Jay recently worked with a client who was concerned that her employer’s mini-med policy would prevent her from qualifying for CoverColorado. She has access to a group plan through work, but it has a $20,000 maximum benefit, which wouldn’t go far in the event of a serious illness or injury. Instead of accepting the mini-med coverage, she opted to keep her individual policy through World Insurance, but has recently found out that World is no longer going to be providing individual health insurance in Colorado.
She called CoverColorado to see if she could get coverage there, and was told that since she has access to a group health insurance policy, she’s not eligible for CoverColorado. I wanted to double check this, and just called CoverColorado myself. I explained the situation, and was specific about the fact that the group plan in question is a limited benefit “mini-med” plan that has been granted a waiver by HHS but has a very low maximum benefit.
The person I spoke with at CoverColorado checked with a supervisor and then told me that mini-meds are an exception to CoverColorado’s rule banning eligibility for people who have access to group health insurance. In order to qualify, the applicant has to provide the usual proof of eligibility along with proof that their employer’s group health plan is a mini-med. This can be the declarations page from the policy or marketing materials for the plan (which now have to include language indicating that the plan has been granted a waiver by HHS and does not meet the minimum benefit requirements defined by the PPACA).
Hopefully this will clarify things for others in a similar situation. Normally, access to a group health insurance policy (even if it’s one you don’t like or your doctor isn’t on the network, etc.) makes a person ineligible for CoverColorado. But if that group plan happens to be a mini-med and you also meet the other eligibility criteria for CoverColorado, you can submit an application to CoverColorado.