Colorado joins four other states terminating Friday Health to protect members
New insurance enrollment available
DENVER — Due to the financial instability of Friday Health Plans of Colorado and growing concerns about healthcare providers refusing to treat Friday enrollees, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is taking action to protect the public and ensure the smooth operation of open enrollment for 2024.
The DOI has proactively asked the courts to move Friday Health into liquidation. Their health plans in Colorado will terminate on August 31, 2023. As a result, a special enrollment period (SEP) will begin immediately for current Friday members so they can sign up for new coverage. People who want coverage starting on September 1, must enroll in a new plan by August 31. Individuals who enroll after August 31, will have their coverage start on the first of the month after enrolling in a new plan. For more information on how to sign up for a new plan for the remainder of the year, view these Frequently Asked Questions.
“Diving deeper into Friday’s finances after putting the company into rehabilitation, the Division became concerned about its ability to make it through the rest of the year. As a result, I am taking this step to protect Coloradans and the people enrolled in Friday, and to protect the open enrollment process for 2024,” said Colorado Insurance Commissioner Michael Conway. “Yet, as we work to protect people, I am disappointed that some health care providers are refusing to see Friday members and provide treatment. It’s especially concerning because of the Division’s efforts to make sure Friday Health became a member of the Colorado Guaranty Association in order to, in part, protect providers.”
Earlier this year, Governor Polis signed HB 23-1303, legislation championed by the DOI, which added Friday Health to the Colorado Life and Health Guaranty Association. This ensured that providers and Colorado consumers would be protected in the event that Friday failed. The Division remains committed to ensuring that health care providers will be paid both through Friday’s remaining assets and through the Guaranty Association.
On June 21, the DOI took control of Friday Health Plans of Colorado, placing them into rehabilitation. This allowed the Division to analyze the company’s financial projections in greater detail. That analysis led to concerns that the company would not be able to make it through the end of 2023. Allowing the company to continue operations at this point could negatively impact Colorado consumers trying to enroll in health insurance during the upcoming open enrollment for 2024, leading to consumer confusion and creating additional problems. As a result, Commissioner Conway made the decision to take action now.
Impact to People with a Friday Health Plan
Health insurance coverage for people who have a plan from Friday Health Plans of Colorado will end on August 31, 2023. To continue coverage for the rest of 2023, these Coloradans will have an immediate Special Enrollment Period so that they can select other coverage for the last four months of the year.
Key Facts for Consumers
- The Special Enrollment Period (SEP) in Colorado for Friday Health members starts today, Monday, July 17, 2023, and runs through October 31, 2023.
- People who enroll between July 17 and August 31 will have their new health insurance start on September 1, 2023. Individuals who enroll after August 31, will have their coverage start on the first of the month after enrolling in a new plan. For example, someone enrolling on October 8, will have coverage starting on November 1, 2023.
- If a Friday enrollee attests to difficulty in accessing health care, and needs an August 1 effective date of their new coverage, the DOI has created an emergency SEP. Enrollees should report the loss of coverage as July 31 instead of August 31 when applying for new coverage. This emergency SEP is only available July 17 - 31, 2023.
- People enrolled in a plan from Friday Health through Connect for Health Colorado or through Colorado Connect, including the OmniSalud program, can select new health insurance through those enrollment platforms. It is critical to act as soon as possible to avoid becoming uninsured for the rest of the year.
- People enrolled through Connect for Health Colorado, can get free, virtual and in-person help - see their We Can Help page for more information. Members who used a certified insurance broker in the past, can again get help from those brokers. People can also use Connect’s Quick Cost and Plan Finder tool to shop for plans.
- People enrolled in a Friday Health Plan through Colorado Connect, including the OmniSalud program, should contact the Assister or Broker who helped them apply and enroll last year, to get help submitting a new application and finding a new plan.
- Insurance brokers who help Friday members find new coverage should know that the DOI plans to issue an emergency regulation requiring the health insurance companies to maintain their current commission structures.
- Small businesses enrolled in small group plans from Friday should contact their insurance brokers about how to choose a new plan for their employees.
- In order to help Friday members during this transition, the DOI requested that other insurance companies in Colorado honor the deductibles and out-of-pocket maximums that Friday Health members have already accumulated for 2023.
- Kaiser has agreed to honor people’s deductible and out-of-pocket maximum accumulations. Of current Friday enrollees, 85% have access to a Kaiser plan.
- Denver Health is still working through a decision about this. Once we know their decision, the DOI will update the FAQ.
- Anthem, Cigna and Rocky Mountain Health Plans WILL NOT honor Friday members’ deductibles and out-of-pocket maximums so far for 2023. People enrolling in these plans will have to start over with these cost accumulators as of September 1.
- Because the Division is committed to doing everything possible to help Friday members as they transition to new plans, we will work to allow Friday members to recover, from the remaining Friday assets, any deductibles, out-of-pocket maximums or other cost shares members will pay only because they moved to a new plan. Once we have that process developed, including clarity on the cost shares that can be recovered, we will add it to the FAQs.
- Doctors, hospitals and other health care providers should still expect to be paid pursuant to their contracts for services they provide to Friday Health members through August 31, 2023. If a health care provider is asking you to pay more than your cost share amounts, such as your usual co-payment, deductible or coinsurance that are part of your plan, or is refusing to bill Friday Health, please contact the Colorado Division of Insurance Consumer Services Team as soon as possible - 303-894-7490 / [email protected].
For additional information, Friday members can refer to this list of Consumer Frequently Asked Questions (FAQs), jointly developed between both the DOI and Connect for Health Colorado.
Impact to health care providers
Doctors, hospitals and other health care providers will still be paid for claims submitted for services to people with health insurance from Friday, pursuant to the contractual terms with the company. This action triggers the Guaranty Association to pay claims, and the Association will pay up to $500,000 (the statutory limit) for claims for each person covered by Friday.
The DOI has set up a special email address for health care providers to contact the DOI with questions and concerns about providing care to Friday members, claims submission, and claims payment. Please email [email protected] or call 303-894-7490, and provide a brief description of your issue(s) and provide claims lists for those claims that are still outstanding that involve Friday members.
Health care providers should refer to this list of Frequently Asked Questions (FAQs) for Health Care Providers for more information.