Frequently Asked Questions

How do I decide which health insurance plan is best?

The choices can be overwhelming! The best health insurance plan for you is the one that gives you the value based on a number of considerations.

Here are a few points to remember:

  1. What copays, deductibles, and coinsurance requirements apply?
  2. How much freedom do you have to choose your own health-care providers?
  3. Does the plan cover the health services that you need?
  4. Does the plan cover the health-care providers you are currently using?
  5. Does the plan offer family, as well as individual, coverage?
  6. Does the plan cover pre-existing conditions? If so, is there a waiting period?
  7. Does the insurance company have a good reputation in the industry and a positive rating from a major ratings organization? (Contact your state’s department of insurance for more information.)

What will it cost?

In addition to the monthly premium expense, you may have other out-of-pocket costs which can add up. Check to see if the health insurance plan you are considering requires you to pay any or all of the following:

  1. Copayment: The amount you will have to pay each time you visit a health insurance provider.
  2. Deductible: The amount you will have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims.
  3. Coinsurance: The percentage of your medical costs you will have to pay after you reach any deductibles that apply.

I am in between jobs and need short term medical insurance. How broad is the benefit coverage under short term medical insurance?

Short-term medical coverage is designed to fill the temporary coverage gap that can occur when you are between permanent plans. Such a gap can occur when you are between jobs, laid off, or waiting for group coverage, among other reasons. You and your dependents may be eligible for coverage if you meet certain age, health, and U.S. residency requirements.

To keep the premiums affordable, coverage is not as extensive as that under most permanent plans, but it generally covers basic charges in the event of an accident or sudden illness. Like other medical insurance plans, short term medical coverage may subject you to copayments and benefit limits.

Generally, short term medical plan coverage includes:

  1. Your choice of doctors and hospitals
  2. Charges for inpatient and outpatient services provided by medical professionals
  3. Hospital room and board charges
  4. Intensive care unit charges
  5. Ambulance services
  6. Diagnostic lab exams and x-rays
  7. Prescription drugs

Generally, short-term medical plan coverage does not include:

  1. Pre-existing conditions
  2. Routine medical exams
  3. Dental care
  4. Pregnancy and childbirth expenses
  5. Intentionally self-inflicted injury
  6. Expenses not medically necessary
  7. Medical expenses outside the U.S

Short-term medical coverage is typically available for periods of 30 to 180 days, in Colorado. While you may be able to renew your plan, generally short-term coverage cannot continue for more than 365 total days. Coverage can often be implemented quickly, sometimes the same day that your application is received. Many insurance companies offer a choice between a single payment or a monthly premium, as well as a choice of plan deductible limits. There may be a free look period during which you can cancel your policy for a full refund.

I am adopting a child with health problems. Will I have trouble adding him to my health insurance policy?

Whether the child you are adopting has health problems that can be corrected with proper treatment, or has a medical condition that will require ongoing care, you may be concerned that your health insurance provider will refuse to cover your child because of his pre-existing condition. In general in Colorado, you may add your child to your health insurance plan within 30 days of either the adoption or the placement for adoption regardless of pre-existing conditions.

Check with your health insurance provider, though, to make sure that the treatment the child will require is covered under your policy. If the provider does not normally cover the treatment for you or your naturally born children, it will not cover that treatment for your adopted child. Check with your carrier for their procedure to add an adopted child. If your child is hospitalized when you legally adopt him, call right away to ensure that all medical claims are paid.

I am planning on living abroad for several months. Do I need special health insurance?

Taking an extended trip abroad requires an enormous amount of planning. Although it may not be foremost in your mind, your health insurance coverage is an important part of this planning. Standard health insurance plans are generally not designed to cover extended periods of international travel. Most managed care plans do cover emergency treatment regardless of where it is administered, but other types of care are typically limited to a local network of providers. Health maintenance organizations (HMOs) may pay nothing if you seek routine care from a non-network provider, while preferred provider organizations (PPOs) generally cover only a portion of these costs.

Before you go abroad, find out what coverage you will have. You may need to purchase additional insurance to cover gaps in your plan.

If a company goes out of business, are the employees eligible for COBRA even though there is no longer a health insurance policy for the company?

In most cases, no. Under the Consolidated Omnibus Budget and Reconciliation Act of 1985 (COBRA), workers who lose their jobs may have the right to continue group health care coverage under their employers’ plans. However, if the company goes out of business and no longer has a group health insurance policy in force, then COBRA coverage is no longer available. One possible exception: union employees who are covered by a collective bargaining agreement may be entitled to COBRA coverage if the agreement provides for a medical plan.

Many employees who are not eligible for group coverage under COBRA may be able to obtain group health insurance elsewhere. For instance, they may find a new job with an employer who provides health insurance or may be eligible for employer-sponsored coverage through a family member’s employer-sponsored plan. And, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the health coverage they had through their former employer may “count” towards reducing or eliminating any pre-existing condition exclusion that might apply when they seek group health insurance with another employer. In addition, there are may be other options available, depending on the circumstances.

Can I get disability insurance if I am self-employed?

Yes. In fact, as a self-employed person, disability insurance may be even more important for you than for the average employee. If you suffer an injury and are unable to work, you do not have the built-in luxury of paid sick leave to tide you over. Thus, you should take a serious look at your financial situation and decide whether your cash reserves are sufficient to carry you through an extended disability. If not, disability insurance may be a good idea for you.

If you choose to purchase it, disability insurance could be the only thing that prevents you from losing your home, your business, etc. If you are unable to work for an extended period of time because of an injury or illness, disability insurance provides a financial safety net by paying you monthly benefits until you are able to return to work. Since your business is likely your only source of income, your disability insurance policy should have as short a waiting period as possible. Several factors such as current income, health, occupation and waiting periods can affect the cost of this type of protection.

I am planning to change jobs, but I am also pregnant. Should I be concerned about qualifying for health insurance coverage?

Federal law provides some degree of protection for pregnant women who change jobs. Under the Health Insurance Portability and Accountability Act (HIPAA), pregnancy cannot be considered a pre-existing condition in most circumstances. Although group health insurance policies in Colorado provide coverage for maternity care and pregnancy, it is important to check the specifics of your new employer’s health insurance plan to make sure you understand how you are covered.

You may be eligible for coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act) through your former employer. This will generally require you to pay the full premium. Keep in mind that some employers do not provide health insurance coverage at all. And being caught without group health insurance can be a serious problem for a pregnant woman. As you can see, it is important to do some careful planning before making a career move when you are pregnant. To protect your health and the health of your baby, make sure you completely understand the employer’s health insurance plan and eligibility requirements before accepting a new job.