More About Colorado’s Kaiser Permanente Benchmark Health Insurance Plan

Yesterday’s article about Colorado selecting a benchmark health insurance plan for individual and small group policies sold starting in 2014 has raised a few more questions and I wanted to clarify some details.

This publication from the Colorado Division of Insurance, the Health Benefit Exchange and the Governor’s office is an excellent resource and answers a lot of frequently asked questions.  It was released earlier this summer, before the Kaiser small group plan was selected, so it includes details about all nine options that were considered as possible benchmark plans.  The Kaiser small group plan that was ultimately picked as the benchmark is listed on page 11 as option A, under “one of the three largest small group plans in the state”.

The 2011 Colorado health insurance plan description for the Kaiser policy is here if you’re interested in the plan specifics.  We had a question from a reader who wondered whether chiropractic care would be covered, but it’s listed as “not covered” on the plan description form (item number 30).  It’s important to note that cost sharing details like deductible, coinsurance and copays are not part of the benchmark program.  The concept of benchmark here only applies to the benefits provided by the Kaiser Permanente health insurance plan.  The deductible on the Kaiser health insurance plan is $1200, but that DOES NOT mean that all policies will have to have a $1200 deductible in 2014.  In order to be sold in the exchanges, health insurance plans will have to cover at least 60% of costs in order to qualify for a “bronze” designation.  And there will also be silver, gold and platinum ratings, so there will still be plenty of variation in terms of cost sharing.

If Colorado had not selected a benchmark plan, HHS would have picked one for us.  HHS would have defaulted to the largest small group plan in Colorado, which is what the state ultimately picked anyway.  So HHS would have made the same choice as the DOI/Exchange/Governor’s office committee.

The next step (after official approval of the Kaiser health insurance plan benchmark selection next week) is for other health insurance carriers in Colorado to go over the details of the benchmark plan, come up with their own “substantially equal” plans and determine pricing.  If you have comments on the selection, you can submit them to the Division of Insurance before Monday (ehb@dora.state.co.us)

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

Comments

  1. Not liking the look of this…60% of coverage and I assume that means anything above bronze is more expensive.

    What is the qualifier for help if you can’t afford this bottom rung plan?

    • Michelle,
      Health insurance premium subsidies will be available in the exchanges starting in 2014 for people earning up to 400% of the federal poverty level (in 2012, that’s roughly $92,000/year for a family of four). The subsidies will be based on income, and you can see more details about the specifics at the bottom of the first page of this Kaiser Family Foundation brief: http://www.kff.org/healthreform/upload/7962-02.pdf

  2. Are there good alternatives? I’d love to know about them.

  3. Hi, Louise, Are you there?

    • Hi Lane,
      Yep, I’m here. We’re happy to respond to comments, but I didn’t really understand your first question about alternatives. Alternatives to what? Please elaborate and we’d be happy to get back to you. Thanks for stopping by!

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