Summary of Colorado’s Standardized Health Benefit Plan
The Colorado Division of Insurance (DOI), within the Department of Regulatory Agencies (DORA), released the draft proposed regulation that would establish the requirements for the Colorado Option standardized health benefit plan. Beginning January 1, 2023, the Colorado Option will be offered at the bronze, silver, and gold tiers in the individual and small group markets.
The proposed regulation will take effect on March 17, 2022. Carriers have until May 1, 2022, to notify DOI if they cannot offer the Colorado Option at the premium rate target – a five percent premium reduction from 2021 filed premium – for benefit year 2023. DOI will review standardized plans in the May through July and release standardized plan rates in September or October. The Colorado Option will be available for purchase in November.
Background
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.
Standardized Health Benefit Plan
Table 1 summarizes the standardized plan designs across bronze, silver, and gold tiers. Carriers will also be required to meet current federal and state requirements (e.g., essential health benefits). If DOI determines a carrier’s standardized plan does not comply with financial requirements and quantitative treatment limitations under the Mental Health Parity and Addiction Equity Act of 2008, then DOI will modify the cost sharing structure to meet those requirements.
Gold and silver Colorado Option plans would cover all primary care visits, behavioral health visits, and prenatal and postnatal visits with no cost-sharing. Bronze plans would provide first-dollar, pre-deductible coverage for the first three visits for each type before a $50 copay would be required.
All three metal tiers would cover certain diabetes self-management education with $5 co-sharing and the Colorado QuitLine for tobacco cessation program with $0 cost-sharing.
The draft proposed regulation also includes plan designs for standardized silver cost sharing reduction plans (73% AV, 87% AV, and 94% AV) that are only required to be offered in the individual, on-Exchange market.