Frequently Asked Questions (FAQs) Regarding Colorado HealthOP Can I enroll in or renew a Colorado HealthOP plan through for 2016? No. Plans from Colorado HealthOP will not be available for 2016, either through Connect for Health Colorado or off of the exchange. 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, 2015 and continues through Jan. 31, 2016.  To make sure that coverage starts on Jan, 1, 2016, and avoid a gap in coverage, members must enroll before December 15.  If you enroll between Dec. 16 and Jan. 15, 2016, your coverage will become effective on Feb. 1, 2016.  If you enroll between Jan. 16 and Jan. 31, your coverage will become effective on March 1, 2016. If you are a small employer with small group coverage from Colorado HealthOP, your small group policy will terminate December 31, 2015. You will also need to select coverage from another carrier to be effective January 1, 2016 to avoid a gap in your employees' coverage. What happens to my current Colorado HealthOP coverage? When will it expire? For individual policyholders, your current coverage will remain effective until December 31, 2015. For those with small group policies, your coverage will also terminate December 31, 2015, and your employer will have to choose a plan from another carrier to be effective January 1, 2016 to avoid a gap in coverage. Contact your employer or employer's human resources office for more information about your options. 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, December 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 at866-915-6619, or contact the Colorado Division of Insurance at 303-894-7490 or 800-930-3745 (outside the Denver Metro area). Why did this happen? On October 8, the Centers for Medicaid and Medicare (CMS) announced that it would only reimburse the nation’s health insurers 12.6% 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? The Division has reviewed each carrier to assess the financial impact of the reduced payments and has determined that no other carrier was impacted enough as to raise questions to their continued sustainability.

FAQs - HealthOP action.pdf

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