Consumer's Guide to Individual Health Insurance in Colorado

Click For an instant, no-obligation, online Colorado health insurance quote comparison for you or your family!  This tool allows you to compare instant quotes from every leading carrier in the State of Colorado side by side.  (When requesting a quote for child only coverage, the only child or youngest child must be the "applicant")

Shop by Carrier If you already have a health insurance carrier in mind that you would like to look into, click to obtain a quote, look at brochures or apply online now!

Pre-Existing Conditions & Medical Underwriting Unlike group (employer) sponsored health insurance coverage, which is guaranteed-issue, individual and family health insurance is subject to medical underwriting in the State of Colorado.  A person's request for coverage may result in:  an exclusion rider a premium rating, or a decline due to pre-existing conditions.  To qualify for preferred rating, you must be in excellent health and meet required height and weight, cholesterol and blood pressure guidelines.  Certain pre-existing conditions, such as diabetes and most forms of cancer, are uninsurable.  If you have been treated for pre-diabetes, diabetes or any form of cancer other than basal cell skin cancer during the past five years, please do not apply for individual coverage on this website.  NEVER exaggerate your weight or intentionally fail to disclose a pre-existing condition, regardless of whether or not you have been treated or diagnosed for that condition!  If you are even experiencing symptoms of a problem that has not yet been diagnosed, you must disclose that on your application.  (For example; if you have a lump or mass that you would like to be treated for and it has not yet been diagnosed as cancer, you still need to disclose the fact that you have a lump.)  If the insurance carrier investigates a claim after policy inception and discovers fraudulent failure to disclose, they can "rescind coverage", which means that they have the right to refund all of your premiums back to policy inception and cancel the policy as if it never existed, potentially leaving you with a huge liability.  Please understand that each carrier has their own underwriting guidelines, and just because you may have been turned down by one carrier does not necessarily mean you will automatically be turned down by another.  For example, someone may be turned down with a history of Breast Cancer with Blue Cross but be accepted with different carrier, such as Rocky Mountain Health plans.  It all depends on the treatment, severity, and how long ago the illness occurred, in addition to the carrier's own underwriting rules.  If you would like to contact our office for a pre-screening prior to applying, please do not hesitate to call us at 1-800-373-1164 or 719-388-7150.  We are happy to pre-screen anonymously with multiple different carriers in order to obtain likely underwriting outcome in advance of applying for coverage. If you have already been declined for individual coverage AND if you are not eligible for coverage as a self-employed individual, you may qualify for Cover Colorado.  If you are a self-employed individual, please contact our office.  We may be able to assist you. <Back to Top>

Health insurance is protection against the liability of medical costs.  There are many different types of health insurance plans available, ranging from the more expensive, full coverage options to the lower-priced, limited benefit options.  A health insurance policy is a contract between a health insurance carrier and an individual or group of people, in which the insurer agrees to provide specified health insurance coverage for a specified cost (the premium).   Health insurance usually provides direct payment to a provider (a doctor, hospital, lab or pharmacy) for expenses associated with illnesses and injuries. However, on occasion, the policy could provide direct reimbursement to the insured.  The cost and range of protection provided by your health insurance will depend on your insurance provider and the kind of policy you purchase. If your employer does not offer a health insurance plan, you may wish to purchase health insurance on your own.  Furthermore, if your employer does not contribute to the premiums for dependent coverage, an individual or family policy for your family members may provide the coverage you need at a much lower cost. 
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How can I find an affordable health insurance plan?

Your health insurance premium will depend upon the amount of risk that you are willing to take on yourself.  For example, the higher your annual deductible is, the lower your premium will be.  The addition of office visit copays and/or a prescription drug copay card will add to the cost of your monthly premium.  Different people have varying definitions of what is "affordable" to them.  For some, a High Deductible, HSA compatible healthplan may be the answer to lower premiums.  For others, the risk of a high annual deductible may be less appealing.  There are many different plan designs available to meet the varying needs of different people.  Full coverage plan designs will inevitably have higher premiums than "major medical" or "catastrophic" plan designs. 

Our society has taught us, through employer-sponsored health insurance benefits, that the word health insurance should be synonymous with the words "$10 copay".  Insurance costs have spiraled out of control in large part because the users of healthcare have been disconnected from the true cost of their care for so many years.  With good intentions, employers have paid for the bulk of employee's health insurance premiums AND offered them Cadillac health insurance plans with little or no out of pocket responsibility. As a society, we have lost touch with the true purpose of health insurance which is protection against bankruptcy and protection against unforseen future health problems.  We have learned that, through employment, we can have access to low cost Cadillac health insurance, even if we have pre-existing health conditions.  We have also been taught that, even for minor medical expenses, we should only be responsible for a small copay. 

But, what happens to those who do not have access to employer-sponsored health benefits?  For many, the reality of having to pay for his or her own health insurance premiums is a rude awakening.  Some will choose not to purchase health insurance when they can't afford a full coverage health insurance plan, even if they can afford and qualify for an inexpensive catastrophic health insurance plan.  Choosing to go without health insurance at all, even when you can qualify for and afford a high deductible health plan (HDHP) is, at the risk of sounding harsh, an irresponsible decision.  Not only do you put yourself at risk of losing your home or other valuable assets when you choose to go without coverage, but you also put others at risk for having to pay higher health insurance premiums (cost-shifting) in the future if you are unable to pay for a catastrophic claim.  We often read stories in the news about those who lose their homes because they had no health insurance.  This should be a rare occurrence, because inexpensive, high deductible, major medical health plans are available to provide protection against loss of valuable assets.  Although a high deductible plan may not provide much protection against everyday colds, flus, bumps and bruises, you will be protected in a very big way (for example, against the loss of your home or good credit standing) should you be diagnosed with a catastrophic illness, such as cancer, or a serious injury.  Most people are unaware that high deductible health plans also serve as a "discount" plan until the deductible is met, so there is still value in having one, even if you have to pay out-of-pocket for medical expenses below the deductible.  These "network discounts" can be very significant, particulary for diagnostic services. 

Many young people worry about having a high deductible health plan for fear that they might not be able to afford their deductible in the event of an accident or injury.  One way to get inexpensive, first dollar coverage (coverage in front of the plan deductible) for accidents is to combine a high deductible health plan with supplemental accident coverage.  The Humana One Total Plus Rx plans with Supplemental Accident Coverage and the Assurant Health Coremed plans with Secure Solutions option are two ways to do this.  

Another very inexpensive high deductible plan that comes to mind is the Humana One Monogram Plan.  Despite it's high deductible, this plan offers first dollar coverage for preventive care and generic prescription drugs for a very competitive premium.  Even Cover Colorado, Colorado's State guaranteed health insurance plan for the uninsurable offers high deductible plans on a sliding scale for those who can't qualify for coverage in the individual and family market due to pre-existing conditions.   HSA compatible plans are another good option for affordable, catastrophic coverage. 

Colorado health insurance carriers offer a wide variety of plans with many different options to choose from.  For more information, read about the types of plans that Colorado health insurance carriers have to offer.
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What is the Maximum Age Allowed for Applicants?

The maximum age allowed for applicants who wish to apply for an individual health insurance policy in Colorado is going to depend on the health insurance carrier.  Some carriers will allow you to apply only until age 62 1/2, while others will allow you to apply until age 64.  Please contact our office for more information.
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Does Colorado Law Require Insurance Carriers to cover Preventive Care? 

See (10-16-104 - Mandatory Coverage Provisions)

All Colorado healthplans must provide first dollar coverage (coverage not subject to deductible) for preventive services including Child Well Visits and Immunizations from birth through age 13, Mammograms and Prostate Screenings. Colorado healthplans are not required to cover the cost of preventive office visits for people who are over the age of 13, but they must cover, at minimum, Mammograms and Prostate Screenings .  Carriers may balance bill for the cost of the mammogram or prostate screening above and beyond the minimum coverage requirement depending on your healthplan's provisions.  

Does it Cost More if I Buy from an Agent?

A common misperception is that insurance costs more when purchased through an agent or broker.  On the contrary, agents and brokers are obligated to quote rates as filed by each carrier with the Colorado Division of Insurance.  Your rates will be the same whether you purchase your policy directly from the carrier or through an insurance agent or broker.  Agents and brokers exist primarily to offer advice and to help you make the right choices for yourself and/or your family.  Agents and brokers can sometimes be helpful with the negotiation of premium ratings when a pre-existing condition exists.  Lastly, your agent is your liason between the insurance carrier and yourself.  Agents assist with difficult claims issues, billing problems and general questions when they arise, and you may find these services to be extremely valuable.  Find out more about how Erickson Financial Services can be of service to you!
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What if I am Self-Employed?

When Can a Self-Employed Person Enroll onto a "Group of One" Health Plan?
A self-employed person is allowed to buy business group health insurance for themselves and their eligible dependents in the State of 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.  This is called "Group of One" health insurance.  A self-employed person who is not currently an expectant parent and is currently in excellent health may qualify as "preferred risk", which would allow him/her to enroll in a "group of one" plan immediately, instead of having to wait for an open enrollment period. 

Maternity Coverage for Self-Employed Individuals
We often receive a lot of questions about maternity coverage for self-employed individuals.  For those under the age of 35, maternity coverage can be more comprehensive and less expensive on a "group of one" plan than on a personal or "individual" health insurance plan.  This is particularly true if the person applying for coverage is of preferred risk and without any pre-existing health conditions.  Additionally, there are no waiting periods for maternity coverage on a "group of one" plan once a person is enrolled, while on personal or "individual" health insurance plans, there is typically a waiting period for maternity coverage after policy inception.  Please contact us if you would like a quote for maternity coverage on a "group of one" health plan.

Group of One Coverage and Pre-Existing Conditions
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 or 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.  (This, of course, is not true if the applicant wants maternity coverage, in which case, "group of one" insurance can be less expensive than individual coverage).   Due to the generally 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, 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.

Self-Employed Individuals and The Three Year Rule
As a self-employed individual, you should be aware of the "three year rule".  If you choose to purchase individual and family insurance (as opposed to "group of one" coverage), 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 of one" 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.
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Should I Get a Physical Before I Apply?

Generally, the answer to this quesion is NO.  However, if you are over the age of 55, almost every carrier will require that you have had a physical within the last 24 months before they will make an offer of coverage.  Typically, they will want to see the results of your last physical too. But if you are over the age of 55 AND you have not had a physical within the past 24 months, consider making an application with Anthem Blue Cross and Blue Shield, Humana or United Healthcare (Golden Rule) rather than running out and getting a physical first.  Currently, these carriers do not require the results of a complete physical for applicants over the age of 55 in order to apply for coverage.   
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How do I Cancel My Policy?

Most carriers will allow you to cancel your policy either by phone or in writing with 30 days advance notice.    If you cancel your individual policy within 10 days of receipt, you will receive a refund of any premiums paid upfront. If there was an application fee, it may not be refunded.
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When will my policy become effective?  

Most insurance carriers will allow you to request an effective date as early as the next business day after receipt of the application.  (However, there are a few exceptions to this rule, particularly if you have had a gap in coverage of more than 60 days prior to applying).  Although the underwriting time may take anwhere from a couple of days to several weeks, if you are approved for coverage, the health insurance carrier will typically grant you your requested effective date and begin coverage and premium billing based on that date.  If underwriting takes an excessively long time to approve coverage (typically when medical records need to be ordered), the underwriter may change the actual effective date to the date that the policy is approved or offer an amended policy with a different effective date than what was originally requested.  Keep in mind that individual and family health insurance is always medically underwritten, and there is always a possibility that you can be declined for coverage based on your current health status.  Therefore we ask that you DO NOT CANCEL YOUR EXISTING COVERAGE until you are certain that you have been approved for coverage with your new carrier.
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Types of Plans

• Full Coverage Copay Plans with Office Visit and Prescription Drug Copays
  • These tend to be the "most expensive" plan types.  They offer comprehensive major medical coverage after a $500 or more deductible as well as 100% coverage after copay for office visits and prescription drugs.  For major medical services, such as hospitalization, lab, X-ray, CAT, PET or MRI scans, you will typically be responsible for the deductible as well as 20% coinsurance after deductible of the next $5000-$10,000 when you use an in-network provider.  After your "maximum out-of-pocket" (Maximum OOP) is met (deductible plus coinsurance), the policy will pay 100% of covered expenses up to the policy's lifetime maximum. You are responsible for the deductible and coinsurance on your policy each calendar year.  Examples of Full coverage plans include:
    • BCBS-Anthem Blue Cross and Blue Shield Blue Preferred
    • Humana One - Portrait Plan (includes $200 first-dollar coverage for diagnostic tests)
    • Golden Rule - Copay Select
    • Time Insurance / Assurant Health Max Plan
    • Rocky Mountain Health Plan Solo Select with generic and brand name drug coverage
    • Celticare II (with the Plus option)
      
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• Major Medical or "Catastrophic" Plans
  • These plans will have a higher calendar year deductible ($1000 or more), and they may or may not offer coverage for routine office visits and prescriptions.  If they do offer coverage for office visits and prescriptions you may be required to meet a high deductible first, before coverage will begin, or you may be limited to a certain number of office visits paid at 100% after copay per family member each calendar year.  These plans are designed to protect you financially only in the event of a major medical expense, and because of this, these plans often offer lower premiums than full coverage plans.  Since "catastrophic" plans offer both insurance coverage AND the advantage of membership within a preferred provider network, you will be able to take advantage of significant PPO network discounts for deductible expenses such as routine office visits, diagnostic laboratory, and pharmacy by staying "in-network" when you seek services.  Examples of Major Medical plans include:
    • BCBS-Anthem Blue Cross and Blue Shield Tonik
    • Humana One Autograph Share 80, Autograph Share 70, and Monogram Plans 
    • Time Insurance / Assurant Health CoreMed Plan
    • Rocky Mountain Health Plan Solo Smart Choice or Saftey Net Plans
    • Celticare II (without the Plus option)
    • World Insurance (Flex Advantage without optional office visit and Rx upgrades)
      
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• Qualified HSA Compatible, High Deductible Health Plans (HDHPs)
  • If you are 18 or over, you may be interested in lowering your premiums even further by purchasing a qualified High Deductible Health Plan (HDHP). We recommend that you read more about health savings accounts (HSA s) before making a decision to purchase a policy.  HSAs are a lot like "Catastrophic" plans, but different in that all covered services, including office visits and prescriptions, are subject to a single, individual or family, calendar year deductible, and paid at either 80% co-insurance to the out-of-pocket maximum or 100% after deductible based on the plan design you choose.  Some HSA Compatible plans do not offer prescription drug coverage (such as Humana Autograph Total/HSA), so be careful when choosing an HSA product, and make sure you are aware whether or not the plan you choose will pay for prescriptions after the deductible is met.  We prefer HSA plans that pay for prescriptions after the plan deductible is met.  There are no separate deductibles or copays for prescriptions or office visits on HSA plans.  Having an HSA compatible health plan encourages you to spend your deductible $$ wisely, such as using only providers within the preferred network, choosing generic drugs over brand name or choosing an urgent care facility instead of an emergency room for minor emergencies.  Thus HSAs offer significant premium savings, allowing you to put money into a separate, tax-advantaged, health savings account to plan, long-term, for future deductible expenses.  This health savings account can be thought of as a "Medical IRA".  You can even use "HSA money" from your tax-deductible health savings account to pay, without being penalized or taxed, for eligible expenses that aren't covered on your medical plan, such as dental, orthodontia, vision, and over-the-counter medications.  Just about all of the major carriers offer HSA compatible options.
    • Tip:  The Humana One HSA Compatible Healthplan , and the BCBS-Anthem Blue Cross and Blue Shield Lumenos HSA plan both offer100% coverage NOT SUBJECT TO DEDUCTIBLE for preventive services including age appropriate wellness visits and immunizations through age 18, annual physicals for adults, and state mandated mammogram and prostate screenings.   Most other carriers only pay for state mandated immunizations and mammogram and prostate screenings on a first dollar basis BUT do not offer first dollar coverage for adult physical examinations or pap tests on their HSA plans.
      
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• Low -Priced, Limited Benefit Options
  • These plans often include high deductibles, upper limits or annual maximums on certain services such as outpatient services, and limited Dr. Copay and prescription drug benefits (usually a prescription drug discount card).   They do offer limited major medical coverage as well as member discounts for in-network services, which makes them better than having no coverage at all, however, because of the upper limits on certain services, they can tend to leave you under-insured.   There is definitely a market for these plans due to their very low monthly premiums, so they will be included in your instant quote.  Examples of Limited Benefit plans include:
    • Golden Rule Copay Saver & Saver 80
    • Time Insurance / Assurant Health Right Start Plan
    • Golden Rule HSA Saver
    • Celtic Basic
    • World Insurance - HD Advantage without Annual Max upgrade and Value Advantage without optional upgrades
      
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Commonly Overlooked and Misunderstood Odds and Ends

• In-Network vs. Out-of-Network
  • Before applying for coverage, please make sure that your physicians and local facilities are in-network.  Dr. directories are available within your instant quote and in our self-help area, but if you need any help, we can certainly look up your physicians for you to see which carriers they are contracted with.  Although PPO plans offer out-of-network benefits, there is usually a separate deductible, and coinsurance will be higher.  Additionally, you can be "balanced billed" for charges above and beyond what the carrier is willing to pay for out-of-network services, so you will always want to make sure that you are seeing in-network physicians whenever you seek professional services. In-network physicians & pharmacies have contracts with the carriers that they work with, and they offer discounted services to members. You cannot be "balanced billed" above and beyond the discounted rates when you use an in-network physician or pharmacy. HMOs, like Kaiser Permanente, do not offer coverage outside of the network.  Note:  Celtic Insurance does not work well in some of the rural areas and mountain towns such as Steamboat, Vail, & Summit County due to lack of network physicians.
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• Covered vs. Not Covered
  • "Covered" means that the service is payable AFTER your deductible is met or it is payable AFTER a copay is paid.  A few services, such as State mandated preventive care services like immunizations, mammograms and prostate screenings, are covered without being subject to a deductible or a copay.  But many people mistake deductible expenses as expenses that are "not covered".  For example, if your PPO plan's annual deductible has not been met yet, a trip to the lab for bloodwork might result in a deductible expense, an expense that reduces your calendar year deductible, and you will be required to pay the network discounted fee for the blood test.  This service is considered a "covered" expense, even though you have to pay for it.  If the service is "not covered", it will not reduce your calendar year deductible.
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• Deductibles
  • Plan deductibles typically range from $500.00 and up, and they are almost always tracked by calendar year vs. plan year.  Keep in mind that if you purchase your policy late in the calendar year, your deductible will most likey start over again in January, unless you purchase a policy with a "plan year" deductible.  Right now, the only plans available on this site with a "plan year" deductible are the BCBS-Anthem Blue Cross and Blue Shield Blue Preferred Plans.  Some plans have a "per person" deductible with no family maximum, while other plans have a "per person" deductible with a family maximum of two or three times the individual deductible.  Larger families might want to look for plans with a family cap on the annual deductible, such as plans available from Humana One.  The only individual health plans available at this time with a Zero deductible option are BCBS-Anthem Blue Cross and Blue Shield's Rightplan PPO 40 and Aetna First Dollar MCOA 25.
    
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• Co-insurance
  • Co-insurance is the percentage of healthcare costs that you will split with the insurance carrier after your calendar year deductible is met.  Like the deductible, co-insurance is also typically tracked by calendar year and starts over again each calendar year.  Typical Coinsurance splits are 80/20 and 50/50.  You will continue to pay your portion of the co-insurance until your co-insurance maximum is met.  The policy summary will always tell you what your co-insurance maximum is.  Some plans have a "per person" co-insurance with no family cap, and some plans have a "per person" co-insurance with a family cap of two or three times the individual co-insurance maximum.  Once the co-insurance maximum is met, your insurance carrier will pay 100% of covered expenses.
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• Office Visit Copays
  • An office visit copay is the flat dollar amount that you would pay for a routine visit to either a primary care physician or a specialist, with coverage kicking in at 100% after the copay.  Most traditional, employer sponsored plans offer an office visit copay.  However, individual and family plans may or may not include office visits copays as part of the coverage.  SOME of the plans listed in your instant quote will not offer copays for routine office visits.  If you see "$0" or "N/A" in the Copay column on your instant quote, then those plans will not have an office visit copay.  On plans with no office visit copay, routine office visits will typically apply to your deductible, and you will be responsible to pay the network-discounted rate for office visits until your deductible is met.  On some of the catastophic plan designs with no copays, routine office visits may not even be covered at all!  Carriers that do not offer office visit copays on their basic plan design will usually give you the option to add office visit copays for an additional premium.  Please remember that when you pay a copay on a PPO plan, your deductible IS NOT reduced by the amount of that copay.  Copay expenses, whether for office visits or prescriptions, are unlimited and never included in your PPO plan's maximum out-of-pocket limit.
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• Lab, X-Ray & Other Diagnostic Tests
  • In the individual and family market, lab, X-ray & other diagnostic tests are almost always subject to deductible first and then coinsurance on most PPO plans.  Plans that do not require a deductible to be met before coverage applies for lab, X-ray, and other diagnostic services include:
    • BCBS-Anthem Blue Cross and Blue Shield RightPlan PPO 40
    • Kaiser Permanente HMO Plans (Available in the Denver/Boulder areas only)
    • Humana One - Portrait plans and Autograph Share 80 plans offer $200 of first dollar coverage per person per year for lab & x-ray services before you will be required to meet your deductible.
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• Facility and/or Hospitilization Copays/Fees
  • Some major medical plans have, in addition to your deductible and coinsurance maximum, require an out of pocket facility fee or "per admission" hospitalization fee.  Although these types of plans will tend to offer lower premium rates, these fees can greatly add to your out-of-pocket expenses in the event of a major medical claim, so we just want you to be aware of them.  For example, Time Insurance's CoreMed plan's basic plan design comes with a $750/day facility fee for up to a maximum of three days, and BCBS-Anthem Blue Cross and Blue Shield's RightPlan PPO 40 has a $500 per admission hospitalization fee.  Some carriers, such as Time Insurance,  will allow you to upgrade to a lesser facility fee or no fee for an additional premium. (Call us for a customized quote.)
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• Prescription Drug Coverage
  • Some of the plans in your instant quote, particulary the limited benefit plan designs, will offer a prescription drug DISCOUNT card on the basic plan design with an OPTION to purchase a drug copay card for an additional premium.  Additionally, some of the HSA compatible healthplans will have a discount card vs. coverage after the deductible.  Be sure you are aware whether or not the policy you choose will have a DISCOUNT card vs. actual prescription drug COVERAGE.  Also be aware whether or not your Rx card will have a separate deductible before copays will apply.
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• Plan Summaries
  • Plan Summaries are available within your instant quote for every plan that we offer.  Please read the policy summaries carefully before choosing and purchasing a policy. 
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• Quoted Rates
  • Quoted rates are not guaranteed and are always subject to the underwriter's final decision.  Some of your instant quotes, particularly those offered by Time Insurance and Golden Rule, are based on "Preferred" rating.  To qualify for "Preferred" rating, you must be in excellent health, and meet certain height, weight, cholesterol, and blood pressure guidelines.  A preferred rating questionnaire is included with the Time Insurance application and must be completed in order to qualify for preferred rates.  Approximately 60% of applicants will qualify for preferred rating, so please keep this in mind when comparing quotes.  Based on your current health status, the final offer from the insurance carrier may or may not match the quoted rates.
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• Rate Changes-How Often will Your Rates Change?
  • Some carriers, such as Humana One, offer a 12-month rate guarantee on the first year of coverage.  Others, such as BCBS-Anthem Blue Cross & Blue Shield make rate changes across the board once or twice a year.  BCBS-Anthem Blue Cross and Blue Shield usually reviews rates in January for all members, regardless of plan anniversary date.  Insurance carriers will not raise your rates based on your personal claims experience or utilization.  By law, they can base rate increases on inflation trends in the healthcare industry within geographic areas and by the overall claims experience of large groups of members.   They can also increase rates based on a change in your age category.
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• Questions & Concerns?
  • If you have any questions or concerns, please contact us before you buy.  There are many plans to choose from, and we know how confusing it can be to sift through all of the information.  We are here to help you make the right choices for you and your family.
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Maternity - Plans with Optional Maternity Benefits

• Regardless of plan, conception must occur AFTER policy inception.
• Note:  A current pregnancy will result in a declination of a NEW health insurance policy for both the mother AND/OR the father.  Expectant mothers AND expectant fathers are ineligible to apply for a new individual health insurance policy until AFTER the baby is born;  This is due to the risk involved with the possibility of giving birth to an unhealthy child.  Since, by law, a newborn child is given guaranteed issue onto either parent's healthplan, insurance carriers must disqualify expectant parents from coverage in order to protect themselves from the risk of an unhealthy newborn.  If you are already expecting a child, your only option for NEW health insurance and maternity coverage would be in the group market under a self-employed, business group of one plan, an employer sponsored health insurance plan or through Cover Colorado.  There are certain open enrollment restrictions for self-employed groups of one, so you may have to wait for an open enrollment event, depending on your circumstances, before you can become enrolled on a new policy. 
• Complications of pregnancy are covered under your regular health insurance policy and do not require separate maternity coverage.
• The instant quote comparison tool on this website will not include rates for maternity coverage.  Instead, click on a link below to obtain a quote for maternity coverage from one of the following carriers:
• Humana One
  • Waiting Period - Birth must occur at least 12 months AFTER policy inception .
  • Plan pays 60% after waiting period and separate, $1000 maternity deductible.
• Golden Rule
  • No waiting period - 80/20 Coinsurance with Maximum Benefit equal to:
    • $2500 in years 1&2
    • $5000 in years 3&4
    • $7000 in year 5+
• Time Insurance/Assurant Health
  • Waiting Period - Conception must not occur prior to 90 days (3 months) after policy inception.
  • Plan pays 100% of covered services after maternity deductible.
  • Deductible Options - $1000, $2500, $5000 and $10000
  • Why choose one of the high deductible options ($5000 or $10000)? - Premiums are extremely affordable so you can cap your exposure AS WELL AS receive access to significant network discounts.  You cannot receive network discounts for maternity services unless you have one of the above maternity options added to your policy.
• Rocky Mountain Health Plans
  • Plan pays 50% coinsurance after separate, $500 maternity deductible - no waiting period.  The maternity rider is only available with the Solo Select 500 plan, and you must be age 35 or younger to qualify for maternity coverage.
    
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