Colorado Health Insurance

The Carriers We Work With

More About Group Health Insurance in Colorado...

In the State of Colorado, agents and brokers are required to quote group rates as filed by each Colorado health insurance carrier with the Colorado Division of Insurance.  Independent Brokers, Agents, and Agencies do not set pricing, and they are prohibited from "rebating" clients monetarily or with gifts after the purchase of a policy.  For groups of up to 50 eligible employees, State Law allows insurance carriers to discount quoted rates up to 25% below the quotation based on the current, overall, health status of the group.  (Note:  Effective Jan 1st, 2008, insurance carriers are no longer allowed to add a 10% rate factor above filed rates for unhealthy groups).  Although misleading, some agents or brokers will quote rates at the lowest possible discount (25% less than the filed rates).  Be wary of this practice.  Regardless of the agent or broker you choose, your rates will be determined during the underwriting process and by the insurer's final decision.   Your choice of agent or broker should not be soley based on the rates that are quoted to you, but more importantly, by the quality of the services provided to you, and by the experience and creativity brought before you.. Find out more about how Erickson Financial Services can be of service to your group.  Groups of more than 50 eligible employees are subject to Federal Regulation and are rated differently than "small groups".   All quoted rates are subject to final underwriting review by the insurer.    

Self-Employed

A self-employed person is allowed to buy business group health insurance in Colorado during periods of annual "open enrollment " such as exhaustion of COBRA, an involuntary loss of other coverage, and within 30 days of his or her birthday.  A self-employed person who is not an expectant parent and is currently in excellent health may qualify as "preferred risk", which has the following benefits:

• Preferred Risk is not required to wait for an open enrollment period.
• Preferred Risk may apply for any group health plan available in the State of Colorado. 

For those who would not qualify as preferred risk, there are a couple of limitations:

• Non-Preferred Risk must wait for an open enrollment period such as exhaustion of Cobra, an involuntary loss of other coverage or the period in time within 30-days after the person's birthday.
• Non-Preferred Risk may only apply for one of the Colorado State Mandated Standard or Basic Plans.  Typically, most carriers offer the Standard & Basic PPO plans and some carriers offer the Standard & Basic HMO plans.  Unfortunately, we are unaware of any carriers currently offering the Basic HSA plans.

Unlike individual and family health insurance, which is medically underwritten, "group of one" insurance is "guaranteed issue", meaning that you cannot be turned down for coverage, and you cannot have exclusions for pre-existing conditions provided you have not had a gap in coverage of more than 90 days during the past six months prior to enrollment onto a group policy.  Because it is "guaranteed-issue", "group of one" insurance for a self-employed person and his or her eligible dependents tends to be quite a bit more expensive than individual and family coverage, which is medically underwritten and therefore, less risky to the insurance carrier.  Due to the higher cost of "group of one" coverage, most self-employed individuals will choose to purchase individual or family insurance, unless one or more family members have a pre-existing condition that would otherwise cause them to be declined for or excluded from coverage in the individual and family market.  To request a quote for "group of one" coverage or to find out if you qualify as "preferred risk", click here.   Please make sure to include a cover letter describing your current open enrollment event; ie..you are running out of COBRA, losing other coverage, or within 30 days of your birthday.

As a self-employed individual, you should be aware of the "three year rule".  If you choose to purchase individual and family insurance, which does not cover maternity and may have limitations on self-administered injectible drugs, mental healthcare, skilled nursing facilities, and other categories of coverage that may be more comprehensive in the group market, you MAY not simply be able to switch to the group market whenever you need these services.  To protect carriers against adverse selection, or switching to group coverage only when certain types of coverage such as maternity are needed, the "three year rule" was created.  By contracting with an individual or family policy, you will waive your right to coverage in the "group of one" market for a period of up to three years, depending on the discretion of any group carrier that you choose to apply with during the three years after obtaining individual coverage.

The State of Colorado gives the insurer the discretion to require employers to pay up to 50% of the employee's premium as a condition of enrollment into a group benefit plan.  Employers are not required to pay premiums for employee's dependents.  While most carriers enforce the 50% rule, some carriers will allow employers to pay less than 50% of the employee's premium.  Please contact our office for more information.

Some benefits, such as dental, vision, life, disability, and long-term care can be offered on a  "voluntary" basis, meaning that the employer is not required to contribute to the premium at all.  Oftentimes, it can be difficult to obtain affordable ancillary coverage on an individual basis.  Employers that offer these benefits voluntarily can provide better quality coverage at a more affordable rate for their employees than what their employees would be able to obtain on their own.  Some carriers now offer voluntary dental and vision benefits down to only 2 participants.  Please contact our office for more information.

In order for a group to qualify for enrollment into a group benefit plan, there are certain participation requirements.  Depending on the benefit package, an insurer may require up to 75% of eligible employees to enroll onto the health plan in order to qualify as a group. Those who are waiving coverage because they are already covered under another creditable healthplan are excluded from the requirement to participate.  (Example:  In a group of 10 eligible employees, where 5 employees do not wish to participate because they have other creditable coverage, four of the remaining five (75% or more of the remaining employees) will be required to participate in order for the group to qualify for coverage.)  While most carriers enforce the 75% participation rule, there are a few carriers that offer health benefits with lower participation requirements.  Dental and Vision participation rules will vary.  Please contact our office for more information. 

A person cannot be turned away from group health insurance in the State of Colorado, nor can they be charged more, individually, or be cancelled if they get sick, provided they qualify for group coverage and remain employed.  A new employer may restrict health coverage to an employee for a limited time at the beginning of a new job (this is defined as the waiting period).  With pre-existing conditions (defined as any condition an employee has had symptoms of, treatment for or consultation for within the  six months prior to enrollment), the insurer can exclude coverage for a maximum of six months going forward if and only if the employee has had a gap in coverage of more than 90 days within the 6 months prior to enrolling on to the group healthplan. (Note:  This rule applies to groups of 1-50 only.  Please contact our office to discuss pre-existing condition regulations for large groups, as large group regulations differ from small group.) To avoid having a gap in coverage during a waiting period, new employees may wish to consider short-term insurance coverage. 

In the group market, maternity cannot be considered a pre-existing condition and it can never be exluded from coverage.  Maternity is covered from the moment an employee or dependent of an employee is enrolled on to the group health plan.  Be careful...If you or your spouse waived coverage when originally eligible to enroll onto the group healthplan, you may have to wait until the open enrollment period to enroll, unless a qualifying event has occurred such as an involuntary loss of other coverage or a marriage has occurred.  This wait can be up to a year long.  Open enrollment typically happens during the month the group policy renews. 

Due to the rising cost of health insurance premiums, many employers no longer contribute to the cost of insurance for employee's dependents.  As an alternative to group coverage, and to save on premiums, employees with families may wish to consider a high-deductible individual or family insurance policy for their "healthy" spouse and/or children.  Family members with costly pre-existing conditions may not qualify for an individual policy.  Please contact our office to discuss alternate coverage options for "unhealthy" family members, or click here to learn more about how pre-existing conditions affect the ability to obtain coverage in the individual and family market.