IMPORTANT ANNOUNCEMENT

Yes. You will have a Special Enrollment Period (SEP) when you can enroll in new coverage for the remainder of 2023.  It’s important to act soon so that you (and any covered family members) are not left uninsured come September 1.  Currently, the SEP ends on October 31, 2023.

If you enrolled by August 31, your new health insurance coverage will start on September 1, 2023.  If you enroll after August 31, your new coverage will start on the first of the month after enrolling.

If you enroll between…                                             Your new health insurance starts…

July 17, 2023 — August 31, 2023                                September 1, 2023

September 1, 2023 — September 30, 2023                October 1, 2023

October 1, 2023 — October 31, 2023                          November 1, 2023

If you are enrolled in a plan from Friday Health through Connect for Health Colorado or through Colorado Connect, including the OmniSalud program, you can select new health insurance through those enrollment platforms.

If you, your spouse, or a parent (for those under age 26) has access to health insurance from an employer, you may also have the option to enroll in that health insurance plan. Contact the employer’s human resources or employee benefits office for specific rules and enrollment deadlines.

Employers who have a small group plan (for small employers with less than 100 employees) from Friday Health should contact their broker for details.  Employees enrolled in these plans should contact their employer for more information.

If you’re enrolled in a plan through Connect for Health Colorado or through Colorado Connect, including the OmniSalud program, your Special Enrollment Period will start on July 17, 2023 and run until October 31, 2023. 

You will be able to see your new health insurance plan options and enroll in a new plan by reporting your loss of coverage in your Connect for Health Colorado account.

Login to your Connect for Health Colorado account and report that you will lose health coverage on August 31, 2023 to open your Special Enrollment Period.  Doing so will open your Special Enrollment Period to select a new plan.  Remember to also report any changes to your income or household to make sure you’re getting the right amount of financial help.

If you need help reporting these changes in your account or selecting a new health insurance plan, contact your certified insurance broker for assistance.  If you don’t have a certified broker, find one here.

You can get free, virtual and in-person help with enrollment from Connect for Health Colorado - see their We Can Help page for more information about certified Assisters, Brokers, and Enrollment Centers in your community.  Connect for Health Colorado’s certified experts can answer your questions and will help you free of charge.  You’re not obligated to buy a plan when you contact an expert.

You can also use Connect for Health Colorado’s Quick Cost and Plan Finder tool to get an estimate of financial help, see the plans you can buy, and compare plans.

If you are an employer with a small group plan from Friday Health for your employees,

contact your insurance broker about selecting new health coverage.

It depends. Connect for Health Colorado will re-evaluate the amount of financial help you qualify for when you update your account, and you’ll see the amount of financial help you qualify for when you shop for a new plan.

The amount of financial help you can get to lower your monthly payment is calculated based on your family size, where you live, your family’s estimated annual income, and the cost of plans available to you.  Remember to report any changes to your income or household when you report your loss of Friday Health Plans coverage so Connect for Health Colorado can provide you with the right amount of financial help.

Learn more about how financial help works here:

https://connectforhealthco.com/financial-help/get-financial-help

Yes.  Doctors, hospitals and other health care providers will still be paid for medical claims from Friday Health Plan members, pursuant to the contractual terms with the company.  Liquidating the Friday Health Plans triggers the Colorado Guaranty Association to pay medical claims, and the Association will pay up to $500,000 (the statutory limit) for medical claims for each member covered by Friday Health Plans.

Yes.  Medical claims could be denied, as the medical benefits and services through the end of day August. 31, 2023, will still be subject to the terms of your Friday Health Plans policy.  However, as with any denied claim, you may appeal the denial of your medical claim.

No.  At this time, you should follow the normal process as described in your information from Friday Health Plans (such as a plan description) to file an appeal.

No.  For medical services that were covered by your Friday Health Plans policy, you do not need to file a Proof of Claim with the liquidator for such medical claims.  The process for acceptance or denial of medical claims is unchanged.  You may file a Proof of Claim with the liquidator for all other circumstances. (e.g., for Friday Health Plans policyholders that prepaid their premium they may file a Proof of Claim for the amount of premium prepaid after the termination date of their health insurance plan with Friday Health Plans).  You may download the Proof of Claim form at this LINK.

No.  Consistent with federal and state law, in-network providers may not seek payment from a covered person beyond what is permitted by the cost-sharing in the covered person’s policy.  In other words, you are not responsible for paying more than the copayment, coinsurance, and deductible amounts for care received by an in-network provider prior to September 1, 2023.

If a provider bills you in this way or tries to collect money beyond your copayment, coinsurance or deductible responsibilities under your Friday Health Plans policy, you may contact the Colorado Division of Insurance Consumer Services Team at 303-894-7490 or DORA_Insurance@state.co.us for guidance.

Maybe. Balance billing, or a provider billing a covered person for the amount that insurance does not pay under the covered person’s policy, is permitted only in certain circumstances.  These circumstances arise when a provider does not participate in a plan’s network.

Balance billing is NOT permitted when an out-of-network provider performs covered services at an in-network facility, including ancillary services such as radiology and anesthesiology.  Balance billing is also NOT permitted when a provider is administering emergency services.  Balance billing is permitted when a covered person has received notice of a service to be administered by an out-of-network provider and given consent consistent with Colorado statute and the federal No Surprises Act.

If a provider is not complying with these balance billing protections, you may contact the Colorado Division of Insurance Consumer Services Team at 303-894-7490 or DORA_Insurance@state.co.us for guidance.

You may file a Proof of Claim only if you have switched to a new plan and that insurer does not honor the deductibles and out-of-pocket-maximum payments (also known as accumulators) you had paid to Friday Health Plans during the 2023 plan year and you make new payments towards the new deductible or out-of-pocket maximum, past the amount remaining on your Friday Health Plans deductible or out-of-pocket maximum.

EXAMPLE: You had a $1,000 deductible under your Friday Health Plans policy and paid $700 towards that deductible prior to when your plan terminated on September 1, 2023.  Any amounts you pay towards your new deductible under your new plan on or after September 1, 2023, up to the $700 you paid to Friday, may be filed as a Proof of Claim, but only after you have paid the remaining $300 that would have gone towards your Friday Health Plans deductible.

EXAMPLE: You had a $10,000 out-of-pocket maximum under your Friday Health Plans policy and paid $300 towards that out-of-pocket maximum prior to when your plan terminated on September 1, 2023.  Any amounts you pay towards your out-of-pocket maximum under your new plan on or after September 1, 2023, up to $300, may be filed as a Proof of Claim, but only after you have paid the remaining $9,700 that would have gone towards your Friday Health Plans out-of-pocket maximum.    

Complete the Proof of Claim form (download HERE) that was also mailed to Friday Health Plans policyholders (this was mailed to the most recent address Friday health Plans has on file for policyholders).  Once completed you may submit completed Proof of Claim form and associated documents at the following email address:

     fhpco@examresources.net

or you may mail the Proof of Claim form to the following postal address:

     Friday Health Plans of Colorado, Inc. in Liquidation

     P.O. Box 519 

     Stuart, VA 24171

NOTE: Kaiser and Denver Health, will carryover accumulated deductibles and out-of-pocket maximum amounts from your Friday Health Plans policy. In this circumstance you should not file a Proof of Claim to cover cost shares (such as deductibles and out-of-pocket maximums) because you have not lost your accumulated deductible and out-of-pocket maximum balances.

All Proofs of Claim are due by July 1, 2024, or will not be considered.  After all Proofs of Claim are received the Proofs of Claim will be adjudicated and then the Liquidator will file a plan of distribution with the Court and distributions will be made in accordance with the approval of the Court and subject to the availability of assets in the Friday Health Plans liquidation estate.

A liquidation occurs under the supervision of a state court of law to facilitate the orderly liquidation of assets and winding up of affairs of an insolvent insurance company.  The Commissioner of Insurance is appointed as Liquidator and the Commissioner may designate other individuals or firms as a special deputy to assist in the liquidation process.

The association, officially known as the Life and Health Insurance Protection Association, is a non-profit organization made up of life and health insurance companies that sell insurance products in Colorado.  The Colorado legislature authorized the formation of the association in 1991 to assist Coloradans with insurance policies from companies that become insolvent.

To protect consumers, the Colorado Division of Insurance championed the passing of HB23-1303 - Protect Against Insurers' Impairment And Insolvency as it monitored the situation regarding Friday Health.  This legislation made Friday Health Plans of Colorado a member of the Guaranty Association, offering protections to both consumers and health care providers in the event of the failure of a company like Friday health insurance company that is licensed as an HMO (health maintenance organization).

Yes.  On February 12, 2024, we began processing and mailing refund checks to the policyholder’s last known address based upon Friday Health Plans’ records. Where our records show that you paid premiums in error for health coverage on a health insurance plan that was cancelled or terminated because of or following the liquidation of Friday Health Plans of Colorado, or our records show you paid premium in advance for health insurance policies that were later cancelled or terminated premium refund checks will be issued for refundable amounts above $10.  

If you believe that you are due a premium refund, you should file a Proof of Claim (LINK) with the Liquidator.

If you believe that you are due an additional premium refund, you should file a Proof of Claim (LINK) with the liquidator.

Yes. Doctors, hospitals and other health care providers will still be paid for medical claims from Friday Health Plan members, pursuant to the contractual terms with the company.  Liquidating the Friday Health Plans triggers the Colorado Guaranty Association to pay medical claims, and the Association will pay up to $500,000 (the statutory limit) for claims for each member covered by Friday.

You should continue to follow the existing process.
 

For additional information, call or email:

     Provider Service: (800) 475-8466
    Colorado Provider Support Email:  CO-Providers@fridayhealthplans.com
    Open Negotiation Requests: IDR@fridayhealthplans.com 

State guaranty associations act as a safety net to protect policyholders if the insurance company that issued an annuity or insurance policy cannot meet its financial obligations.

This protection works similarly to how the Federal Deposit Insurance Corporation (FDIC) protects bank funds up to a maximum amount in the event of insolvency.  The Colorado Life and Health Insurance Guaranty Association will be handling claims from Friday Health Plans of Colorado.

On September 1, 2023, the Guaranty Association coverage was triggered and it will pay covered medical claims subject to an overall limitation of $500,000 per individual member.

In the event you have a claim for a covered service that is not paid or not paid in full because the Guaranty Association limitation was reached, then you may file a Proof of Claim (LINK) for amounts that exceed the limitation.

We are finalizing a process and will update this FAQ when there is further information to share.

Please refer patients to this list of Frequently Asked Questions (FAQs) for Policyholders (LINK) concerning the situation with Friday Health on the Colorado Division of Insurance’s website.

Yes.  We will immediately publish a notice if we update the claims process on this website.

You should continue to follow the existing process.
 

For additional information, call or email:

     Provider Service: (800) 475-8466
    Colorado Provider Support Email:  CO-Providers@fridayhealthplans.com
    Open Negotiation Requests: IDR@fridayhealthplans.com 

You only need to file Proof of Claim for claims that exceed the Guaranty Association limitation or for claims that are unrelated to covered services under the Friday Health Plans insurance policies.

You may dispute such a determination in accordance with your provider agreement, if any, and the relevant Friday Health Plans policy.  Call (800) 475-8466 or email appeals@fridayhealthplans.com for additional information.

The association, officially known as the Life and Health Insurance Protection Association, is a non-profit organization made up of life and health insurance companies that sell insurance products in Colorado.  The Colorado legislature authorized the formation of the association in 1991 to assist Coloradans with insurance policies from companies that become insolvent.

To protect consumers, the Colorado Division of Insurance championed the passing of HB23-1303 - Protect Against Insurers' Impairment And Insolvency as it monitored the situation regarding Friday Health.  This legislation made Friday Health Plans of Colorado a member of the Guaranty Association, offering protections to both consumers and health care providers in the event of the failure of a company like Friday health insurance company that is licensed as an HMO (health maintenance organization).

Commissions will be paid in accordance with the Colorado law governing the priority of distributions and the availability of assets in the Friday Health Plans liquidation estate.

Friday Health Plans was insolvent and as a result the District Court of the City and County of Denver (“Court”) ordered Friday Health Plans into receivership and ultimately into liquidation.  You may obtain and read the Order at this LINK.

You should file a Proof of Claim with as soon as you can.  You may download a copy of the Proof of Claim at this LINK.

All Proofs of Claim are due by July 1, 2024, or will not be considered.  After all Proofs of Claim are received the Proofs of Claim will be adjudicated and then the Liquidator will file a plan of distribution with the Court and distributions will be made in accordance with the approval of the Court and subject to the availability of assets in the Friday Health Plans liquidation estate.

Friday Health Plans is being liquidated because it was insolvent, and as a result, the District Court of the City and County of Denver (“Court”) ordered that Friday Health Plans be liquidated after a temporary period of rehabilitation to allow for members to find new health plans. You may review the Order at this LINK.

A liquidation occurs under the supervision of a state court of law to facilitate the orderly liquidation of assets and winding up of affairs of an insolvent insurance company.  The Commissioner of Insurance is appointed as Liquidator and the Commissioner may designate other individuals or firms as a special deputy to assist in the liquidation process.

Friday Health Plan policies were terminated and coverage ended at the end of the day, August 31, 2023.

We have created FAQs for policyholders (LINK), healthcare providers (LINK) and agents and brokers (LINK) to provide specific guidance.  All others should follow the general guidance set forth in the following FAQs.

For all such matters you should complete the Proof of Claim form downloaded HERE. Once completed you may submit completed Proof of Claim forms and associated documents at the following email address:

     fhpco@examresources.net

or you may mail the Proof of Claim form to the following address:

     Friday Health Plans of Colorado, Inc. in Liquidation

     P.O. Box 519 

     Stuart, VA 24171

All Proofs of Claim must be received by July 1, 2024, or will not be considered.       

All Proofs of Claim must be received by July 1, 2024, or will not be considered.  After all Proofs of Claim are received the Proofs of Claim will be adjudicated and then the Liquidator will file a plan of distribution with the Court and distributions will be made in accordance with the approval of the Court and subject to the availability of assets in the Friday Health Plans liquidation estate.