Key Takeaways
- Colorado requires a 10-day free look period for individual health insurance policies
- Connect for Health Colorado is the state's health insurance marketplace
- Colorado requires coverage for mental health parity, maternity, and preventive care
- Pre-existing condition exclusions are prohibited in Colorado individual and small group markets
- Colorado has enacted additional consumer protections beyond federal requirements
Colorado Health Insurance Policy Requirements
Colorado has comprehensive health insurance regulations that meet and sometimes exceed federal requirements. Understanding these state-specific rules is essential for the licensing exam.
Regulatory Structure
Colorado health coverage is regulated by:
| Agency | Role |
|---|---|
| Division of Insurance (DOI) | Regulates health insurers and HMOs |
| Department of Health Care Policy & Financing | Administers Medicaid (Health First Colorado) |
| Connect for Health Colorado | Operates state marketplace |
Free Look Period
Colorado requires a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual health policies
- Different from the 30-day period for seniors with life insurance
Exam Tip: Health insurance has a 10-day free look in Colorado. Remember life insurance is also 10 days (30 days for seniors 60+).
Required Coverage
Colorado mandates coverage for numerous benefits:
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Mental Health Parity
Colorado's Mental Health Parity requirements:
- Mental health benefits equal to medical benefits
- Same copays, deductibles, and limits
- Covers mental illness and substance use disorders
- Applies to group and individual plans
- Aligns with federal Mental Health Parity and Addiction Equity Act
Covered Conditions
- All mental health conditions
- Substance use disorders
- Behavioral health conditions
- Autism spectrum disorders
Pre-Existing Condition Protections
Colorado prohibits pre-existing condition exclusions:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited restrictions under ACA |
| Medicare Supplement | Special rules apply |
Connect for Health Colorado
Connect for Health Colorado is the state's health insurance marketplace:
- Only place to get premium tax credits (subsidies)
- Offers qualified health plans (QHPs)
- Open enrollment and special enrollment periods
- Determines Medicaid (Health First Colorado) eligibility
Key Features
- Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
- Premium tax credits based on income
- Cost-sharing reductions for Silver plans
- Special enrollment for qualifying life events
- Advanced Premium Tax Credit (APTC) available
Guaranteed Issue and Renewal
Colorado requires:
Guaranteed Issue
- Insurers must accept all applicants
- Cannot deny coverage based on health status
- Applies to individual and small group markets
Guaranteed Renewal
- Insurers cannot cancel coverage except for:
- Non-payment of premium
- Fraud or misrepresentation
- Plan discontinuation (with notice)
What is the name of Colorado's state health insurance marketplace?
How long is the free look period for individual health insurance policies in Colorado?