In an effort to simplify the eligibility process for CoverColorado, the recently enacted Colorado Insurance Regulation 4-2-36 allows applicants to submit a short prescreen questionnaire (in lieu of a complete application) to any individual health insurance carrier in Colorado. The prescreen questionnaire (pages 3 – 5 of this link) includes a list of 21 serious medical conditions and the applicant checks yes or no depending on whether their medical history includes any of those conditions. The questionnaire is then submitted to the applicant’s health insurance carrier of choice and the carrier will determine whether the applicant could still be approved for an underwritten policy (if any of the answers are “yes” it’s highly unlikely that any individual health insurance carrier in Colorado would be able to offer a policy to the applicant).
If the health insurance carrier issues a denial letter based on the prescreen, that denial letter can be used as proof of eligibility for CoverColorado. The applicant can then proceed with an application for CoverColorado and include the denial letter.
The prescreen is intended to replace the need for an applicant (with one or more of those 21 medical conditions) to submit a complete application to a private carrier in order to receive a letter of decline and thus be eligible for CoverColorado. The prescreen is definitely shorter and easier to complete than a full application.
It should be noted however that all 21 of the medical conditions listed on the prescreen questionnaire are also included on the list of medical conditions that automatically make an applicant eligible for CoverColorado. This list of conditions has long been an option for CoverColorado eligibility, and it is more comprehensive than the new prescreen list (it includes the 21 conditions on the prescreen as well as 13 others).
In the past, an applicant could submit a decline letter from a private health insurance carrier (which could only be issued after the applicant completed a full application, even if he knew from the start that he was going to be declined and was only going through the application process in order to get the letter of decline), or the applicant could submit a letter from his doctor indicating that he has one of the conditions on the presumptive eligibility list.
Applicants can still submit a letter from a doctor stating that they have one of the conditions on the presumptive eligibility list. But if they don’t want to go through that process and they have one of the conditions on the prescreen questionnaire, they can opt instead to submit the prescreen to a carrier and use the resulting decline letter as proof of eligibility for CoverColorado.
