DENVER, CO — Rep. Susan Lontine’s bill to enact protections for consumers in health care cost-sharing arrangements that are not health insurers today was approved by the House Health and Insurance Committee. The bill would protect consumers by giving the Colorado Division of Insurance authority to conduct specific oversight of healthcare cost sharing arrangements to help ensure that they provide consumers with full information about their financial capacity to pay claims.
“Consumers should know what to expect when they pay into a health care cost-sharing agreement,” said Health and Insurance Chair Rep. Susan Lontine, D-Denver. “This bill would ensure that those buying into cost sharing agreements understand exactly how they operate and what their limits are. While there are plenty of well-meaning and responsible cost sharing communities out there, we have heard too many stories of bad actors taking advantage of health care consumers to not take action.”
As defined in HB20-1008, a “health care cost-sharing arrangement” is a health care cost sharing ministry or medical cost-sharing community that collects funds from its members on a regular basis, at levels established by the arrangement, for purposes of sharing, covering, or defraying the medical costs of its members.
These are not traditional health insurance companies and are exempt from federal insurance requirements like guaranteed coverage for pre-existing conditions, established by the Affordable Care Act. Last year in Colorado, the Division of Insurance made the decision to prevent one of these arrangements, Trinity HealthShare, from marketing in the state for the foreseeable future because of complaints received from consumers about these companies. Health care cost sharing ministries like Trinity are being scrutinized by state legislatures across the country for misleading health care consumers and failing to cover the medical bills of their members.
The bill would not prohibit cost-sharing arrangements from operating in the state but would require increased and improved reporting from the administrators of these arrangements. Under the bill’s new requirements, health care cost-sharing arrangements would have to provide the Commissioner of Insurance with information regarding their operations, financial statements, membership, and specific information surrounding medical claims submitted, paid, and denied.
The arrangements would also be required to disclose to consumers and potential customers the limitations of these agreements and other specific information as required by the bill. Finally, health care cost-sharing arrangements would be required to respond to requests for payment of medical expenses from health care providers within a period specified by the Commissioner of Insurance.