(1) The commissioner shall promulgate a rule concerning geographic case characteristics, which may include metropolitan statistical areas for small employers. In promulgating such rule, the commissioner shall take testimony from all interested parties, including, but not limited to, consumer advocates and consumers, insurers, health-care providers, the state demographer, and producers. The rule shall include, without limitation, the following features:
(a) If the rule establishes separate geographic areas, in rate filings to the commissioner, a carrier shall be required to show that rates reflect a relativity to rates for other areas in the state and that rates and relativities are not excessive, inadequate, or unfairly discriminatory in such geographic areas;
(b) The rule shall contain a determination of the appropriate population base for statistical reliability in determining geographic areas or metropolitan statistical areas;
(c) (I) The rule shall provide justifications of why any separate geographic areas, which may include metropolitan statistical areas, serve the public interest in regard to ensuring that premium rates for different geographic areas of the state are not excessive, inadequate, or unfairly discriminatory;
(II) If the commissioner determines that metropolitan statistical areas are no longer the best method for addressing geographic case characteristics, the commissioner shall provide detailed justifications concerning the separate geographic areas, in connection with which the commissioner shall make public the impact the geographic case characteristics may have on insurance premiums for the separate geographic areas; and
(d) In adopting such rule, the commissioner may consider the cost of health care in a geographic area, experience of health care of any separate geographic area, and information including actuarial opinions or certifications and set loss ratios for loss ratio guarantees submitted by small employer carriers pursuant to section 10-16-107 (1). The cost of health care and experience and the population that may be served may be a consideration when determining whether separate geographic case characteristics are necessary, but shall not be the sole factors of separate geographic case characteristics, nor shall it compromise the public interest of insureds and potential insureds of this state.
Source: L. 2002: Entire section added, p. 1294, � 7, effective June 7. L. 2003: (1)(c)(I) amended, p. 1988, � 21, effective May 22.
Editor's note: This section was originally enacted as � 10-16-104.7 in House Bill 02-1003 but has been renumbered on revision for ease of location.
10-16-105. Guaranteed issuance of health insurance coverage - individual and small employer health benefit plans. (1) (a) (I) Subject to subsections (2) and (4) to (6) of this section, each carrier that offers an individual health benefit plan in this state shall issue any applicable health benefit plan to any eligible individual who applies for the plan and agrees to make the required premium payments and satisfy the other reasonable provisions of the health benefit plan consistent with this article.
(II) During any period of open enrollment, a carrier shall offer child-only plan coverage to all applicants under twenty-one years of age on a guaranteed-issuance basis.
(b) (I) Subject to subsections (2) to (6) of this section, each carrier that offers a small employer health benefit plan in this state shall issue any small employer health benefit plan to any eligible small employer that applies for the plan and agrees to make the required premium payments and satisfy the other reasonable provisions of the health benefit plan not inconsistent with this article.
(II) A carrier offering small employer health benefit plans as described in subparagraph (I) of this paragraph (b):
(A) Shall offer coverage to all of the eligible employees of the eligible small employer and the employees' dependents, if the small employer offers dependent coverage to its employees, who apply for enrollment during the period in which the employee first becomes eligible to enroll under the terms of the plan; and
(B) Shall not offer coverage to only certain individuals or dependents in the small group or to only part of the small group.
(2) A carrier offering individual or small employer health benefit plans:
(a) May restrict enrollment in an individual or small employer health benefit plan to open or special enrollment periods; and
(b) Shall establish special enrollment periods for triggering or qualifying events consistent with section 10-16-105.7 and in accordance with rules adopted by the commissioner.
(3) A carrier offering small employer health benefit plans:
(a) Shall not apply any waiting period that exceeds ninety days;
(b) Shall apply any requirements it uses to determine whether to provide coverage to a small employer, including requirements for minimum participation of eligible employees and minimum employer contributions, uniformly among all small employers with the same number of eligible employees applying for or receiving coverage from the small employer carrier;
(c) May vary the application of minimum participation requirements and minimum employer contribution requirements based on the size of the small employer group and by product;
(d) In applying minimum participation requirements with respect to a small employer, shall not consider employees or dependents who have creditable group coverage or individual coverage that has been consistently maintained and that was in force before the individual's eligibility for group coverage under an existing group plan when determining whether the applicable percentage of participation is met. However, a small employer carrier may consider employees or dependents of the small employer who have coverage under another health benefit plan that is sponsored by the small employer.
(e) Shall not increase any requirement for minimum employee participation or for minimum employer contribution with respect to a small employer at any time after the small employer carrier accepts the small employer for coverage.
(4) (a) Subject to paragraph (c) of this subsection (4), with respect to coverage offered through a managed care plan, a carrier is not required to offer coverage under that plan or accept applications for that plan pursuant to subsection (1) of this section in the following situations:
(I) In an area outside of the carrier's established geographic service area for the managed care plan;
(II) (A) Under an individual health benefit plan, to an individual when the individual does not live or reside within the carrier's established geographic service area for the managed care plan; or
(B) Under a small employer health benefit plan, to an employee when the employee does not live, work, or reside within the carrier's established geographic service area for the managed care plan; or
(III) Within the geographic service area for the managed care plan where the carrier reasonably anticipates, and demonstrates to the satisfaction of the commissioner, that it will not have the capacity within its established geographic service area to deliver service adequately to any additional individuals and the members of the small employer groups because of its obligations to existing covered persons.
(b) A carrier that cannot offer coverage pursuant to subparagraph (III) of paragraph (a) of this subsection (4) shall not offer coverage in the individual or small group market in the applicable geographic service area to new individuals or small employer groups until the later of:
(I) One hundred eighty days following each refusal; or
(II) The date on which the carrier notifies the commissioner that it has regained capacity to deliver services.
(c) A carrier shall apply the requirements of this subsection (4) uniformly to all individuals and small employers in this state consistent with applicable law and without regard to the claims experience of or any health-status-related factor relating to an individual and his or her dependents or the small employer and its employees and their dependents.
(5) (a) A carrier offering individual or small employer health benefit plans is not required to provide coverage if:
(I) For any period of time, the carrier demonstrates, and the commissioner determines, that the carrier does not have the financial reserves necessary to underwrite additional coverage; and
(II) The carrier is applying this subsection (5) uniformly to all individuals in the individual market and to all small employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of or any health-status-related factor relating to the individual and his or her dependents or the small employer and its employees and their dependents.
(b) A carrier that denies coverage in accordance with paragraph (a) of this subsection (5) shall not offer coverage in the applicable individual market or small group market in this state until the later of:
(I) One hundred eighty days after the date the coverage is denied; or
(II) The date on which the carrier demonstrates to the commissioner that it has sufficient financial reserves to underwrite additional coverage.
(6) This section does not require a carrier:
(a) Offering health benefit plans only in connection with group health plans to offer coverage in the individual market;
(b) Offering health benefit plans only in connection with individual health plans to offer coverage in the small group market;
(c) Offering health benefits plans only through one or more bona fide associations to offer coverage in the individual market. However, if the carrier offers bona fide association health benefit plan coverage in the individual market, the health carrier shall offer the coverage to eligible individuals in the individual market as required under paragraph (a) of subsection (1) of this section; or
(d) Offering only student health insurance coverage to otherwise offer coverage in the individual market, as long as the carrier is offering student health insurance coverage consistent with the provisions of federal law.
(7) Issuance of coverage to members of military. (a) All sickness and accident insurance policies and all service or indemnity contracts issued by any entity subject to part 3 or 4 of this article shall not refuse to provide coverage to an individual, refuse to continue to cover an individual, or limit the amount or extent of coverage available to an individual solely based on that individual's membership in the uniformed services of the United States. Nothing in this section prohibits a carrier from excluding or limiting coverage for some other factor permitted by law.
(b) As used in this subsection (7), unless the context otherwise requires:
(I) Membership means active duty, National Guard, or reserve duty in or retirement from the uniformed services of the United States.
(II) Uniformed services of the United States means the United States Army, United States Navy, United States Marine Corps, United States Air Force, United States Coast Guard, United States Space Force, national oceanic and atmospheric administration commissioned officer corps, and United States public health service commissioned corps.
(8) Domestic partner coverage. Notwithstanding any provision of law to the contrary, a small employer carrier may offer, and a small employer may accept or reject, coverage for employees' domestic partners and their dependents or for employees' designated beneficiaries and their dependents.
Source: L. 92: Entire article R&RE, p. 1634, � 1, effective July 1. L. 94: (8) amended and (6.5), (6.6), (7.2), (7.3), (7.4), (7.5), (7.6), (8.1), (8.2), (10), and (11) added, p. 1902, � 7, effective July 1. L. 96: (9) and (10) repealed, p. 1230, � 51, effective August 7. L. 97: (8)(a)(I) and (8)(a)(VII) amended and (8)(a)(X), (8)(a)(XI), and (8)(a)(XII) added, p. 210, � 4, effective April 8; (3) to (5), (7.3)(a), IP(7.3)(b)(I), (7.3)(c)(I), (7.3)(d.5), (7.3)(e), (7.3)(h), and (7.4)(c) amended and (12) added, p. 633, � 4, effective May 1. L. 99: (8)(a)(I), (8)(a)(VII), (8)(a)(X), and (8)(a)(XI) amended, p. 147, � 2, effective March 25; (7.3)(a) and (7.3)(c)(I) amended and (7.3)(b)(V) and (7.3)(i) added, pp. 226, 227, �� 2, 3, effective August 4. L. 2001: (7.3)(b)(IV) and (11) amended, p. 1167, � 1, effective July 1; (7.4)(c) amended, p. 812, � 3, effective January 1, 2002. L. 2002: (7.2), (7.4)(c), (7.6)(a)(I), IP(8)(f), and (8)(f)(II) amended, p. 1291, � 3, effective January 1, 2003; IP(7.3)(c)(II) amended and (7.3)(c)(IV) added, p. 331, � 3, effective January 1, 2003. L. 2003: (8)(f)(II) amended, p. 1988, � 22, effective May 22; (5)(g), (8.5), and (8.7) added and (7.2) and (7.5)(a) amended, pp. 1778, 1775, �� 11, 10, effective July 1; (8)(a)(VIII), (8)(e), and IP(8)(f) amended and (13), (14), and (15) added, p. 2691, � 1, effective January 1, 2004. L. 2004: (7.2)(b), (7.3)(c)(II), and (7.3)(c)(III) amended, p. 762, � 1, effective July 1; (5)(a), (5)(c), (5)(f), (6.5), (6.6), (7), (7.3)(b)(I), (7.3)(b)(II), (7.3)(b)(III), (7.3)(c), (7.3)(g), (8)(a), (8)(b), (8)(c)(I), (8)(e), (8.1), (8.2), and (8.5)(c) amended, p. 981, � 5, effective August 4. L. 2005: (7.2)(c) added, p. 1030, � 1, effective June 2; (13)(a)(I)(G) added, p. 421, � 2, effective January 1, 2006. L. 2006: (7.4)(b) amended, p. 223, � 1, effective March 31; (16) added, p. 1075, � 2, effective May 25; (7.6)(a)(I) amended, p. 1491, � 15, effective June 1; (11) amended, p. 1075, � 2, effective July 1; IP(7.2) and (7.2)(b) amended, p. 1075, � 2, effective January 1, 2007. L. 2007: IP(13)(a)(I) amended, p. 2052, � 109, effective June 1; (5)(g), (7.2)(b)(I), (7.2)(b)(III), and (7.2)(b)(IV)(A) amended, pp. 449, 450, �� 1, 2, effective January 1, 2008; (5)(g)(I) amended, p. 892, � 4, effective January 1, 2008; (8.5)(a)(II)(C) added, p. 1754, � 3, effective January 1, 2008; (5)(a), (8)(e), IP(8.5)(a), (8.5)(a)(I)(A), (8.5)(a)(V), (8.5)(c), (8.7)(a)(I), (8.7)(a)(III), and (8.7)(b), amended, p. 1752, � 2, effective January 1, 2009. L. 2008: (6) and (6.6) amended, p. 2250, � 4, effective July 1; IP(7.2) amended, p. 386, � 3, effective August 5; IP(8.7)(b) amended, p. 1881, � 13, effective August 5; (7.2)(b)(I), (7.2)(b)(III), IP(7.2)(b)(IV), and (7.2)(b)(IV)(A) amended, p. 2076, � 3, effective January 16, 2009. L. 2009: (7.2)(c) amended, (HB 09-1260), ch. 107, p. 440, � 4, effective July 1; IP(13)(a)(I), (13)(a)(I)(D), (13)(a)(I)(E), and (13)(a)(I)(F) amended, (SB 09-292), ch. 369, p. 1944, � 17, effective August 5; (7.2)(b)(I), (7.2)(b)(II), (7.2)(b)(III), (7.2)(b)(IV)(A), and (7.2)(b)(IV)(C) amended, (HB 09-1204), ch. 344, p. 1806, � 4, effective January 1, 2010. L. 2011: (16) repealed, (SB 11-103), ch. 43, p. 112, � 2, effective March 21. L. 2013: Entire section R&RE, (HB 13-1266), ch. 217, p. 926, � 6, effective May 13. L. 2021: (7)(b)(II) amended, (HB 21-1231), ch. 206, p. 1077, � 3, effective May 28.
Editor's note: (1) (a) The provisions of this section are similar to provisions of several former sections as they existed prior to 1992. For a detailed comparison, see the comparative tables located in the back of the index.
(b) Subsection (7) is similar to former � 10-16-104 (16) as it existed prior to 2013.
(c) In 2013, former subsections (8)(c)(II) and (8)(d) were relocated to � 10-16-107 (6)(b) and (6)(c); former subsection (12) was relocated to � 10-16-102 (61)(e); former subsection (13)(a) was relocated to � 10-16-105.6 (3)(a), (3)(b), and (3)(c); former subsection (13)(d) was relocated to � 10-16-105.6 (3)(d); and former subsection (14)(a) was relocated to � 10-16-105.6 (4).
(2) Section 8(1) of Senate Bill 06-036 provided that subsection (7.2)(b) is effective January 1, 2007; except that section 8(2)(c) of Senate Bill 06-036 provided that subsection (7.2)(b)(IV) is effective January 1, 2008.
(3) Amendments to subsection (5)(g)(I) by Senate Bill 07-004 and Senate Bill 07-078 were harmonized.
(4) If the commission on mandated health insurance benefits twice fails to reach a quorum to consider the mandated health insurance coverage established by section 10-16-104 (18) or concludes that the benefits of such mandated health insurance coverage outweigh its harms, amendments to subsections (7.2)(b)(I), (7.2)(b)(III), IP(7.2)(b)(IV), and (7.2)(b)(IV)(A) shall take effect. (See L. 2008, p. 2077.) On January 16, 2009, the revisor of statutes received notice from the division of insurance that the commission was unable to reach a quorum.
(5) Subsection (8.5)(a)(II)(C) provided for the repeal of subsection (8.5)(a)(II)(C), effective January 1, 2009. (See L. 2007, p. 1754.)
Cross references: For the legislative declaration contained in the 1996 act repealing subsections (9) and (10), see section 1 of chapter 237, Session Laws of Colorado 1996. For the legislative declaration contained in the 1997 act amending subsections (8)(a)(I) and (8)(a)(VII) and enacting subsections (8)(a)(X), (8)(a)(XI), and (8)(a)(XII), see section 1 of chapter 77, Session Laws of Colorado 1997. For the legislative declaration contained in the 1997 act amending subsections (3) to (5), (7.3)(a), IP(7.3)(b)(I), (7.3)(c)(I), (7.3)(d.5), (7.3)(e), (7.3)(h), and (7.4)(c) and enacting subsection (12), see section 1 of chapter 154, Session Laws of Colorado 1997. For the legislative declaration contained in the 2002 act amending subsection IP(7.3)(c)(II) and enacting subsection (7.3)(c)(IV), see section 1 of chapter 117, Session Laws of Colorado 2002. For the legislative declaration contained in the 2005 act enacting subsection (13)(a)(I)(G), see section 1 of chapter 127, Session Laws of Colorado 2005. For the legislative declaration contained in the 2006 act amending the introductory portion to subsection (7.2) and subsections (7.2)(b) and (11) and enacting subsection (16), see section 1 of chapter 236, Session Laws of Colorado 2006. For the legislative declaration contained in the 2008 act amending subsections (7.2)(b)(I), (7.2)(b)(III), the introductory portion to (7.2)(b)(IV), and (7.2)(b)(IV)(A), see section 1 of chapter 411, Session Laws of Colorado 2008. In 2008, subsections (6) and (6.6) were amended by the Fair Accountable Insurance Rates Act. For the short title and legislative declaration, see sections 1 and 2 of chapter 439, Session Laws of Colorado 2008. For the legislative declaration contained in the 2009 act amending subsections (7.2)(b)(I), (7.2)(b)(II), (7.2)(b)(III), (7.2)(b)(IV)(A), and (7.2)(b)(IV)(C), see section 1 of chapter 344, Session Laws of Colorado 2009.
10-16-105.1. Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules - notice to revisor of statutes. (1) Except as otherwise provided in subsection (2) of this section, a carrier providing coverage under a health benefit plan shall renew or continue the coverage at the option of the policyholder.
(2) A carrier may refuse to renew or discontinue coverage under a health benefit plan only for the following reasons:
(a) Nonpayment of the required premium or failure to timely pay premiums in accordance with the terms of the health benefit plan;
(b) The policyholder or the policyholder's representative has performed an act or practice that constitutes fraud or has made an intentional misrepresentation of a material fact under the terms of coverage;
(c) For small group health benefit plans, the policyholder fails to comply with the carrier's minimum participation or employer contribution requirements or the small employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan;
(d) In the case of a carrier that offers coverage through a managed care plan, there are no longer any enrolled individuals or employees living, working, or residing within the carrier's established geographic service area and the carrier would deny enrollment in the plan pursuant section 10-16-105 (4)(a)(III);
(e) In the case of an individual or small employer health benefit plan that is made available only through one or more bona fide associations, the membership of the policyholder or small employer in the association on the basis of which the coverage is provided ceases, but only if the coverage is terminated under this paragraph (e) uniformly without regard to any health-status-related factor relating to any covered person;
(f) In the case of individual health benefit plans that are made available as student health insurance coverage, the student policyholder covered under the coverage ceases to be a student at the institution of higher education through which the student health insurance coverage is offered, as long as the coverage is terminated under this paragraph (f) uniformly without regard to any health-status-related factor related to any covered person;
(g) The carrier elects to discontinue offering a particular individual or small group health benefit plan, but only if the carrier:
(I) Provides notice of the decision not to renew coverage at least ninety days before the nonrenewal of the health benefit plan to each policyholder, individual, certificate holder, participant, or beneficiary covered by the plan;
(II) Offers each policyholder covered by the plan the option to purchase any other health benefit plans currently being offered by the carrier in this state and specifies the special enrollment periods for the plans pursuant to section 10-16-105.7;
(III) In exercising the option to discontinue that particular type of health benefit plan, acts uniformly without regard to the claims experience of the policyholders or any health-status-related factor relating to any individual, participant, or beneficiary covered by the plan or new individuals, participants, or beneficiaries who may become eligible for coverage;
(IV) Provides notice to the commissioner before providing the notice pursuant to subparagraph (I) of this paragraph (g) and certifies the following to the commissioner:
(A) The premiums for other health benefit plans the carrier offers pursuant to subparagraph (II) of this paragraph (g) are not excessive, inadequate, or unfairly discriminatory relative to the plan that the carrier is discontinuing; and
(B) The benefit levels the carrier offers in the other health benefit plans comply with the requirements of law applicable to individual and small employer health benefit plans; or
(h) (I) The carrier elects to discontinue offering and renewing all of its individual, small group, or large group health benefit plans delivered or issued for delivery in this state, but only if the carrier:
(A) Provides notice of the decision to discontinue coverage, at least one hundred eighty days before the discontinuance, to all policyholders and covered persons; and
(B) Provides the notice to the commissioner at least three business days before the date the notice is sent to the affected policyholders and covered persons pursuant to sub-subparagraph (A) of this subparagraph (I).
(II) In the case of a discontinuance under subparagraph (I) of this paragraph (h), the carrier shall:
(A) Continue to provide coverage through the first renewal period not to exceed twelve months after the notice provided pursuant to subparagraph (I) of this paragraph (h); and
(B) Not write new health benefit plans of the same type as those the carrier discontinued in this state for five years after the date of the notice to the commissioner pursuant to sub-subparagraph (B) of subparagraph (I) of this paragraph (h).
(3) A carrier offering individual or small employer health benefit plans shall clearly disclose in its contracts and marketing materials the conditions of renewability, which conditions must conform with the requirements of this section.
(3.5) (a) [Editor's note: This version of subsection (3.5)(a) is effective until January 1, 2026.] If a carrier issues a small group health benefit plan to a small employer that, at the time the plan was issued, was a small employer but subsequently employs more than one hundred eligible employees, this article 16 and any rules promulgated by the commissioner concerning small group health benefit plans continue to apply to the health benefit plan as long as the employer renews its current small group health benefit plan or a similar plan offered by the carrier pursuant to subsection (3.5)(b) of this section, in accordance with the renewal requirements applicable to other small group health benefit plans subject to this article 16 and rules promulgated by the commissioner pursuant to this article 16.
(3.5) (a) [Editor's note: This version of subsection (3.5)(a) is effective January 1, 2026.] If a carrier issues a small group health benefit plan to a small employer that, at the time the plan was issued, was a small employer but subsequently employs more than fifty eligible employees, this article 16 and any rules promulgated by the commissioner concerning small group health benefit plans continue to apply to the health benefit plan as long as the employer renews its current small group health benefit plan or a similar plan offered by the carrier pursuant to subsection (3.5)(b) of this section, in accordance with the renewal requirements applicable to other small group health benefit plans subject to this article 16 and rules promulgated by the commissioner pursuant to this article 16.
(b) [Editor's note: This version of subsection (3.5)(b) is effective until January 1, 2026.] If a small employer was issued a small group health benefit plan and subsequently employs more than one hundred employees and the employer opts to renew the small group health benefit plan, the carrier that issued the small group health benefit plan shall offer the employer the same small group health benefit plan or, if the same plan is no longer being offered to any small employer, a similar small group health benefit plan that the carrier offers to other small employers.
(b) [Editor's note: This version of subsection (3.5)(b) is effective January 1, 2026.] If a small employer was issued a small group health benefit plan and subsequently employs more than fifty employees and the employer opts to renew the small group health benefit plan, the carrier that issued the small group health benefit plan shall offer the employer the same small group health benefit plan or, if the same plan is no longer being offered to any small employer, a similar small group health benefit plan that the carrier offers to other small employers.
(c) [Editor's note: This version of subsection (3.5)(c) is effective until January 1, 2026.] A carrier that issued a small group health benefit plan to a small employer shall notify the employer, within sixty days after becoming aware that the employer employs more than one hundred employees, but no later than the anniversary date of the issuance of the employer's health benefit plan, that the provisions of Colorado law governing small group health benefit plans will cease to apply to the employer if the employer fails to renew its current small group health benefit plan or elects to enroll in a different health benefit plan.
(c) [Editor's note: This version of subsection (3.5)(c) is effective January 1, 2026.] A carrier that issued a small group health benefit plan to a small employer shall notify the employer, within sixty days after becoming aware that the employer employs more than fifty employees, but no later than the anniversary date of the issuance of the employer's health benefit plan, that the provisions of Colorado law governing small group health benefit plans will cease to apply to the employer if the employer fails to renew its current small group health benefit plan or elects to enroll in a different health benefit plan.
(d) [Editor's note: Subsection (3.5)(d) is effective January 1, 2026.]
(I) If an employer was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees, the employer may elect to remain in the small group health benefit market for five years after the date of the issuance of the employer's existing health benefit plan or elect to enter the large group health benefit market at the expiration of the employer's existing health benefit plan.
(II) (A) An employer that was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees may switch between small group health benefit plans being offered by the carrier for five years after the date of the issuance of the employer's health benefit plan.
(B) An employer that switches between small group health benefit plans offered by the carrier must switch to a small group health benefit plan that is one metal level above or below the employer's existing small group health benefit plan.
(III) If an employer that was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees elects to enter the large group health benefit market and not to continue receiving coverage under a small group health benefit plan before the expiration of the five-year period described in subsection (3.5)(d)(I) of this section, the employer may not switch back to receiving small group health benefit coverage within the five-year period and is classified as a large employer, as defined in section 10-16-102 (40.5).
(e) (I) On or before July 1, 2025, carriers offering small group health benefit plans shall submit to the commissioner two rate filings for plan year 2026. The two rate filings must demonstrate the impact of Senate Bill 24-073, enacted in 2024, on premiums for small group health benefit plans for employers with fewer than fifty-one eligible employees.
(II) This subsection (3.5), section 10-16-102 (40.5) and (61), and section 10-16-1401 (15), as amended by Senate Bill 24-073, enacted in 2024, will be repealed if the rate filings submitted by carriers pursuant to subsection (3.5)(e)(I) of this section demonstrate that the premiums for the majority of individuals covered by small group health benefit plans would increase by more than three percent after accounting for normal premium trends for small group health benefit plans.
(III) The commissioner shall notify the revisor of statutes in writing of the date when the conditions specified in subsection (3.5)(e)(II) of this section have occurred by emailing the notice to revisorofstatutes.ga@coleg.gov. This subsection (3.5), section 10-16-102 (40.5) and (61), and section 10-16-1401 (15), as amended by Senate Bill 24-073, enacted in 2024, are repealed upon the date identified in the notice that the conditions specified in subsection (3.5)(e)(II) of this section have occurred or, if the notice does not specify that date, upon the date of the notice to the revisor of statutes.
(IV) Notwithstanding section 10-16-155, the commissioner shall utilize resources allocated for actuarial review pursuant to section 10-16-155 to analyze the rate filings submitted by carriers pursuant to subsection (3.5)(e)(I) of this section.
(4) A carrier offering a large group health benefit plan may modify the plan at renewal if the carrier modifies the plan uniformly for all large groups covered by the same plan.
(5) With respect to benefits provided under an individual or small employer health benefit plan, a carrier may make reasonable modifications if:
(a) The modification is effective only upon renewal of the plan;
(b) The carrier modifies the benefits uniformly for all individuals and groups covered by the plan;
(c) The carrier provides the proposed modification to policyholders and the commissioner at least ninety days before the effective date of the modification; and
(d) The carrier provides each affected policyholder the opportunity to purchase any other health benefit plan offered by the carrier.
(6) (a) The commissioner may promulgate rules as necessary to implement and administer this section.
(b) Repealed.
Source: L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 930, � 7, effective May 13. L. 2021: (3.5) added, (SB 21-090), ch. 21, p. 104, � 1, effective September 7. L. 2024: (3.5) amended, (SB 24-073), ch. 146, p. 590, � 2, effective January 1, 2026 (see editor's note).
Editor's note: (1) Subsection (6)(b)(II) provided for the repeal of subsection (6)(b), effective January 1, 2015. (See L. 2013, p. 930.)
(2) Section 5 of chapter 146, (SB 24-073), Session Laws of Colorado 2024, provides that subsection (3.5)(e) takes effect May 1, 2024, and the remainder of subsection (3.5) takes effect January 1, 2026.