CO| The amended Colorado Amended Regulation 4-2-78 establishes updated standards for health insurance affordability, focusing on state-funded enhanced premium subsidies for eligible enrollees on non-grandfathered individual health plans beginning in the 2026 benefit year and annually thereafter. The regulation responds to the expiration of federal enhanced premium tax credits post-2025 and outlines how carriers will receive compensation for subsidy amounts, exclusively funded by the Colorado Health Insurance Affordability Enterprise, separate from any federal waiver funds.
Key Points:
- Starting with benefit year 2026, state-funded enhanced premium subsidies will be provided to eligible enrollees whose household income does not exceed 400% of the Federal Poverty Level, reducing monthly insurance premiums after federal advance premium tax credits are applied.
- Carriers issuing individual health plans will receive structured payments by June 30 following each benefit year covering the cost of these subsidies, using state funds only, and must comply with disclosure, eligibility determination, and reporting requirements.
- The regulation takes effect November 30, 2025, replacing previous versions, and noncompliance may lead to civil penalties, cease and desist orders, or license actions by the Division of Insurance.