STATE OF COLORADO HEALTH INSURANCE LAWS
What Rights Do I Have Regarding Health Insurance?
Adapted from a publication of the Colorado Department of Regulatory Agencies-Colorado Division of Insurance.
Colorado law provides you certain protections regarding health insurance.
All companies selling health insurance in Colorado are to make sure their members receive:
To know more about how the Colorado Division of Insurance can help you, call (303) 894-7490, or (800) 930-3745, or use the website at www.dora.state.co.us/insurance .
People covered by health insurance plans regulated by the State of Colorado have certain rights through state law. Some of these rights apply to all types of plans; others apply only to managed-care plans.
All Health Plans
Regardless of the type of health insurance plans you are insured under, you have a right to:
Managed Care Plans
Managed care plans, including health maintenance organization (HMO) and preferred provider organization (PPO) plans, encourage or require the use of specific doctors and hospitals, and closely review appropriateness of services.
In addition to the rights listed in the previous section, if you are enrolled in a managed care plan you also have the right to:
Special Protections For Small Employer Groups
Colorado has established special health insurance rules for small employer groups (those with 50 or fewer employees), including qualified self-employed persons and household employees.
Your Complaint And Appeal Rights
All health plans must have written procedures for receiving and resolving complaints.
Information on complaint procedures can be found in your policy or membership booklet, or by calling your plan's customer service representative.
The most common complaint occurs when a health plan denies coverage for a service or procedure on the grounds that it is not medically necessary, appropriate, efficient or effective. In such cases, Colorado requires companies to have a two-level appeals process, followed by the right to an independent external review.
Refer to the Section titled: "What Happens When Your Health Insurance Company Says No" for detailed information on the appeals process.
If You Cannot Afford Private Insurance Coverage
Colorado has a number of special programs for those who cannot afford private health insurance for themselves and/or their children due to limited income. Examples are:
Medicaid is a state-federal health insurance program for persons with very low incomes who meet certain categorical eligibility requirements. For more information call 303-866-3513 or 1-800-221-3943.
Child Health Plan Plus
This is a subsidized health insurance program for uninsured children with family incomes below 185% of the federal poverty level who are not eligible for Medicaid. For more information, call 1-800-359-1991.
Colorado Indigent Care Program
Colorado Indigent Care is a state program that provides partial reimbursement to providers for some of the care they provide eligible low-income uninsured and underinsured Coloradoans. For more information, call (303) 866-2580.