Any carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article may offer a high deductible health plan that would qualify for and may be offered in conjunction with a health savings account pursuant to 26 U.S.C. sec. 223, as amended. A carrier offering a high deductible health plan that may be offered in conjunction with a health savings account may apply the deductible to mandatory health benefits for prostate cancer screening and prosthetic devices pursuant to section 10-16-104 (10) and (14) if those mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount.
Source: L. 2004: Entire section added, p. 764, � 2, effective July 1. L. 2009: Entire section amended, (HB 09-1204), ch. 344, p. 1808, � 6, effective January 1, 2010. L. 2013: Entire section amended, (HB 13-1266), ch. 217, p. 973, � 23, effective May 13.
Cross references: For the legislative declaration contained in the 2009 act amending this section, see section 1 of chapter 344, Session Laws of Colorado 2009.
10-16-130. Disclosure of rate increases to public entities - legislative declaration - definitions. (1) The general assembly hereby finds, determines, and declares that variability in premiums by carriers offering health benefit coverage to a public entity present difficulties for fiscal planning for the public entity. Therefore, it is in the best interest of the state to promote greater accountability to the public and sound fiscal policy by public entities through disclosure by health insurance carriers of information concerning the public entity's rate, loss ratio, and the total number of claims exceeding ten thousand dollars for the public entity.
(2) A carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article to a public entity, with one hundred or more employees enrolled in such coverage, shall disclose to the public entity, at the request of the public entity, once annually and concurrent with the issuance of the employer's rate renewal, the following information as it relates to the amounts of coverage being considered for calculating the renewal:
(a) The total number of employees covered by the carrier for the public entity;
(b) The total dollar amount of claims paid by the carrier on behalf of the public entity;
(c) Total of premiums paid; and
(d) The number of claims that exceed ten thousand dollars for any one covered person under health benefit coverage for the public entity.
(3) As used in this section, unless the context otherwise requires:
(a) Loss ratio means the total claims paid for the coverage period divided by the total amount of premiums paid by a public entity.
(b) Public entity shall have the same meaning as that provided in section 24-10-103 (5), C.R.S.
Source: L. 2005: Entire section added, p. 849, � 1, effective January 1, 2006.
10-16-131. Health care reform project - blue ribbon commission for health care reform - repeal. (Repealed)
Source: L. 2006: Entire section added, p. 1626, � 2, effective June 2. L. 2007: IP(3)(a) amended and (3)(a)(IV) and (3)(b)(III) added, p. 167, �� 1, 2, effective March 22; (2), (3)(d)(V), (4)(a), (4)(b)(III), (4)(b)(IV), (5)(a), and (5)(c) amended and (4.5) and (5.5) added, p. 1993, � 1, effective June 1. L. 2008: (5.3) added and (6) amended, p. 809, � 1, effective May 14.
Editor's note: Subsection (6)(a) provided for the repeal of subsections (1) to (5) and (5.5), effective July 1, 2008. (See L. 2006, p. 1626.) Subsection (5.3)(b) provided for the repeal of subsection (5.3), effective July 1, 2009. (See L. 2008, p. 809.) Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2009. (See L. 2008, p. 809.)
10-16-132. Study of factors driving health care costs in Pueblo county - repeal. (Repealed)
Source: L. 2007: Entire section added, p. 2101, � 1, effective June 4. L. 2008: (2)(c) amended, p. 1881, � 14, effective August 5.
Editor's note: Subsection (4) provided for the repeal of this section, effective January 15, 2009. (See L. 2007, p. 2101.)
10-16-133. Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rules. (1) The general assembly finds and determines that consumers deserve to know the quality and cost of their health-care insurance. Health-care insurance transparency provides consumers with the information necessary, and the incentive, to choose health plans based on cost and quality. The general assembly further finds that providing reliable cost and quality information about health-care insurance empowers consumer choice and that consumer choice creates incentives at all levels and motivates the entire system to provide better care and benefits for less money. Therefore it is the intent of the general assembly to make information regarding the costs of health-care insurance readily available to consumers through the division of insurance.
(2) The commissioner shall implement and maintain a consumer guide on the division of insurance website that is easily accessible and available to consumers regarding each carrier authorized to do business in this state. The website shall:
(a) Be derived from the information that each carrier is required to file with the division, except for records that are not open to public inspection pursuant to part 2 of article 72 of title 24, C.R.S.;
(b) Include such information as the commissioner determines, in his or her discretion and after soliciting input from interested parties, to be useful to consumers and purchasers of health-care insurance; except that records that are not open to public inspection pursuant to part 2 of article 72 of title 24, C.R.S., shall not be included; and
(c) Include a link to the division's complaint form for use by consumers to file a complaint against a carrier and a link to the division's complaint index so that consumers may access information regarding complaints against carriers.
(3) The commissioner is authorized to include additional health plan and quality information on the website from state or nationally recognized organizations that measure performance of health benefit plans.
(4) The commissioner shall consider alternative methods of making the consumer guide accessible to consumers who do not have internet access.
(5) (a) An insurance producer licensed pursuant to part 4 of article 2 of this title 10 who solicits or negotiates an application for health-care insurance on behalf of a carrier shall disclose to the person purchasing the plan that the insurance producer will receive a commission from the carrier. The insurance producer shall provide the consumer with the standard compensation schedule for the product being sold. Any change to the insurance producer's compensation from the initial disclosure to the time of purchase shall be disclosed by the insurance producer to the purchaser at or before the time of sale.
(b) An insurance producer may charge a client a fee for advising the client on the selection of an individual health benefit plan only if the producer:
(I) Will not receive a commission from the insurer offering the individual health benefit plan selected by the client; and
(II) Provides a written disclosure to the client if the producer will charge a fee for the service.
(c) The commissioner shall promulgate reasonable rules that are necessary or proper for implementing and administering this subsection (5). The rules shall include a prohibition on an insurance producer charging a fee to assist a client to enroll in medicaid, as defined in section 10-22-103 (8), or the children's basic health plan, as defined in section 25.5-8-103 (2).
(6) (a) A carrier offering individual health benefit plans or short-term limited duration health insurance policies shall disclose to the covered person the amount of compensation associated with plan selection and enrollment consistent with the federal No Surprises Act, Pub.L. 116-260, as amended.
(b) The commissioner shall promulgate rules to implement the carrier disclosure requirements under this subsection (6).
Source: L. 2008: Entire section added, p. 2067, � 1, effective January 1, 2009. L. 2018: (5) amended, (SB 18-136), ch. 118, p. 817, � 1, effective August 8. L. 2022: (6) added, (HB 22-1284), ch. 446, p. 3151, � 7, effective August 10.
10-16-134. Health-care transparency - information required - website - definition. (Repealed)
Source: L. 2008: Entire section added, p. 1265, � 4, effective May 27. L. 2024: Entire section repealed, (SB 24-135), ch. 34, p. 105, � 1, effective March 22.
10-16-135. Health coverage plan information cards - rules - standardization - contents. (1) (a) [Editor's note: This version of the introductory portion of subsection (1)(a) is effective until January 1, 2026.] The commissioner shall adopt rules requiring every carrier providing a health benefit plan to issue to covered persons to whom a health benefit plan identification card is issued a standardized printed card containing plan information. To the extent possible, the rules shall incorporate and not conflict with the requirements of section 10-16-124 regarding prescription information cards. The commissioner shall adopt initial rules by October 31, 2008, that describe the format of a standardized, printed card to be issued by carriers to persons covered under a health benefit plan to whom health benefit plan identification cards are issued. The rules establishing the format for the printed card shall include a standard size, shall require the card to be legible and photocopied, and shall delineate the information to be contained on the card, including, but not limited to, the following information, as applicable:
(1) (a) [Editor's note: This version of the introductory portion of subsection (1)(a) is effective January 1, 2026.] The commissioner shall adopt rules requiring every carrier providing a health benefit plan to issue to covered persons to whom a health benefit plan identification card is issued a standardized printed or electronic card containing plan information. To the extent possible, the rules shall incorporate and not conflict with the requirements of section 10-16-124 regarding prescription information cards. The format for the printed or electronic card shall include a standard size, shall require the card to be legible and photocopied, and shall delineate the information to be contained on the card, including but not limited to the following information, as applicable:
(I) The covered person's name and the applicable plan number;
(II) Copayment and deductible amounts for the most commonly used health-care services;
(III) Contact information for the carrier or health benefit plan administrator; and
(IV) An indication of whether the health benefit plan is regulated by the state.
(b) [Editor's note: This version of subsection (1)(b) is effective until January 1, 2026.] The rules adopted pursuant to paragraph (a) of this subsection (1) shall require all carriers to issue a standardized printed card to a covered person to whom a health benefit plan identification card is issued upon the purchase or renewal of or enrollment in a plan on or after July 1, 2009. No later than July 1, 2010, all carriers shall issue the standardized, printed card to covered persons to whom health benefit plan identification cards are issued.
(b) [Editor's note: This version of subsection (1)(b) is effective January 1, 2026.] A carrier shall issue a standardized printed or electronic card to a covered person to whom a health benefit plan is issued upon the purchase or renewal of or enrollment in a plan.
(c) [Editor's note: This version of subsection (1)(c) is effective until January 1, 2026.] Nothing in this section shall preclude a carrier from including information on the standardized printed cards that is in addition to the information required to be included on the card pursuant to rules adopted pursuant to this section.
(c) [Editor's note: This version of subsection (1)(c) is effective January 1, 2026.] Nothing in this section shall preclude a carrier from including information on the standardized printed or electronic cards that is in addition to the information required to be included on the card pursuant to rules adopted pursuant to this section.
(d) [Editor's note: Subsection (1)(d) is effective January 1, 2026.] A carrier shall provide a printed card to a covered person upon request.
(e) [Editor's note: Subsection (1)(e) is effective January 1, 2026.] The commissioner may adopt rules to implement this section.
(2) (a) No later than thirty days after June 3, 2008, the commissioner, in consultation with the director of the division of professions and occupations in the department of regulatory agencies and the executive director of the department of public health and environment, shall establish a work group comprised of representatives of the divisions of insurance and registrations in the department of regulatory agencies; the departments of public health and environment, personnel, and health care policy and financing; the governor's office of information technology; carriers; providers, including hospitals, physicians, and pharmacists; private businesses; consumers; and other stakeholders deemed appropriate by the commissioner. The work group shall:
(I) Make recommendations on standards for technology and tools through which information may be electronically recognized, exchanged, or transmitted between carriers and providers, which standards shall conform to any standards adopted by a nonprofit organization that sets relevant national technical standards;
(II) Make recommendations as to the specific information that such technology and tools should be able to electronically exchange or transmit;
(III) Make recommendations to simplify eligibility and coverage verification through electronic data interchange utilizing swipe card or other appropriate technology;
(IV) Make recommendations regarding eligibility notification, preauthorization, or service notification and retroactive denial through electronic data interchange using swipe card or other appropriate technology;
(V) Make recommendations regarding how to incorporate the requirements of section 10-16-124 pertaining to uniform prescription drug information as part of the technology and tools for electronically recognizing, exchanging, or transmitting information between carriers and providers;
(VI) Make recommendations regarding whether, once electronic data interchange technology and tools are fully implemented, standardized, printed cards are necessary and, if so, what information needs to be included on the printed cards;
(VII) Make recommendations regarding when such technology could be implemented for medical assistance programs, as defined in sections 25.5-1-103 and 25.5-4-103, C.R.S.; and
(VIII) Make recommendations, if the work group so chooses, to create a pilot program for initial use of the recommended technology and tools.
(b) The work group established pursuant to paragraph (a) of this subsection (2) shall report its recommendations to the commissioner no later than six months after its first meeting; except that, if the work group is unable to complete its duties in six months, it may request that the commissioner extend the deadline by not more than an additional six months.
(c) After receipt of the work group's recommendations, the commissioner shall adopt rules to implement a standardized electronic swipe card or other appropriate technology to be used by carriers, providers, and covered persons under a health benefit plan to allow access to information regarding the applicable coverage under the plan. Carriers shall implement the new technology no later than two years after the effective date of the rules adopted pursuant to this paragraph (c); except that, if the work group concludes that carriers are unable to fully implement the technology by the deadline, the work group may recommend that the commissioner grant an extension of not more than six months for full implementation of the requirements of such rules.
(3) The rules adopted by the commissioner pursuant to this section shall conform to applicable federal guidelines on standardized claims attachment forms once such federal guidelines are adopted.
(4) The commissioner shall amend, modify, reenact, update, or otherwise revise the rules adopted pursuant to this section as necessary to reflect the most current technology available that will allow real-time data exchange, benefits eligibility, coverage determinations, and other appropriate provider-carrier transactions.
(5) Licensed or certified hospitals and physicians licensed pursuant to article 240 of title 12 shall use the standardized, printed card provided to covered persons and children's basic health plan enrollees and, once implemented, shall use the standardized electronic technology for accessing information about the coverage available under a health benefit plan or the children's basic health plan for a covered person or enrollee to whom health-care services are or will be provided by the hospital or physician.
(6) A carrier or provider located in a rural area of the state, as determined by the commissioner, may apply to the commissioner for, and the commissioner may grant, an extension of any of the deadlines imposed by this section if meeting a particular deadline would impose a financial hardship on the rural carrier or provider. The commissioner may require the rural carrier or provider to submit documentation supporting the financial hardship claim.
(7) The commissioner shall adopt rules that require each carrier that provides a dental coverage plan, as defined in section 10-16-165 (1)(b), to issue to covered persons to whom a dental coverage plan identification card is issued a standardized written or virtual card containing plan information. To the extent possible, the rules must incorporate and not conflict with the requirements of section 10-16-124 regarding prescription information cards. The commissioner shall adopt rules by March 31, 2024, that describe the format of the standardized card to be issued by carriers. The rules establishing the format for the card must include a standard size, must require the card to be legible and photocopied, and must delineate the information to be contained on the card, including the following, as applicable:
(a) The covered person's name and the applicable plan number;
(b) Contact information for the carrier or dental coverage plan administrator; and
(c) An indication of whether the dental coverage plan is regulated by the state of Colorado.
Source: L. 2008: Entire section added, p. 2008, � 1, effective June 3. L. 2019: (5) amended, (HB 19-1172), ch. 136, p. 1655, � 49, effective October 1. L. 2023: (7) added, (SB 23-179), ch. 332, p. 1993, � 4, effective August 7. L. 2025: IP(1)(a), (1)(b), and (1)(c) amended and (1)(d) and (1)(e) added, (SB 25-010), ch. 11, p. 25, � 1, effective January 1, 2026.
Editor's note: Section 3(2) of chapter 11 (SB 25-010), Session Laws of Colorado 2025, provides that the act changing this section applies to conduct occurring on or after January 1, 2026.
Cross references: For the legislative declaration in SB 23-179, see section 1 of chapter 332, Session Laws of Colorado 2023.
10-16-136. Wellness and prevention programs - individual and small group health coverage plans - voluntary participation - incentives or rewards - rules - definitions - legislative declaration - repeal. (Repealed)
Source: L. 2009: Entire section added, (HB 09-1012), ch. 188, p. 819, � 1, effective July 1. L. 2010: (1), (2)(a), (2)(b), (3)(a), (3)(c), (3)(d), and (5) amended and (3)(f), (3.5), (3.7), (6.5), (6.7), (7)(a.5), and (8) added, (HB 10-1160), ch. 283, pp. 1321, 1326, 1327, �� 1, 2, 3, effective July 1. L. 2013: (2)(a), (3.5)(a), and (5)(b) amended and (5)(a)(III)(A) repealed, (HB 13-1266), ch. 217, p. 973, � 24, effective May 13; (7)(a) repealed, (HB 13-1115), ch. 338, p. 1972, � 10, effective March 31, 2015.
Editor's note: Subsection (8) provided for the repeal of this section, effective July 1, 2015. (See L. 2010, p. 1321.)
10-16-137. Policy forms - explanation of benefits - standardization of forms - rules. (1) The commissioner shall convene a group of stakeholders, including carriers, providers, and consumers, to develop a standardized format for the following regarding health benefit plans, limited benefit health insurance, and dental plans:
(a) Section names and the placement of those sections in the policy forms issued by all carriers; and
(b) The required information for carriers to provide on an explanation of benefits form sent to covered persons or providers making a claim for benefits under a health benefit plan, limited benefit health insurance, or dental plan.
(2) The commissioner shall adopt rules after considering the input from carriers, providers, consumers, and other stakeholders in developing the standardized format for policy forms and explanation of benefits forms. The rules shall apply to health benefit plans, limited benefit health insurance, and dental plans issued or delivered on or after January 1, 2012.
Source: L. 2010: Entire section added, (HB 10-1004), ch. 141, p. 477, � 1, effective August 11.