Colorado HealthOP, which provides low-cost individual and small-group plans to about 80,000 customers, can’t sell 2016 policies on Connect for Health Colorado, the state health insurance exchange. the Colorado Division of Insurance cut the co-op from the exchange because it missed cash-reserve requirements just before the open enrollment period opens nov. 1.
Anticipating that co-op customers would have questions, the insurance regulators offered this q&a:
Can I enroll in or renew a Colorado HealthOP plan through Connect for Health Colorado for 2016?
No. Plans from Colorado HealthOP will not be available on Connect for Health Colorado for 2016.
What do I need to do to get coverage for 2016?
If you have an individual policy from the HealthOP, you will need to choose a plan from another insurance company in the upcoming open enrollment, which begins Nov. 1, and continues through Jan. 31. To make sure that coverage starts on Jan. 1, and avoid a gap in coverage, members must enroll before Dec. 15.
If you are a small employer with small-group coverage purchased through Connect for Health Colorado’s SHOP program, you will also need to select coverage from another carrier when your plan comes up for renewal, although small-group coverage is not tied to the Nov. 1 – Jan. 31 open enrollment dates.
What happens to my current Colorado HealthOP coverage? When will it expire?
For individual policyholders, your current coverage will remain effective until Dec. 31. For those with small-group policies, your coverage will be effective until the anniversary date of the policy.
Will my tax credit for health insurance for Colorado HealthOP coverage stay in place for the remainder of 2015?
If you are receiving a tax credit for your 2015 Colorado HealthOP individual coverage, it will continue through the end of the policy, Dec. 31, 2015, provided you keep paying your premiums.
Do I still need to keep paying premiums to Colorado HealthOP?
Yes, to keep your coverage in place through the end of 2015, you must continue to pay your premiums to Colorado HealthOP.
Will my claims still be paid?
Yes, the HealthOP will continue to pay claims for its current members. However, should the company become unable to pay those claims, you will not be responsible for those claims. The Colorado Life & Health Insurance Protection Association, a nonprofit organization that assists Colorado residents with health insurance policies from insurance companies in financial difficulties, would pay claims if the HealthOP is unable to.
Can I still see my doctors and other providers? What about ongoing or upcoming care? What about my prescriptions?
Yes, members can continue to see providers and receive coverage for both medical and pharmacy needs. If you have problems with providers not honoring your insurance, contact the Colorado HealthOP member services at 866-915-6619, or contact the Division of Insurance at 303-894-7490 or 800-930-3745 (outside the Denver Metro area).
Why did this happen?
On Oct. 8, the Centers for Medicaid and Medicare (CMS) announced that it would only reimburse the nation’s health insurers 12.6 percent percent of what they were entitled to under a federal, risk-based reimbursement program known as “risk corridor” — only $362 million out of $2.9 billion promised. Colorado HealthOP was expecting around $16.2 million this year from the risk corridor payments, but instead will only receive about $2 million.
The shortfall in funds resulted as there were more insurance companies eligible for risk corridor payments than those required to pay into the program. It is likely because many companies underestimated the risk of the new members they were taking on in 2014, and thus set their premiums too low. Additionally, CMS was recently prevented from using any other resources to make up this year’s shortfall in the risk corridor program.
Such a drastic reduction in risk corridor payments made the financial situation for the Colorado HealthOP unsustainable.
Were any other carriers impacted by the reduced risk corridor payments?
We have reviewed each carrier to assess the financial impact of the reduced payments and have determined that no other carrier impacted enough as to raise questions to their continued sustainability.
Who to contact with questions?
Colorado HealthOP members enrolled through Connect for Health Colorado should contact Connect for Health Colorado with questions about renewals and choosing new options at 855-752-6749. Consumers with questions about payment of claims by the HealthOP should contact Colorado HealthOP member services at 866-915-6619.
