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Colorado
Individual & Family Health Insurance Plans
Can I purchase health insurance for just my child/children without having to purchase health insurance on me?
Yes! You can purchase health insurance for just one or more children. Some carriers will allow you to purchase one policy for all your children. The youngest child is the primary policy holder, and all the other children will receive a dependent child rate. Other carriers will require you purchase a separate policy for each child. Please call us for help in determining the best carrier for your situation.
How soon can I have health insurance coverage?
The date you can start coverage depends on the health insurance carrier you have chosen. For example, Anthem (Blue Cross/Blue Shield) allows you to have coverage within 24 hours of submitting your application (assuming that your application is approved). While the underwriting process generally takes a few weeks and you may not know whether you have coverage during that time, if you are approved the carrier will provide coverage to the date you requested and pay any claims incurred within that time.
Am I guaranteed coverage on an individual/family plan?
All individual plans require underwriting. The application includes questions about your health conditions over the last 5-10 years. Some carriers will compare the information you provide with an insurance database to see if any other carriers have reported any claims you may not have disclosed. With some conditions, the carrier may request additional records from your doctor before making a decision on your application. The underwriter has the option of accepting or declining your application or putting riders on certain conditions. If you have any pre-existing conditions, please call Roper Insurance at (303) 721-1145 so we can help you find the carrier most favorable for your conditions. If you have your own business, we may be able to arrange a group plan for you with guaranteed coverage.
What happens if I don't disclose a pre-existing condition on my application?
If the carrier finds out that you did not disclose a pre-existing condition, they have the option of refunding all premiums (minus any claims paid) and cancelling your policy as if it never existed. They understand that you may not have remembered a sinus infection you were treated for 3 years ago, but they will certainly expect you to remember treatment in the last 6-12 months and all the major health issues you had in the last several years. It's best to be as honest as possible on the application to make sure you have coverage in place.
Do individual and family plans provide maternity coverage?
As a general rule, individual and family plans do not cover maternity. There is currently one plan available and a few other plans with maternity riders. By Colorado law, all plans must cover any complications of pregnancy, but not prenatal care or a routine delivery. Please call Roper Insurance at (303) 721-1145 for more details.
I'm pregnant now -- can I get coverage?
At this time, no individual plan will accept an applicant that is expecting a child. This includes a man whose wife is pregnant or a couple considering adoption. Colorado law requires that children be added to the parent's plan if the coverage is requested within 30 days of birth or adoption. The risk of having to accept a child with potential birth defects or other pre-existing conditions is too high for all current carriers. If you had the plan prior to the pregnancy, then the carrier would have to accept your child upon birth or adoption.
What is a PPO (Preferred Provider Organization) plan?
PPO Plans are health insurance plans that contract with preferred providers to offer medical services to plan participants at a reduced rate. The insured has the choice to use in-network or out-of-network providers. They will pay more out-of-pocket costs if they use out-of-network providers.
What is an HMO (Health Maintenance Organization) plan?
Each member pays a premium for which he receives medical care when desired. The emphasis is on preventative medicine, and a primary care physician gives medical care and generally controls access to specialists. Other than emergency care, there is usually no out-of-network coverage.
What is an HSA (Health Savings Account)?
An HSA is a tax-favored account that allows eligible individuals covered by a qualified high-deductible health plan (HDHP) to pay for current and future qualifying medical expenses tax-free. By law, the HDHP cannot allow copays for office visits or prescriptions. These expenses must be allocated to the deductible.
How much can I contribute to an HSA?
The maximum contribution is the lesser of the deductible amount under the High Deductible Health Plan (HDHP) or (for 2006) $2,700 for individuals or $5,450 for family coverage. These dollar limits will be adjusted for inflation each year and are based on a full year of participation in an HDHP.
A co-pay represents the payment made by the insured at the time medical services are received. For example, an insurance policy may require the insured to pay a $25 co-pay for office visits or $100 co-pay for emergency room visits. Once the insured pays the co-pay, the insurance company will pay the remaining charges.
The initial amount of covered medical expenses an insured must pay before the insurance company will pay for medical expenses. Most deductibles are fixed-dollar amounts that apply separately to each person under a health insurance policy.
After the deductible is paid, the next provision is coinsurance. Coinsurance is a split between the insured and the insurance company. The most common split is 80/20. For example, if an insured has a $1,500 medical bill, a $500 deductible, and an 80/20 coinsurance provision, the insured will pay the first $500 (the deductible), and $200 (20% of $1,000). The insurance company pays the remaining $800 (80% of $1,0000). Most plans put a limit on the amount of coinsurance you will have to pay -- this is generally referred as to the out-of-pocket maximim. Some carriers include the deductible in their out-of-pocket maximum -- others do not.
What is an in-network provider?
In-network providers are paid on a fee-for-service basis. They usually have a contract with the carrier that specifies what they will be paid for each procedure. Most plans provide incentives for insureds to use in-network providers, including such benefits as the use of copayments and lower costs for services and lower deductibles and/or coinsurance rates.
What is an out-of-network provider?
Out-of-network providers do not offer discounts for their services. If an insured obtains services from an out-of-network provider, the health insurance company will require the insured to pay more for their services. In addition to the increased deductible and/or coinsurance rates, the insured may be responsible for paying costs that exceed reasonable and customary charges.
How do I know what is the best health insurance plan for me?
Finding the best health insurance for you can be overwhelming. There are several different health insurance companies to compare and calling each company can be time-consuming. By contacting an agent at Roper Insurance (303) 721-1145, you can find the best rates and health insurance plan for your needs. We listen to your needs and help you find the plan that works best for your situation.
What is the difference between buying health insurance from Roper Insurance or buying insurance directly from the insurance company?
At Roper Insurance we pride ourselves on our fast-friendly, personalized customer service. We represent all the major insurance companies and offer the guaranteed lowest rates available. There is no charge for quotes, and the rates are the same whether you go directly through the insurance company or through us. The difference is:
- We serve as your personal assistant by taking care of all of the legwork for you (price shopping, comparing benefits and providers, etc.)
- We are also an advocate and use our experience to deal directly with the insurance company on your behalf when needed.
How do I pay the health insurance premiums?
You can pay the health insurance company by check or credit card in most instances. Most health insurance companies require that you pay the first month's premium when you submit your application.
When I apply for health insurance, does this obligate me to buy?
You can cancel your policy at any time. Once you are approved, you will have a 10-day free look period. In order to receive a full refund, you must cancel your coverage in writing during the free-look period.
How can I receive the best insurance prices?
Since Roper Insurance is an independent broker, we can sell for several different health insurance companies. By using Roper Insurance, we will help you find the best prices for health insurance.
Who do I contact if I need help applying for health insurance?
If you need help applying for health insurance, you can contact Roper Insurance. We have knowledgeable agents who can help answer your questions. Just call us at (303) 721-1145 or toll-free at 1-877-ROPER11.
Colorado Group Health Insurance
Why should I provide health insurance for my employees?
There are several reasons why an employer should provide health insurance to employees. Health insurance is a critical benefit for employees and is often a key factor in attracting and keeping key employees. Additionally, accessibility to health insurance and health benefits can help employees maintain a quality of life essential in retaining a quality workforce and can increase employee loyalty.
Can an employer decide which employees receive health insurance?
Employers can specify whether management, supervisors, or all employees are eligible for health insurance benefits. To qualify as an employee, they must work a minimum of 24 hours per week. The employer can set the minimum hours per week required at any amount from 24 to 40 hours per week. The employer will also determine how long each employee must work for the company before they are eligible for coverage. Typical waiting periods are the first of the month following 30, 60, or 90 days after the date of hire, depending on the industry and growth of the company.
Does an employer have to cover 100% of the employee's premium?
The employer can pay as much as 100% of the employee's premium and 100% of the employee's dependents' premium. The carrier will require the employer to pay a minimum of 50% of the employee premium (nothing for the dependents). Anthem is the exception in allowing the employer to pay a flat amount ($125 minimum) for each employee rather than the percentage if they wish. The portion of health insurance premium paid by the employer is tax-deductible.
Does a company's zip code or county affect the premiums they will pay?
The county and zip code are important in determining the company's rates. Insurance companies will offer a discount or an increase in premiums based on the company's county and zip codes. As a general rule, costs tend to be higher in rural areas where there is less competition among healthcare providers.
How are the health insurance rates calculated for my company?
Age of employees and ongoing health conditions are huge factors in determing the rate your company will pay. In the small group (under 50 employee) market, carriers issue "standard rates," and these are the rates we quote. The rates will vary for each employee based on their age. For groups of 10 employees or more, the carriers offer "composite" rates where the total costs are averaged and each employee costs the same no matter what their age, but the total company costs are initially calculated based on average employee age. Part of the application process also includes health questionnaires for each enrolling employee. Based on these questionnaires, the carrier can adjust the final rates up by as much as 10% or discount them as much as 25%.
What is a PPO (Preferred Provider Organization) plan?
PPO Plans are health insurance plans that contract with preferred providers to offer medical services to plan participants at a reduced rate. The insured has the choice to use in-network or out-of-network providers. They will pay more out-of-pocket costs if they use out-of-network providers.
What is an HMO (Health Maintenance Organization) plan?
Each member pays a premium for which he receives medical care when desired. The emphasis is on preventative medicine, and a primary care physician gives medical care and generally controls access to specialists. Other than emergency care, there is usually no out-of-network coverage.
What is an HSA (Health Savings Account)?
An HSA is a tax-favored account that allows eligible individuals covered by a qualified high-deductible health plan (HDHP) to pay for current and future qualifying medical expenses tax-free. By law, the HDHP cannot allow copays for office visits or prescriptions. These expenses must be allocated to the deductible.
How do I know what is the best health insurance plan for me?
Finding the best health insurance for you can be overwhelming. There are several different health insurance companies to compare and calling each company can be time-consuming. By contacting an agent at Roper Insurance (303) 721-1145, you can find the best rates and health insurance plan for your needs. We listen to your needs and help you find the plan that works best for your situation.
Short-Term Health Insurance
When would you apply for short-term/temporary health insurance?
There could be several reasons why an individual would need to apply for short-term health insurance. For instance, individuals might need short-term health insurance if they are between jobs and only need coverage temporarily. In addition, short-term insurance is often purchased when individuals are waiting for employer-sponsored coverage to begin, thus avoiding a gap in coverage. This becomes important for individuals since insurance companies typically require new clients to serve a probationary period on health insurance if they have had 90 or more days of non-coverage. During a probationary period, health insurance plans do not cover pre-existing conditions. The probationary period for group coverage is 6 months and for individual coverage is 12 months.
Will purchasing a short-term/temporary health insurance plan prevent any gap in coverage and avoid pre-existing waiting periods?
Yes. If an individual has more than 90 days of non-coverage, they will have a probationary period on health insurance. During a probationary period, pre-existing conditions will not be covered by health insurance plans. The probationary coverage for group plans is 6 months and for individual coverage is 12 months.
After the application is received, insurance coverage begins at 12:01 a.m. on the effective date selected by the applicant.
What is the length of short-term/temporary health insurance coverage I can purchase?
The length of coverage for short-term health insurance can be from 30-185 days.
Can I purchase short-term/temporary health insurance every month?
You can purchase short-term health insurance only twice a year. You may want to consider purchasing the maximum length of time of 185 days if you are not sure the exact number of days you will need short-term health insurance coverage. Some carriers offer the option of month-to-month coverage, but rates are typically about 30% higher.
Which payment option is best for me?
There are two options you can choose from: the single payment option or the monthly payment option. If you know the exact number of days you will need coverage, the single payment option will save you money. If you are unsure about the length of time you will need temporary coverage, choosing the monthly payment may be the better option. Although it will be more expensive, you will not have to worry about unused premiums if you cancel the policy. If you choose the single payment option and cancel prior to the end of the policy period, you will not receive any refund of premiums.
What are the requirements to qualify for short-term health insurance coverage?
If you are a healthy individual between the age of 30 days and 64 years 11 months and have a temporary insurance need, you may apply for short-term health insurance coverage. In addition, dependent children may be covered under their parent's plan through age 18 or through age 24 if they are a full-time student.
Am I guaranteed coverage on the short-term plan?
No. Most plans will accept you unless you have a history of heart disease, cancer, emphysema, Crohn's disease, AIDS/HIV, stroke, kidney disorder, diabetes, alcoholism, obesity, or if you are currently pregnant or have been denied coverage for any other health condition that is still present. The short-term policy will not cover any pre-existing conditions including medications. They will cover any new conditions that arise or any accidents.
If I apply for an insurance plan, am I obligated to buy?
No. You may cancel your short-term health insurance policy at any time while it is in the underwriting stage. However, once the policy is approved and the effective date begins, you must cancel the policy within the 10-day free-look period in order to receive a refund. Any application fees are generally not refunded.
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