Colorado HealthOP Folds: What Consumers Need To Know

October 16, 2015
Photo: HealthOP workers hand out information (AP file)
HealthOp workers in Denver encourage the public to get health coverage under the Affordable Care Act in this March 2014 photo.

Colorado HealthOP collapsed. The state Department of Insurance says the financial viability of HealthOP was in jeopardy when it found out it would receive only about $2 million in federal reimbursements this year, after expecting about  $16.2 million. The shortfall meant HealthOP's rainy day fund would be erased, and would likely go into the red to the tune of about $34 million by year's end.

How many people are affected?

HealthOP says it had 82,785 members as of Sept. 15. Of those, 79,877 held individual policies and another 2,908 are covered under small group policies.  

What happens to them?

All individual policy holders will be covered until their existing 2015 policies expire, as long as they pay their premiums. Small group policies will be effective until the anniversary date of the policy. After that, HealthOP customers will have to look for new health insurance.

Do they need to keep paying premiums?

Yes. HealthOp customers must also continue to pay deductibles, co-payments and co-insurance when required.  

What about claims?

HealthOP will keep paying claims for current members. If HealthOP can't pay, the Colorado Life & Health Insurance Protection Association, a  nonprofit will step in and pay claims.

What are the deadlines?

Individual policy holders must choose another carrier during open enrollment, which starts Nov. 1 and goes through Jan. 31. They can work with Connect for Health Colorado, the state's insurance marketplace, or find coverage off the exchange. Small group policy holders have until their anniversary date of their policy.

Can consumers still see their doctors and other health care providers?

Yes, for both medical and pharmacy needs. Anyone who experiences problems should contact Colorado HealthOP member services at 866-915-6619.

What about the tax credit?

If you get a tax credit for your 2015 Colorado HealthOP individual coverage, it will continue through the end of the policy. The insurance department is reminding all consumers that health insurance tax credits are only available if coverage is purchased through Connect for Health.

For every one else, the calculations on advance premium tax credits will likely change since since the Colorado HealthOP was the carrier with that second-lowest Silver premium in many areas . The APTC is calculated based upon the second-lowest Silver plan in an area, says the Colorado Division of Insurance.

Are any other health care providers in trouble?

The DOI says no other carriers are affected.

More questions? Here's contact information:

The Colorado Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. For more information call 303-894-7499 / toll free 800-930-3745.

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