Customer Support 

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Broker Relationship and Compensation

Broker Relationship and Compensation

Broker Appointments with Carriers

  • The Board voted on August 27, 2012 to adopt guiding principles, including that COHBE should partner with brokers and agents, that broker and agent compensation should be comparable inside and outside the Exchange, that brokers and agents are able to participate in both the Individual and the SHOP Exchanges, and that individuals and small businesses should NOT be required to use a broker or agent.
  • The Board voted on March 11, 2013 to adopt the guiding principle that all carriers doing business through the Exchange, except those who do not market their products through brokers, be required to appoint all brokers who are certified by the Exchange for the sale of their products within the Exchange. COHBE is willing to allow carriers to wait until the first business is placed before carriers actually appoint brokers as long as carriers review the list of prospective brokers and make known their concerns about the ones they consider unacceptable before that broker starts the certification program.

Carrier Dedicated Sales Teams

Carrier Dedicated Sales Teams

Consumer Feedback on Notices Regulated by DOI

  • The Board voted on April 8, 2013, to allow Exchange QHPs to be offered to consumers via carrier dedicated sales teams. COHBE will work with the Division of Insurance in any disclosure notifications that they require of carriers to send to consumers. Consumers will also be notified that they have the option to provide their financial information directly to the Exchange.

Connect for Health Assistance Network

Conflict of Interest Policy

  • The Board voted on February 11, 2013 to adopt the Conflict of Interest Framework for Assistance Sites and Health Coverage Guides.

Customer Service Center Policy

Customer Service Center Policy

  • The Board voted on August 27, 2012 to adopt guiding principles, including that there should be customer service offered in multiple languages, that the customer service center should refer people to public programs for which they qualify, and that the customer service center should be staffed by representatives that can educate, provide assistance and answer questions as well as licensed staff who can advise on plan choice.

Navigator Role and Compensation

Navigator Role and Compensation

  • On August 27, 2012 the Board voted on guiding principles including definitions, broad selection criteria, funding model, training and certification, oversight and ongoing stakeholder feedback and assessment of needs.

Eligibility and Enrollment 

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Approach to Interoperability with State IT Systems

Minimum Interoperability Approach and Background Analysis

  • The Board voted on March 12, 2012 to establish minimum interoperability with the state Medicaid/CHP system, including the shared use of an eligibility determination system and sharing of customer data.

Facilitated Enrollment:

Facilitated Enrollment

Consumer Feedback on Notices Regulated by DOI

  • On April 8, 2013, the Board voted to allow COHBE to partner with carriers and stakeholders to develop an approach that allows carrier’s existing consumers to make an active Exchange product selection directly from their carrier. In this process, consumers should be notified of the Exchange and their right to shop in the market, but they should not be required to do so.

Certification of Exemption from the Individual Mandate

Overview of Certification of Exemption from Individual Mandate

Response to Questions Related to Certification of Exemption from the Individual Mandate

Table of Exemptions & System Verification Requirements

  • The Board voted on June 11, 2012 to use the federal service for certifying exemptions from the individual mandate in its initial years of operation and to review the decision after the initial operating period.

Management of Eligibility Appeals

Management of Eligibility Appeals

  • The Board voted on July 9, 2012 to adopt guiding principles that include implementing a process to handle appeals in the areas in which the Exchange has control, directing people to the programs for which they are eligible, building a technology solution that will facilitate a “no wrong door” approach to coverage options, adopting best practices to ensure the verification and appeals process is automated as much as possible, and defining a process for individuals and employers to verify their information and appeal eligibility decisions.

Single Streamlined Application (Uniform Enrollment Application)

Single Streamlined Application

  • The Board voted on August 13, 2012 to use the baseline application data elements set forth in federal guidelines, with the addition of primary care provider, gender neutral identifiers and inclusive relationship reporting terminology, and to clarify what is needed to properly screen for eligibility.

Financial

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Financial Reporting Requirements and Audit Requirements

Financial Reporting Requirements and Matrix

Audit Requirements

  • The Board voted on May 30, 2012 to provide financial reports that are required under state law and federal grant regulations and to make them available to the public.
  • The Board voted on May 30, 2012 to comply with audit requirements related to federal grants and state law and to follow best practices, including the use of an A-133 Financial and Single Federal audit for the period when the Exchange is grant-funded.

Premium Aggregation

Payment Options and Premium Aggregation in SHOP Exchange

Payment Options and Premium Aggregation in Individual Exchange

Response to Questions from Board about Payment Options and Premium Aggregation

Premium Aggregation Comments from CAHP

Premium Aggregation Comments from CCLP

Premium Aggregation Comments from Diane Dunn

Premium Aggregation Comments from Diane Dunn

Premium Aggregation Comments from CCHI

Premium Aggregation in SHOP

Premium Aggregation in the Individual Exchange (with use cases)

  • The Board voted on April 23, 2012 to provide premium aggregation in the SHOP and conduct a study later to determine if COHBE should also offer the option for employers to pay directly to carriers.
  • The Board voted on April 23, 2012 to not aggregate payments in the Individual Exchange since the Exchange is required to allow individuals to pay directly to carriers.

Consultant Procurement Policy

Consultant Procurement Policy

  • The Board voted on June 11, 2012 to add a section about consultant procurement to the organization’s Procurement Policy, including encouraging procurement from Colorado-based businesses and additional non-discrimination factors.

Sustainability and Administrative Fees

Sustainability and Administrative Fees in Year 1

  • The Board voted on March 11, 2013 to support a balanced revenue approach, minimizing operational risk through the use of a multi-revenue source model.
  • The Board voted on March 11, 2013 to approved a carrier administrative fee for products being sold on the Exchange at 1.4% of premium for 2014.

Health Plan and Carrier Certification

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Certification, Recertification and Decertification of Health Issuers and Qualified Health Plans

Presentation on Certification, Recertification and Decertification of Health Issuers and Qualified Health Plans

Comment Letter from Colorado Community Health Network

Certification of Insurers & Qualified Health Plans (Part 1)

Certification of Insurers & Qualified Health Plans (Part 2)

Carrier Participation Requirements Recommendations

  • The Board voted June 25, 2012 on an approach for addressing plan certification requirements in the areas of accreditation (2-year transition period for accreditation), developing a process for addressing complaints, collecting claims payment data and financial data and providing that information on our website, including formulary and provider information for shoppers, working with the Co. Division of Insurance and partners to validate licensure, gather Medical Loss Ratio information, assist with network adequacy issues, out-of-network payment disclosures, rate review, and solvency requirements.
  • The Board voted on August 27, 2012 to acknowledge the Exchange cannot duplicate the role of the Co. Division of Insurance, which will define the requirements for validation of essential health benefits, discriminatory benefit design and plan differentiation, to require qualified health plan marketing materials to include any connection with the Exchange, to protect Exchange logos, and to expand the federal provider list for Medicaid to include essential community providers and to include the evaluation of essential community provider coverage in existing network adequacy requirements validation through the Division of Insurance.
  • The Board voted on Nov. 26, 2012 to instate a 1-year waiting period for plans that choose not to sell on Exchange in 2014 and a 2-year wait for plans that participate in the Exchange and then voluntarily leave.

Healthcare Reform Policy

Updated October 12, 2018

We continue to monitor potential changes to healthcare policy at the state and federal levels. We offer some background information resources below. Formal presentations to the Connect for Health Colorado Board and other materials pertinent to potential impacts to the future of healthcare policy will also be included on this page.

January 11, 2018

The Connect for Health Colorado Board of Directors’ letter in support of long-term funding authorization for CHP+, Colorado’s Child Health Plan Plus

May 11, 2017

Priorities for Health Reform, adapted by Connect for Health Colorado from the National Health Reform Agenda: Critical Elements for Assuring Patient/Consumer Access to Care

November 28, 2016

Post Election 2016: Potential Impacts to Connect for Health Colorado – A presentation to our Board Policy Committee

November 15, 2016

Colorado Commission on Affordable Health Care – A report to the Colorado General Assembly and the Colorado Governor

November 17, 2016

Health Care Cost Conversation – A public meeting hosted by the Division of Insurance, Colorado Department of Regulatory Agencies

January 31, 2008

Blue Ribbon Commission for Health Care Reform – Final report to the Colorado General Assembly

July 12, 2018Risk Adjustment Program- Letter to U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services from the State Health Exchange Leadership Network in support of the risk adjustment program.

Insurance Market

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Administrative Structure and Risk Pool

Approach to Merging Risk Pools and Administrative Structure of COHBE

  • The Board voted on Feb. 27, 2012 to have one administrative structure that operates separate Individual and SHOP Exchanges.
  • The Board voted on Feb. 27, 2012 to keep the individual and small group (SHOP) risk pools separate and revisit the issue within two years after the Exchange opens

Open Enrollment and Mid-Year Plan Changes

Open Enrollment & Mid-Year Plan Changes

  • The Board voted on July 23, 2012 to establish open enrollment periods for the Individual and SHOP exchanges that align with federal guidelines (Oct 1, 2013 to March 31, 2014, for the first year and Oct 15, 2014 to Dec 7, 2014, for the 2015 plan year. There would be no special open enrollment period for members who are terminated for failure to pay premiums.

Small Group Market Size

Proposed recommendation to Division of Insurance

Small Group Size Policy Issue

Small Group Size: Response to COHBE Board Questions and Public Comment

  • The Board voted on April 23, 2012 to recommend that the Colorado Division of Insurance limit the size of the small group market to 50 employees in 2014 and 2015

Organizational Policies

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Section 1557 Nondiscrimination Policy

Nondiscrimination Policy

  • As required by Section 1557 of the Patient Protection and Affordable Care Act (“PPACA”) and its implementing regulation, Connect for Health Colorado, its employees and associated entities shall not, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under and public programs administered by the Marketplace.

Complaint Management Policy

Complaint Management Policy

  • The Board voted on August 13, 2012 to adopt guiding principles, including creating a formal process for accepting complaints through a standardized form and for reviewing and addressing all submitted complaints, addressing complaints in a timely manner, handling complaints within its jurisdiction, serving as a liaison to other organizations when another party can address the issue more effectively, recording all complaints submitted through the official intake, training staff and customer service representatives about complaint management training.

Individual and Employer Rights & Responsibilities

Individual and Employer Rights & Responsibilities

  • The Board voted on September 24, 2012 to adopt guiding principles, including that the Exchange will protect the rights of employers and individuals according to state and federal laws, that the Exchange will facilitate a discussion when a complaint is filed, that the Exchange will provide educational materials to Coloradans about rights and responsibilities and that service representatives will be trained to answer questions about this.

Public Policy Approach

Public Policy Priorities Approach

  • On October 12, 2015 the Board voted to accept an amended Legislative Approach that broadens how the Board will engage in public policy issues that impact the Marketplace’s mission and goals.

COHBE Board Legislative Approach

  • On January 14, 2013 the Board voted to accept a Legislative Approach that outlines how the Board will engage with issues at the Colorado General Assembly that relate to the continued functioning of the Exchange.

Organizational Tax Structure

Organizational Tax Structure

  • The Board voted on Nov. 12, 2012 to apply for federal 501c3 status in addition to Section 115 status, to clarify the organizations tax exempt and public nature.

Protecting from Fraud, Waste & Abuse

Fraud, Waste & Abuse Policy

Fraud, Waste & Abuse – Subscriber Data

Fraud, Waste & Abuse – Health Plans

Fraud, Waste & Abuse – Technology

Fraud, Waste & Abuse – Security

  • The Board voted on June 11, 2012 on a framework to develop internal controls and processes to ensure proper financial operations that will be monitored by Board committees.
  • The Board voted on September 24, 2012 to adopt guiding principles for implementing adequate controls to balance the need to guard against fraud with allowing customers to purchase plans in a timely manner and that subscriber data will be obtained through self-attestations.
  • The Board voted on November 12, 2012 to include specific contract language to ensure that carriers comply with the False Claims Act, including policy, process and internal training and management of activities.
  • The Board voted on December 10, 2012 to follow a 6-step approach, including the hiring of an IV&V firm, to control, monitor and prevent fraud, waste and abuse with technology systems and contractors.
  • The Board voted on December 10, 2012 to implement an Information Security and Privacy Program that will meet numerous established security standards and includes specific roles and responsibilities for COHBE staff and technology vendor staff to ensure proper protection of information assets.

Shopping Experience

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Display & Pricing of Supplemental Plans

Display & Pricing of Supplemental Plans

  • The Board voted on July 23, 2012 to build a technology solution that will accommodate the display and pricing of embedded, bundled and stand-alone dental and vision plans.

Display of Quality Information

Display of Quality Information

Quality Metrics Presentation

Recommendation from AARP on Quality Indicators & Measures

Letters to the Board regarding Quality Indicators and Measures

Kaiser Permanente

Colorado Consumer Health Initiative

Rocky Mountain Health Plans

SeeChange Health

Denver Health

  • The Board voted on Sept. 24, 2012 to provide quality ratings for health plans offered on the Exchange.
  • The Board voted on Oct. 8, 2012 to provide a CAHPS composite rating and link to HEDIS information as well as other appropriate metrics about health plan quality.

Standard Comparative Plan Information:

Standard Comparative Plan Information

  • The Board voted on July 9, 2012 to create a comparative plan tool that includes premium and cost-sharing information, summary of benefits and coverage, limitations or exclusions in plans, prescription drug co-pays and qualified health plan identification and the ability to filter plans by specific details, including providers, health conditions treated through special programs in plans, domestic partner coverage information and quality ratings.

Supplemental Plans and Additional Benefits:

Supplemental Plans and Additional Benefits Policy Issue

Response to Questions about Supplemental Plans and Additional Benefits

Comment Letter from Rocky Mountain Health Plans

Comment Letter from Denver Health

Comment Letter from Colorado Eye Care Specialists

Comment Letter from Anthem Blue Cross and Blue Shield

  • The Board voted on May 30, 2012 to create the technology to support the selection and comparison of supplemental plans and additional benefits/products that comply with certification requirements.

Small Business

Please note that prior to May 6, 2013, Connect for Health Colorado was known as the Colorado Health Benefit Exchange (COHBE), the legal name created by SB 11-200.

Defined Contribution:

Employer/Employee Choice – Contribution and Participation

Addendum: Employer/Employee Choice – Contribution and Participation

The Board voted to approve the SHOP Advisory Group recommendations:

  1. COHBE should adopt employer contribution requirements that emulate the outside market,
  2. COHBE should adopt a participation requirement that emulates the outside market, and
  3. COHBE should generate tools to help employers pick their actual contribution amount (i.e., percentage, flat dollar amount – defined contribution, reference pricing). Options should not be too complex, in compliance with state and federal laws, technically feasible, and meet employers’ needs.
  • The Board voted on Nov. 12, 2012 to adopt an approach that the Exchange should emulate employer contribution and employee participation requirements that exist in the broader market outside the Exchange, and should generate tools to help employers pick their actual contribution amount.

Employer and Employee Choice Architecture:

Employer & Employee Choice

Employer & Employee Choice- Appendix 1

Employer & Employee Choice- Appendix 2

Employer & Employee Choice- Appendix 3

  • The Board voted on July 9, 2012 and July 23, 2012 to allow employers to offer employees a single Qualified Health Plan and plans in a single cost-sharing (metal) tier.
  • The Board voted on July 23, 2012 to allow employers to offer employees a panel of qualified health plans from a single carrier representing an actuarial value range that is as extensive as the carrier offers outside of the exchange, any plan that is offered in two adjacent metal tiers, or a subset of any of the four groups of options.