In Colorado, no matter what type of health insurance plan you have by law you have certain rights. These include coverage for certain mandated benefits, the right to know what your plan covers and what it does not, and the right to appeal all insurance company decisions when it comes to denying your claim. If you are denied, the reasons have to be in writing.
If you have a managed care plan -health maintenance organization (HMO) or preferred provider organization (PPO) plan, you are required to go to certain doctors and hospitals, and all requests must be reviewed. You have to be covered for emergency services even if the services fall outside of your health plan. And, if you need specialized services, you have the right to be referred to a specialist.
If you are a small employer, no employee can be denied health benefits because of a medical condition, and your policy cannot be cancelled unless you fail to pay the premiums. Your rates cannot be raised if your medical expenses are high, and you can by coverage through one of Colorado’s health care coverage cooperatives. This allows you to select plans for a variety of insurers. A group health plan might have a 6-month waiting period for pre-existing conditions, but pregnancy is not considered pre-existing and must be covered.
If you are not insured at work and can’t get individual health coverage because you’ve been turned, you may be eligible for CoverColorado, a subsidized state program for uninsurable individuals. Because of risk factors, CoverColorado premiums are about 30 percent more.
Colorado has several programs for those who cannot afford private health insurance. They include Medicaid, Child Health Plan Plus and Colorado Indigent Care — a state program that provides partial reimbursement to providers for some of the care.