Division of Insurance’s closure decision – What does it mean? +

Division of Insurance’s closure decision – What does it mean?

DENVER – Colorado HealthOP has entered state-approved runoff and will not offer insurance coverage in 2016.

The runoff decision came after careful analysis of the company’s future financial condition and lengthy discussions involving the Centers for Medicare & Medicaid Services, and the Colorado Division of Insurance (DOI). Created as a Consumer Operated and Oriented Plan (CO-OP) under the Affordable Care Act, Colorado HealthOP has approximately 80,000 members.

Runoff is when a business winds down its existing business and pays all related policy claims while ceasing to take on new customers.

Colorado HealthOP policyholders will keep their insurance coverage through Dec. 31, 2015 so long as they continue to pay premiums. To continue insurance coverage in 2016, consumers must re-enroll in a new healthcare plan during the next Open Enrollment period beginning Nov. 1. Consumers should enroll by Dec. 15, 2015 for coverage effective Jan. 1, 2016.

Recent guidance about a federal program designed to assist health insurance carriers raised concerns about its future.

Colorado still has several carriers on the Exchange offering insurance coverage for 2016 and allowing Coloradans consumers to select a range of insurance plans, depending on their location.

Frequently Asked Questions (FAQs):

Individual Member Questions

I have doctor appointments scheduled for next week, can I still go? Am I still covered? Yes, so long as you stay current with your premium payments, you will be covered by your health plan through December 31, 2015.

Can I continue to buy insurance through Colorado HealthOP? No. You need to find new coverage to begin January 1, 2016. Open enrollment begins November 1 and runs through January 31, 2016. You must purchase replacement coverage by December 15, 2015 to have insurance on January 1, 2016

Can I change my insurance now? No, members will be able to choose a new health insurer for 2016 during the next open enrollment period, which begins on November 1, 2015 and runs through January 31, 2016. We recommend selecting a new plan during open enrollment before the end of the year as your Colorado HealthOP policy will expire December 31, 2015.

Where else can I enroll for insurance in Colorado? Visit www.connectforhealthco.com for access to insurers participating in the Exchange or call 855-752-6749. There will be several carrier options on the Exchange, depending on your geographic location.

Will this change my premium? No. Premiums will not change through the 2015 plan year. Your premium may change when you purchase coverage from another company for 2016 coverage.

Should I keep paying my premium? Yes. You must pay your premium through the end of 2015 to have coverage.

Can I still see my regular doctor and have prescriptions filled at the same pharmacy? Yes. The provider network should remain in place through 2015. Once you shop for new coverage for 2016, check provider directories for the other companies to ensure your doctors and preferred facilities are members of those networks.

Can my doctor refuse to see me because of the situation? No. Contracts between Colorado HealthOP and providers should remain in force during the runoff.

Who should I contact at Colorado’s DOI if I have questions? You can reach the Division of Insurance at 303-894-7499.

Small Group Member Questions

My business just enrolled our small group with Colorado HealthOP, what happens to our coverage? So long as you stay current with your premium payments, you will be covered by your health plan for the term of your plan. More information will come soon.

Provider Questions

Will I still get paid for treating Colorado HealthOP patients? Yes, you will be paid for claims incurred through December 31, 2015.

What does the dissolution of Colorado HealthOP mean to providers? Providers will be paid for claims incurred through December 31, 2015.

Colorado HealthOP did their part. We are mad that congress reneged on their obligation and caused the failure of a public-minded regional carrier.

Categorized as: About Colorado HealthOP , Members

Why is the government deciding not to pay Colorado HealthOP the promised funds? +

Colorado HealthOP is not the only health insurer being negatively impacted by the government’s decision to pay a fraction of the promised funds. This decision was made across the board for many health insurers and their members.

While we can’t be certain as to why Congress made this decision or if they fully considered the impact to health insurers and their consumers (including the 80,000 members insured by Colorado HealthOP), the reality is that the full funds which were promised are now only partially going to be provided.

Categorized as: About Colorado HealthOP

Am I losing my coverage because of the government’s decision to short-pay Colorado HealthOP? +

NO. As long as you are current on your health insurance premium payments, your claims are being paid and will be paid through December 31, 2015 for your 2015 health plan. You can expect to receive renewal information within the next couple of weeks for how to renew your Colorado HealthOP plan for 2016

Categorized as: About Colorado HealthOP

Does the decision by Congress mean I won’t have Colorado HealthOP coverage in 2016? +

NO. While the decision is disappointing and unexpected, Colorado HealthOP has remained steadfast in our commitment to stay in service and be available to Coloradans through 2015, into 2016, and beyond. That’s why we are coming up with alternate solutions as we continue to pay claims and prepare for renewals of current members and open enrollment of new members for 2016.

Categorized as: About Colorado HealthOP

What happens if Colorado HealthOP doesn’t get the full payment from the government? +

Ideally, we’d like the government to change their decision to shortchange Colorado HealthOP and instead pay in full what was originally promised.

If Congress doesn’t make that decision, Colorado HealthOP is still working on options and pulling on resources to come up with alternate forms of funding. We are thankful to have powerful partners who share our mission to improve health care in this country, and each hour since last week’s congressional decision brings us closer to remaining sustainable for years to come.

Categorized as: About Colorado HealthOP

What can I specifically tell Congress to do? +

Congress can be most moved if they can understand the impact on the lives of Americans. Your story as an insured member of Colorado HealthOP is personal to you, and it needs to be made personal for Congress.

We’re asking our members to contact their Congressional representatives to share their individual experiences with how Colorado HealthOP has helped their health through affordable benefits and being available in the state of Colorado.

Click here to get to our Call to Action page which has all of the resources you need to contact your representative.

Categorized as: About Colorado HealthOP

If the Department of Health and Human Services is the one who sent the letter to Colorado HealthOP about the short payment, why are you asking me to contact Congress about the decision? +

To make good on its promises, HHS would need to go to Congress for the additional funds needed.

Categorized as: About Colorado HealthOP

Is the decision by the government just an excuse for you to raise my rates in 2016? +

NO. This decision was handed down last week, and all insurers in Colorado submitted their proposed rates to the Colorado Division of Insurance earlier this year. There is no correlation between our 2016 rates and the decision by the government to reduce the amount of promised funds to Colorado HealthOP.

Categorized as: About Colorado HealthOP

If I don’t vote in the Board Election, does it impact my policy with Colorado HealthOP? +

No, while voting is highly encouraged, it is not required.

Categorized as: Board Election

When will the election results be announced? +

Election results will be announced to the full membership on October 7, the day after the election closes. The new members of the Board of Directors will be introduced to the full membership at our annual meeting on October 15.

Categorized as: Board Election

What if I lost my ballot? +

If you have misplaced your ballot, please call 952-974-2339 or email the third-party vendor who is administering the election at support@directvote.net.

Categorized as: Board Election

How do I vote online? +

To vote online, you will need to log into your member portal at www.myhealthop.org. If you have not previously registered for the Member Portal, you will be asked to do so. You will need your Member ID card. Once logged in, click on “Vote Today” and follow the online voting instructions.

NOTE: Emails will also be sent to all members for whom we have valid email addresses, which will include direct links to your ballot, and which will not require you to sign into the Member Portal.

Categorized as: Board Election

Can I send my ballot with my premium payment or drop it off at your office? +

No. Please do NOT send payments with election ballot or voting materials. All election materials must be returned directly to Survey & Ballot Systems in order to validate your ballot and include your vote in the overall tally.

Categorized as: Board Election

How are applications for the Board of Directors evaluated? +

While there are no specific qualifications for serving as a Board Member—aside from being a member of the CO-OP – each year the Board seeks candidates that bring a wide-range of skills and experiences. The Board looks for people with fresh ideas who are passionate about improving the health of their neighbors. A Colorado HealthOP Board Member represents all members and looks out for their best interests as he/she works to accomplish the CO-OP’s mission and goals.

Serving on Colorado HealthOP’s Board of Directors is a serious, challenging, and rewarding position. We encourage those who apply and serve each year to think about their level of interest and time commitments. We work hard for our members, and we are committed to making a difference in Colorado’s healthcare system!

Categorized as: Board Election

What are the expectations for members of the Board of Directors? +

Members of the Board of Directors are expected to devote 10 to 20 hours per month to work related to Colorado HealthOP. The Board now meets approximately once each month for several hours, with a considerable amount of reading and preparation beforehand. Each Board member serves on two committees, which typically meet in between Board meetings. Board members also spend time engaging with members through outreach to learn about how to improve the CO-OP.

Categorized as: Board Election

How often are elections held for the Board of Directors? +

Elections are held each year, typically in the fall. Since Board members serve staggered terms, not all 11 seats will be up for election. Typically, there will be 5 or fewer positions open in each election.

Categorized as: Board Election

Who do I contact if I have additional questions about the election when I get my ballot? +

For Member Portal technical support, call Colorado HealthOP at 866-915-6619, (Monday – Friday, 8:00 am – 10:00 pm  |  Saturday, 8:00 am – 4:00 pm), or email us at service@cohealthop.org.

For voting assistance, members can call our third-party voting provider, Survey and Ballot Systems, at 952-974-2339 Monday-Friday, 8am-5pm, Central time, or email support@directvote.net.

Categorized as: Board Election

How will I get my ballot? +

Survey and Ballot Systems, the third-party vendor managing our election, will be sending paper ballots to all eligible members on September 11. Those members with an email address on file with the CO-OP will also receive email communications as to how they can vote online if that is their preferred method.

Categorized as: Board Election

How will the Board election be handled (managed)? +

To ensure complete impartiality, Colorado HealthOP has retained a third-party vendor to manage the election (Survey & Ballot Systems). In addition to ballots being sent to eligible members through the mail, you also have the option to vote online by logging into your Member Portal at www.myhealthop.org.

Categorized as: Board Election

Who or what am I voting on? +

Colorado HealthOP’s Board of Directors is currently made up of 11 individuals who serve three-year terms. In 2015, CO-OP members will elect 5 new members to the Board to replace generally outgoing Board members. The election runs from September 15 through October 6, 2015. You can view candidate bios and complete your ballot by logging into your Member Portal at www.myhealthop.org.

Categorized as: Board Election

Why am I being asked to vote? +

As a nonprofit health insurance CO-OP, members, just like you, take the lead in deciding how to run the organization! Not only are members running for positions on the Board of Directors, but members get to vote on who fills those positions. As a current member of Colorado HealthOP over the age of 18 you are eligible to vote.

The CO-OP’s Board of Directors is elected entirely by CO-OP members. As a member, this is one of your greatest responsibilities – selecting the people who will set the organizational priorities for the next year. The Board of Directors ensures we create innovative services, push boundaries, and improve health care for all of our members. So make sure your voice gets heard and vote today.

Categorized as: Board Election

When is the election for the 2016 Board of Directors? +

The election of the five new members to the Board of Directors will run from September 15 through October 6, 2015.

Categorized as: Board Election

What can I do in the member payment platform? +

The new payment platform has several features that will help you stay up to date on your premiums:

  • Member payment information is pre-populated to reduce errors;
  • Member payment method is saved for future payments;
  • Receipts are sent via email so you can rest assured knowing your payment was received, plus you’ll get alerted if your payment fails; and
  • Your payment is applied to your account faster.

Click here to register and get started with the payment platform.

Categorized as: Individuals , Members

How do I set up recurring or repeating payments of my premium? +

If you have already set up recurring payments before July 20, 2015:

You will need to contact Member Services at (866) 915-6619 to make changes. Do not set up another recurring premium payment on the payment portal that is available after July 20, 2015.

If you want to set up new recurring or repeating premium payments after July 20, 2015:

You can get started on the payment platform for Colorado HealthOP. Click here to set up your recurring payments.

Categorized as: Individuals , Members

How does the Make a Payment tool help me track my premiums? +

The payment platform for members provides a one-stop solution to your premium payment needs.

Once logged in, CO-OP members will be able to:

  • Make a single payment or schedule recurring payments, so you don’t miss a bill;
  • View invoices and payment history going forward; and
  • Update credit card information and make other changes to your account without having to call customer service.

Click here to register on the payment platform.

Categorized as: Individuals , Members

How do I run for a seat on the Board of Directors? +

The application process begins each spring and closes in mid-June for that year’s election. The application period will re-open next year for the 2016 elections. Keep an eye on our website and your email inbox for notifications of when the process opens.

Categorized as: Board Election , Members

What is Colorado HealthOP’s business outlook for the future? +

Colorado HealthOP members can rest assured that the CO-OP is planning ahead and looking forward to meeting the needs of our members. For more information about any questions you may have regarding the business outlook of Colorado HealthOP, click here.

Categorized as: About Colorado HealthOP , Members

What is the Health Survey Gift Card Offer? +

WHO

  • Colorado HealthOP is partnering with ActiveJunky.com.
  • ActiveJunky.com is a Colorado-based online shopping community that gives members exclusive ways to earn cash back when they shop online for outdoor gear and apparel.
  • Shopping is done through an online retail partner called Moosejaw.

WHAT

  • We love living and playing Colorado as much as our members. We wanted to find a unique way to reward our members for taking their health survey!
  • That’s why we’ve teamed up with ActiveJunky.com and the online store Moosejaw.
  • Our members can get a $15 eGift Card to shop online for outdoor apparel and gear through Moosejaw’s online store.

HOW

  • Members that complete their private online health survey can get a $15 eGift Card that’s only available to them after they complete their survey.
  • When Colorado HealthOP members complete their online health survey, they will see an invite on the final screen of their health survey to join ActiveJunky.com
  • Members will need to register for free with ActiveJunky.com before being able to shop online with Moosejaw for great outdoor gear and apparel.
  • When our members join ActiveJunky.com they will receive a FREE $15 eGift Card from ActiveJunky.com for any purchase of $75 or more when they shop online through Moosejaw.

WHEN

  • To take advantage of this offer, members will need to complete their online health survey. (for a limited time)

WHERE

Additional Details

  • What is ActiveJunky.com and Moosejaw?
    • Colorado HealthOP teamed up with ActiveJunky.com, a fast-growing Colorado start-up (like us!).
    • ActiveJunky.com is an online shopping community that rewards and incentivizes users for their passion for gear and the outdoors. ActiveJunky.com is an outdoor gear, outdoor lifestyle, adventure sports and adventure website and community that’s dedicated to providing the widest selection of quality outdoor products at the cheapest prices.
  • When you join ActiveJunky.com you can earn cash back rewards on every gear purchase you make by simply clicking through ActiveJunky.com.
  • ActiveJunky.com has partnered with the top online outdoor gear stores, like Moosejaw to provide access to great outdoor gear and apparel.
    • ActiveJunky.com will provide coupons, cashback and promo codes for purchases on outdoor gear and apparel.
    • Colorado HealthOP is only making this opportunity available and is not responsible for coupons, purchases, refunds, or other transactions and related activity on ActiveJunky.com.
Categorized as: Members

What if I need care after hours? +

From time to time you might find yourself seeking care when your doctor’s office is closed.

For medical emergencies, call 911, or visit either an emergency room or urgent care depending on your needs.

Per state regulation, practitioners should provide patients with a way to seek care outside of their regular office hours. We encourage Colorado HealthOP members to try to contact their primary care provider for their non-emergent healthcare needs.

Colorado HealthOP’s Nurse Advice Line

844-477-8455

Get healthcare help wherever and whenever you need it.
Access to an experienced nurse is just a phone call away.

Our registered nurses are available 24×7 to answer your questions, assess your symptoms and help you decide whether you should call your doctor, head to the ER or urgent care or treat your symptoms at home.

Click here for more information.

Categorized as: Individuals , Members , Providers

Help Finding a Primary Care Doctor +

Care Navigators

Colorado HealthOP’s Care Navigators can provide you with a list of primary care doctors that we have special rates with to help you get the highest quality of care while saving you money.

Learn more

Talk with a Care Navigator Today

720-450-9670
855-796-7680 toll-free

Categorized as: Navigators

How do I log into the Member Portal? +

What’s myHealthOP.org?

myHealthOP from Colorado HealthOP is your personalized member portal designed to help you:

  • Access your plan details and be rewarded for completing simple Health Actions*
  • Manage your health, access lab results, and create your personal health plan for 2015.
  • Manage your claims, check on claims status, and manage payments.
  • Access health tools and get answers to your questions from a trusted source.

Learn more about what else you can do with myHealthOP.org

Categorized as: Individuals , Members

How does a licensed Colorado health insurance broker work with Colorado HealthOP? +

If you’re rearin’ to go to tell your customers about Colorado HealthOP plans, getting appointed to sell our health insurance is easy! Visit our Brokers page to complete the necessary paperwork which will get you started.

Categorized as: Producers

What prescription drugs does Colorado HealthOP cover? +

Our pharmacy benefits (formulary) can be found on the Colorado HealthOP website for 2015 plan benefits. Check the lists out to find your medications to see if they are covered.

Categorized as: Our Plans

Is Colorado HealthOP the same thing as Connect for Health Colorado? +

No. Colorado HealthOP is the state’s non-profit cooperative health insurer. Connect for Health Colorado is the state’s health insurance marketplace where individuals can shop for benefits. Think of Connect for Health as Travelocity, where you would shop for flights from Southwest Airlines (or other carriers).

Categorized as: About Colorado HealthOP

How can I get reimbursed by Colorado HealthOP for a medical service or claim? +

You can download the Colorado HealthOP Health Action Credit Form and mail the completed form and service receipt(s) to:

Colorado HealthOP
Health Action Notification
P.O. Box 14327
Reading, PA 19612-4326

Categorized as: Individuals , Our Plans

What is Colorado HealthOP? +

Colorado HealthOP isn’t really a “what,” as much as we are a “who.” We’re Colorado’s only nonprofit health insurance cooperative (CO-OP) and we were established in response to the growing demand for easy, affordable healthcare for individuals and small businesses across Colorado. We recognize how in the health insurance industry, premiums keep growing, and coverage keeps decreasing. By using a nonprofit CO-OP business model, we’re able to change that. We’re able to reinvest all of our profits into the CO-OP, to lower premiums for everyone, and broaden our coverage and benefits. Keep clicking around and learn more, or just give us a call at (855) 697-1656.

Categorized as: About Colorado HealthOP

What is a cooperative? +

A cooperative is a business that consists of a group of people working together for a mutual economic, social, and cultural benefit. Members sit on our board of directors and have a voice in the organization’s direction, including what is covered under benefit plans, how profits are reinvested into the company, and who runs business operations.

Categorized as: About Colorado HealthOP

How can I sign up for Colorado HealthOP? +

Open enrollment for 2015 coverage runs from November 15, 2014 through February 15, 2015. You can sign up through our website online or through Connect for Health Colorado. You can also contact our call center toll free at (855) 697-1656, or get help enrolling through a statewide network of brokers. To prepare for enrollment learn more about our plans here.

Categorized as: Employers , Individuals , Navigators , Our Plans

Is your customer service available in Spanish? +

Si. Nuestros miembros son importantes por eso ofrecemos excellente servicio al consumidor en Ingles y Espanol. Llame al (855) 796-7677 si desea servicio en Espanol.

We care about our members, and offer great customer service in both English and Spanish.  Please call (855) 796-7677 and ask for a Spanish speaker.

Categorized as: Employers , Individuals

Does Colorado HealthOP have a robust provider network? +

Colorado HealthOP offers a choice of plans with different provider networks. For our PPO (Preferred Provider Organization) plan, we partner with the Cofinity network, which has a statewide coverage with thousands of providers and facilities. Our EPO (Exclusive Provider Organization) plan is a restricted plan that primarily partners with Centura and Banner Health facilities and physicians in targeted geographic areas. These high-quality networks, while more limited, are also more affordable.  They do not offer any coverage outside of the EPO network, so potential members should carefully consider their needs and check to see if their doctors of choice are in the EPO network before buying.

Categorized as: Our Plans , Providers

Will my doctor accept Colorado HealthOP insurance? +

Good question. Let’s find out. Call (855) 697-1656 and we’ll see what plans your doctor is covered under.  Or, find your doctor with our handy tool.

Categorized as: Employers , Individuals , Providers

Can small businesses get financial help for covering retirees who are ages 55-64? +

Yes. Employer-based plans that provide health insurance to retirees who are ages 55-64 can now get financial help through the Early Retiree Reinsurance Program. This program is designed to lower the cost of premiums for all employees and reduce employer health costs.

Categorized as: Employers , Our Plans

Can small businesses get tax credits for insuring employees? +

Yes, you better believe it. All businesses can receive a tax credit of up to 50 percent of the cost to provide insurance (up to 35 percent for nonprofits) if they have fewer than 25 employees, pay average annual wages below $50,000, and provide health insurance to their employees.

Categorized as: Employers

Are there incentives for a small business to participate in wellness programs? +

Yes. We like your thinking. Employers can adjust their contributions and premiums based upon employee participation in wellness programs that promote healthier lifestyles.

Categorized as: Employers

Will Colorado HealthOP cover employees in another state? +

No, Colorado HealthOP is only available to Colorado residents. If you’re having trouble convincing your employees to move here, try taking them on a nice trip to see the aspens in the fall. Gets ’em every time.

Categorized as: About Colorado HealthOP , Our Plans

Can businesses join without a broker? +

Yes. Small businesses and non-profits with fewer than 50 employees can shop on Colorado HealthOP’s quoting tool, which gives them buying power similar to larger businesses.

Categorized as: Employers , Our Plans

Does Colorado HealthOP cover healthcare received out of its provider network? +

If it is an emergency, yes. We always cover our members in cases of emergency, no matter where they are. If it’s not an emergency, it depends on whether you have a PPO (Preferred Provider Organization) or EPO (Exclusive Provider Organization) plan. In our PPO plans, you can choose a provider who is outside of the Colorado HealthOP network, but your costs may be higher. In our EPO plans, healthcare received outside of the Colorado HealthOP network generally is not covered, except in the case of an emergency.

Categorized as: Our Plans , Providers

How do value-based benefits work? +

In our silver and gold plans, when a member takes three health actions (completing a health survey, biometric screening, and wellness visit), they are upgraded from our “Standard” plan to our “Enhanced” plan. In the enhanced plan, they will often pay less out of pocket when they see a doctor, and in some plans, will get money on a debit card to help pay for health expenses.

Categorized as: Our Plans

How can I become part of the Colorado HealthOP provider network? +

Contact us to learn more about partnering with Colorado HealthOP, or complete this easy form to get started.

Categorized as: Providers

How can my patients sign up for Colorado HealthOP? +

You can sign up your patients right here on our website, or by having them call (855) 697-1656.

Categorized as: Providers

What is Utilization Management (UM)? +

Utilization management (UM) or Utilization Review (UR) is how we evaluate health care services, procedures, and settings. Through a variety of techniques, we determine whether or not a procedure is experimental in a given circumstance. It’s about getting you the right care at the right time in the right way. UM or UR are a set of formal techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, effectiveness or efficiency of health care services, procedures or settings. Techniques include ambulatory review, prospective review, second opinion, certification, concurrent review, case management, discharge planning or retrospective review. UR also includes reviews for the purpose of determining coverage based on whether or not a procedure or treatment is considered experimental or investigational in a given circumstance, and reviews of a covered member’s medical circumstance when necessary to determine if an exclusion applies in a given situation.

 

Categorized as: Our Plans

Can I sign up for Colorado HealthOP if I live outside of Colorado? +

Sorry, but you have to be a Colorado resident. That said, in case you ever want to live in the beautiful Rocky Mountains, you can subscribe at CO-OP Connect to keep up with changes in healthcare and get tips on health and wellness.

Categorized as: Individuals , Navigators , Our Plans