CO| Colorado’s Amended Insurance Regulation 4-2-83 establishes the operational, filing, and payment framework for Health Insurance Affordability Enterprise (HIAE) subsidies tied to the Colorado Option Silver Enhanced Plan beginning with the 2027 benefit year. It requires carriers offering non-grandfathered individual-market plans to make a standardized enhanced Colorado Option silver product available through the Colorado Public Benefit Corporation (Connect for Health Colorado) to qualified individuals with household incomes from 0% through 150% of the federal poverty level. The program combines a cost-sharing reduction that raises the plan’s actuarial value to 73% with a premium wrap that limits the eligible enrollee’s monthly premium to $15; carriers are reimbursed by the Enterprise through Division-calculated payments based on premium-wrap costs and incremental projected claims costs. The regulation also prescribes plan naming, HIOS/state plan identification, filing documentation, URRT treatment, calculation methodology, annual adjustment factors, enforcement, and an effective date of January 1, 2027.
Key Points
- Actuarial methodology, enforcement, and timing: Claims-cost differences use carrier rate filings, including URRT claims-to-premium data, plan actuarial values, and prescribed Metal AV Adjustment Factors. For 2027, the factors are 1.098 for base 70% Silver and 1.085 for 73% Silver CSR. Noncompliance may lead to statutory insurance sanctions, including civil penalties, cease-and-desist orders, or license suspension/revocation; the amendment takes effect January 1, 2027.
- Who and what is covered: Starting in benefit year 2027, the rule applies to carriers issuing non-grandfathered individual health benefit plans. Eligible enrollees are qualified individuals enrolled through the Public Benefit Corporation in a Colorado Option Silver Plan with household income between 0% and 150% of the federal poverty level.
- Required enhanced plan and consumer subsidy: Carriers must offer the “Colorado Option Silver Enhanced Plan,” which retains the Colorado Option Silver standardized plan design but raises actuarial value to 73%. Eligible enrollees must receive both the 73% actuarial-value cost-sharing reduction and a premium wrap that results in a $15 monthly premium contribution.
- Carrier filing and identification requirements: Carriers must use the naming convention “[Carrier Name] Colorado Option Silver Enhanced 73%,” retain the related off-exchange Silver Plan’s HIOS ID while using a new state plan identifier ending in “07,” submit the Colorado Plans and Benefits Template in SERFF, and reflect anticipated enrollment and induced-demand changes in the URRT.
- Reimbursement formula: The Division will make carrier payments by June 30 following each benefit year—June 30, 2028 for 2027—to cover (1) the monthly premium less the enrollee’s $15 contribution, multiplied by enrollment months, and (2) the difference between projected enhanced-plan claims cost and base Silver Plan claims cost. Payments are calculated by eligible member and month, with prorating for partial-month enrollment.