Division of Insurance releases preliminary 2017 health insurance information

Final approval expected in late September / early October.

DENVER (June 6, 2016) – The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), today released the preliminary information for proposed health plans and premiums for 2017.

The DOI confirmed that four insurance companies either will not offer or will significantly cut back individual plans (non-employer) next year. A new entrant into the Colorado market will sell plans in the individual market. And a number of companies currently offering individual plans are seeking significant premium increases for their 2017 individual plans.

“As we prepare for the fourth open enrollment of the Affordable Care Act, it’s worth noting that we’re still in the stabilization phase,” said Colorado Insurance Commissioner Marguerite Salazar. “Companies are still figuring it out — where to sell, how to sell, how to price — which is why we’re seeing some companies pull back on individual plans or requesting significant increases, while still other companies are coming into the market. Some companies have done a better job of figuring out how to operate in this new environment and compete for people’s business, while others must step back and reevaluate their approach.”  

Rocky Mountain Health Plans / Anthem PPO

As noted in a May 13 release, UnitedHealthcare and Humana Insurance will not offer individual plans in 2017, which impacts approximately 20,000 consumers in Colorado (UnitedHealthcare – 10,549; Humana – 9,914). In addition, Rocky Mountain Health Plans (RMHP) determined that it will reduce individual plan offerings for 2017, offering individual plans only in Mesa County, only via its Monument Health affiliate. Approximately 10,000 people currently enrolled in an individual RMHP plan will have to find another plan for 2017.  

In addition, Anthem Blue Cross and Blue Shield decided it will not offer its PPO (Preferred Provider Organization) individual plans for 2017, which impacts 62,310 people. However, Anthem will continue to offer HMO (Health Maintenance Organization) individual plans statewide, and these plans will be available to all consumers affected by the PPO decision. 

All of these companies will continue to offer their small and large group plans for employers.  

Rocky Mountain Health Plans has been a key player in the mountain areas and Western Slope, and its departure from the individual market will leave many areas with only one on-exchange insurance company — Anthem Blue Cross and Blue Shield’s HMO division – for individual plans.   

“I’d rather these companies continued in the individual market,” noted Commissioner Salazar. “But in the larger picture, what’s taking place is a market correction; the free market is at work. And it is important to recognize that this is a market correction taking place on a national scale, not just in Colorado. While it was good initially to have so many companies offering so many individual plans, this could be an indication that there were too many options for the market to support.”

“It’s also important to highlight that we are not seeing this market correction in the small group market,” continued the Commissioner. “In many ways, that market seems to be stable.”

Number of People Impacted

Around 92,000 people with individual plans from UnitedHealthcare, Humana Insurance, RMHP and Anthem will need to find other coverage for 2017 during open enrollment, Nov. 1, 2016–Jan. 31, 2017. This represents approximately 20 percent of the 450,000 Coloradans who get their insurance through the individual market, either through the state exchange, Connect for Health Colorado, or off the exchange. Those 450,000 consumers with plans in the individual market represents approximately 7.7 percent of Coloradans. At least 51 percent of people in Colorado, around 2.8 million, continue to get their health insurance through an employer.  

Bright Health Plans

As other companies work to readjust, a new entrant into the Colorado market, Bright Health Plans, will sell individual plans both on and off the exchange.  
“Where others have experienced challenges, Bright sees opportunity with what they believe is an innovative approach,” said Commissioner Salazar. “They are focusing on efficient delivery of quality care through a healthcare partner. This echoes what RMHP is doing through its Monument Health program, and what UnitedHealthcare is doing in other states with its subsidiary, Harken Health. It seems what the market needs is innovation rather than the old operating model.”

Premium Increases Ahead for the Individual Market

For the individual market in 2017, many companies have requested significant premium increases (see the chart below for a breakdown by company). The companies review what they paid out for health claims to doctors, hospitals and other providers this year in order to set appropriate premiums for next year that will allow them to pay claims and remain in business.  

“In general, the companies have indicated that the people enrolled in individual plans have used more healthcare services and with greater frequency than anticipated,” said Commissioner Salazar. “While the DOI will evaluate information provided by the companies to determine if their requested premium increases are correct, all of us in the industry must tackle the more pressing question of what is driving the increased health costs in the individual market that lead to higher premiums.”  

In the small group market, companies are requesting single-digit increases or even decreases.  “We should not lose site of the positive news in the small group market, even while we work to gain an understanding of what’s happening in the individual market,” noted the Commissioner.

Responding to the Changes

The DOI recognizes there are forces at work in Colorado, and particularly in the individual market in certain areas of the state, that make it challenging for insurance companies to offer individual plans, as well as for many consumers to afford them. The DOI has started a study that looks at the underlying costs of healthcare.  The Division is also available as a resource for consumers.

  • Study already underway of a single-geographic rating area - House Bill 1336, passed this past legislative session, directs the DOI to study the feasibility of moving the state to a single geographic rating area. The bill also directs the DOI to study how healthcare costs impact premiums, which will provide greater insight into how the Colorado individual market functions.    
  • DOI’s Consumer Services - Throughout this process, the Division of Insurance is ready and available to help answer consumer questions regarding their health insurance plans or their future options. Contact the Division of Insurance at 303-894-7490 / 800-930-3745 (outside the Denver metro area) / DORA_insurance@state.co.us.

The Rate Review Process

Over the summer, DOI staff will examine each plan to make sure it complies with the Affordable Care Act (ACA) and state laws.

  • The DOI does not set insurance premiums, but will review what the companies submitted to determine if requested increases or decreases are justified.
  • The DOI checks to make sure the premiums are sufficient for the company to continue to pay its members’ claims.
  • The DOI verifies whether the plans meet the metal tier coverage levels:  bronze (an average of 60 percent of medical expenses paid by the plan), silver (70 percent), gold (80 percent) and platinum (90 percent).  
  • The DOI also reviews the benefits and the plans’ networks of healthcare providers to make sure that they meet state and federal requirements.   

Submitting Public Comments

The filings from the companies are available for review on DOI’s Health Insurance Filings page.  During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the DOI. The DOI encourages consumers to submit comments no later than July 6, 2016, so they can be included as part of the review of the filings.

Tips on filing an online comment: When viewing the filings online, there will be a section for comments within each filing. Click on the “Add” link in the “Comments” column of the filing of interest. The user will be prompted to enter his/her name, city and state of residence, email address, and the comment.

After DOI completes its review and analysis in late September / early October, it will notify carriers and Connect for Health Colorado of the approved plans for 2017. At that time, the DOI will also provide summary information and analysis regarding the carriers and plans for 2017.

NOTE - The information below on the number of plans and carriers and the requested premium changes for 2017 is preliminary. The information only reflects what the carriers have requested, not the final approved plans for 2017. Any requested rate has to be justified by the insurance carrier.

Number of Individual & Small Group Plans for 2017

  Individual Small Group Total
On-exchange 131 141 272
Off-exchange 144 526 670
Total 275 667 942

Number of Carriers On / Off-Exchange for 2017
In total, 23 carriers will be offering individual and small group plans in Colorado.

  Individual Small Group
On-exchange 7 5
Off-exchange 10 13


Medical - INDIVIDUAL Plans, Average REQUESTED Premium Change, by Company

Company Requested Overall Change* SERFF Tracking Number**
Anthem BCBS (HMO Colorado) 26.8% AWLP-130560313
Bright Health Plans*** New to market BRHP-130518475
Cigna 9.5% CCGH-130510383
Colorado Choice 36.33% COHP-130547449
Denver Health 0.08% DVHH-130565984
Freedom Life Insurance 9.98% USHG-130545454
Golden Rule 40.6% AMMS-130560610
Kaiser Foundation Health Plan of CO 13.6% KFHP-130552059
National Foundation Life 9.98% USHG-130545468
Rocky Mountain HMO 34.6% LEIF-130564677

* Averaged over all individual plans a company proposes to sell, in all areas of Colorado where the company does business, for all ages.
** The SERFF Tracking Number is way to search for the filing on the DOI’s system.
*** Bright Health Insurance Company is a new entrant into the health insurance market in Colorado.
 


Medical - SMALL GROUP Plans, Average REQUESTED Premium Change, by Company

Company Requested Overall Change* SERFF Tracking Number**
Aetna Health Inc. -4.4% AETN-130554115
Aetna Life Insurance Co. -3.6% AETN-130535284
Anthem BCBS (HMO Colo.) 4.1% AWLP-130560332
Anthem BCBS (Rky. Mtn Hospital & Medical) 2.9% AWLP-130560333
Colorado Choice 7.38% COHP-130547510
Humana Health Plan Inc. 6.35% HUMA-130570800
Humana Insurance Company 4.36% HUMA-130570797
Kaiser Foundation Health Plan of CO 3.7% KFHP-130552141
Kaiser Permanente Insurance -0.9% KHFP-130552206
Rocky Mountain Healthcare Options 11.2% LEIF-130564669
Rocky Mountain HMO 5.1% LEFI-130564686
UnitedHealthcare Insurance Company -7.7% UHLC-130570593
United Healthcare of Colorado -1.6% UHLC-130572383

* Averaged over all small group plans a company proposes to sell, in all areas of Colorado where the company does business, for all ages.
** The SERFF Tracking Number is way to search for the filing on the DOI’s system.

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The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA) regulates the insurance industry and assists consumers and other stakeholders with insurance issues.  Visit dora.colorado.gov/insurance for more information or call 303-894-7499 / toll free 800-930-3745
 
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 1-800-886-7675
 

Media Contact:
Vincent Plymell
Division of Insurance
p: 303-894-2261 | c: 303-910-9614