selected plan deductible, the CoverColorado will pay for 80% of the cost of covered medical expenses done within the network. 60% of the expenses conducted out of network are paid by the plan. There are certain limits applicable for benefits available to a person from the plan both for in network and out of network facilities.

CoverColorado Brochure: http://www.covercolorado.org/documents/PPO%20PLAN%20BENEFITS.doc

Maximum benefit limits: The maximum lifetime benefit payable under the CoverColorado plans is $1000000. Some of the covered benefits available under the plan are restricted under annual maximum benefits.

Eligibility: (1) The applicant has to be a resident of Colorado for a minimum of 6 months. He needs to be a US citizen or a person with legal alien status. (2) The person must have applied for insurance to a carrier and been declined for health reasons. (3) He must have been approved for health insurance but premiums were higher than the minimum offered by CoverColorado.

Enrollment periods: Applications may be submitted at any time. Coverage is made available the first day of the following month. The deductible applicable may be changed at any time and it becomes effective the first of the following year.

Premium payments: The premiums you pay are dependent on your gender, county, age and whether you are a smoker. The premiums are also dependant on your deductibles and as your deductibles increase, the monthly premiums go down.

Premium calculations: The board decides on the monthly premiums and it is usually restricted to a percentage of the standard risk rate. This refers to other benefits that people in Colorado can obtain from private health insurance providers. The rate cannot exceed 125% of the standard risk rate.

Pre existing condition waiting period: The first 6 months following enrollment do not provide benefits for pre existing conditions. This clause is waived if the applicant can provide coverage of continuous coverage that terminated within 90 days preceding the enrollment.

Contact information: CoverColorado. 425 S. Cherry St., Suite 160.Glendale, CO 80246. Phone: 877-461-3811. CoverColorado.

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