Search Results for : payer of last


What is the role of the Colorado Division of Insurance in reviewing health insurance plans and rates?

As part of its role in implementing the Affordable Care Act (ACA), the Colorado Division of Insurance (DOI) reviews individual and small group health insurance plans to be sold in the Colorado market. DOI looks at proposed premiums and any changes to the plans, to determine what is and is not justified. DOI also ensures that the plans comply with the Affordable Care Act (ACA) and Colorado health insurance laws and regulations.

DOI helps ensure a competitive marketplace for health insurance companies in Colorado, which provides consumers with a wide variety of choices. For more than 40 years, DOI has reviewed rate and benefit changes requested by health insurance companies.


Can I update or change information on my online application before it is submitted?

Yes, you can make changes to your online application before it is submitted. After each section of information gathering there is a Summary Screen of the information you provided. You can edit the information you provided on the Summary Screen.  You should not complete a new application since this will cause a delay in you receiving a decision. You can also change answers to parts of your application by using the back buttons in the application up until the last Summary Screen. If you would like to add more people to the application, you must do this from the Summary Screen using the “Add” button.

If you need to make changes to your submitted online application and you did not receive an immediate decision as to whether you qualify for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+), you can call the Medical Assistance Site at 1-800-359-1991. The Medical Assistance site can help you make changes to your submitted application over the phone. Do not complete a new application since this will cause a delay in you receiving a decision.

If you did receive an immediate decision as to whether you qualify for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+),  you can log in to your PEAK account and make changes through the Report My Changes function. You must have a PEAK account to access Report My Changes. Do not complete a new application since this will cause a delay in you receiving a decision.

You will not be able to change identity information such as name spellings or Social Security Numbers through Report My Changes.  To correct any incorrectly entered information you need to contact your local county Human Services office.


Out-of-Pocket Maximum/Limit

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. For private insurance this limit never includes your premiums or health care the plan doesn’t cover. Some health insurance plans don’t count your co-payments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.