Summary of Colorado’s Draft Standard Health Benefit Plan
The Colorado Division of Insurance (DOI), within the Department of Regulatory Agencies (DORA), recently released a draft of the preliminary emergency regulation that would establish the standardized health benefit plan (i.e., Colorado Option). Beginning January 1, 2023, the standardized plan will be offered at the bronze, silver, and gold levels in the individual and small group markets.
Under House Bill 21-1232, the standardized benefit design must be developed through a stakeholder engagement process with a targeted focus on soliciting input from a diverse cross-section of organizations and communities. Additionally, the standardized health plan must be designed, with input from consumer stakeholders, to improve racial health equity and decrease racial health disparities. Improving perinatal health care coverage and providing first-dollar, pre-deductible coverage for certain high-value services, such as primary and behavioral health care, are among the health equity-focused strategies delineated in the law.
In the draft preliminary regulation, DOI proposes the Colorado Option to include the following coverage. Notably, DOI seeks to waive the actuarial value (AV) de minimis ranges under federal regulation in its draft version of the Section 1332 Innovation Waiver Request due to the standardized plan requirements and the 15% premium reduction requirement (by 2025) of the Colorado Option. Additionally, DOI is concerned that, under current federal regulations, non-Colorado-Option plans could offer “plans at a lower AV that are inequitable and exacerbate health disparities.”
With support from Arnold Ventures