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Colorado Statutes, Title 10

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Colorado/Statutes

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Title 10, Insurance

0 chapters · 1,275 sections in this title.

All chapters in Title 101,275 Ch 16287 Ch 3271 Ch 4209 Ch 7100 Ch 271 Ch 169 Ch 1442 Ch 1128 Ch 1525 Ch 524 Ch 1223 Ch 620 Ch 1920 Ch 2020

287 sections·Filtered byTitle 10✕Ch 16✕

Colo. Rev. Stat. § 10-16-147 Parity reporting - commissioner - carriers - rules - examination of complaints
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(1) (a) By June 1, 2020, and by each June 1 thereafter, the commissioner shall submit a written report to the health and insurance committee and the public health care and human services committee of the house of representatives, or their successor committees, and to the health a…
Colo. Rev. Stat. § 10-16-148 Medication-assisted treatment - limitations on carriers - rules
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(1) Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary: (a) Not impose prior autho…
Colo. Rev. Stat. § 10-16-150 Primary care payment reform collaborative - created - powers and duties - report - definition - repeal
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(1) The commissioner shall convene a primary care payment reform collaborative to: (a) Consult with the department of personnel, the executive director of the department of health care policy and financing, and the administrator of the Colorado all-payer health claims database de…
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Colo. Rev. Stat. § 10-16-1501

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The short title of this part 15 is the "Colorado 340B Prescription Drug Program Anti-discrimination Act". Source: L. 2022: Entire part added, (HB 22-1122), ch. 312, p. 2230, § 1, effective August 10.

Colo. Rev. Stat. § 10-16-1502 Legislative declaration

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(1) The general assembly declares that the purpose of this part 15 is to: (a) Prohibit a pharmacy benefit manager or carrier from imposing fees, charge backs, or other adjustments on covered entities or contract pharmacies based on their participation in the 340B drug pricing pro…

Colo. Rev. Stat. § 10-16-1503 Definitions

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As used in this part 15, unless the context otherwise requires: (1) "340B covered entity" means a covered entity, as defined in section 340B (a)(4) of the federal "Public Health Service Act", 42 U.S.C. sec. 256b (a)(4), as amended. (2) "340B drug" means a drug purchased through t…

Colo. Rev. Stat. § 10-16-1504 Applicability - exclusions

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(1) This part 15 applies to any third party that reimburses 340B covered entities or contract pharmacies in this state. (2) Nothing in this part 15: (a) Prohibits a third party from maintaining differential reimbursement rates for participating and nonparticipating providers, so …

Colo. Rev. Stat. § 10-16-1505 Prohibition on 340B discrimination

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(1) A third party that reimburses a 340B covered entity or contract pharmacy for 340B drugs shall not: (a) Reimburse the 340B covered entity or contract pharmacy for a pharmacy-dispensed drug at a rate lower than the amount paid for the same drug to pharmacies similar in prescrip…

Colo. Rev. Stat. § 10-16-1506 Enforcement - rules

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(1) A third party that violates this part 15 engages in an unfair or deceptive act or practice in the business of insurance under section 10-3-1104 (1)(tt), and the act of the third party that violates this part 15 is void and unenforceable. (2) The commissioner may adopt rules a…

Colo. Rev. Stat. § 10-16-151 Cost sharing in prescription insulin drugs - limits - definition - rules

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(1) As used in this section, unless the context otherwise requires, "prescription insulin drug" means a prescription drug, as defined in section 12-280-103 (42), that contains insulin and is used to treat diabetes. (2) A carrier that provides coverage for prescription insulin dru…

Colo. Rev. Stat. § 10-16-152 HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal

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(1) A carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a pharmacist may, pursuant to section 12-280-125.7, prescribe or dispense an HIV prevention drug. (2) Before July 1, 2027, a carrier shall not require a covered perso…

Colo. Rev. Stat. § 10-16-153 Coverage for opioid antagonists provided by a hospital - definition

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(1) As used in this section, unless the context otherwise requires, "opioid antagonist" has the same meaning as set forth in section 12-30-110 (7)(d). (2) A carrier that provides coverage for opioid antagonists pursuant to the terms of a health coverage plan the carrier offers sh…

Colo. Rev. Stat. § 10-16-154 Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcement

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(1) A carrier that has a contract with a physical therapist, an occupational therapist, a chiropractor, or an acupuncturist shall not: (a) Prohibit the physical therapist, occupational therapist, chiropractor, or acupuncturist from providing a covered person information on the am…

Colo. Rev. Stat. § 10-16-155 Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - rate filings - repeal

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(1) On or before November 1, 2022, the division shall retain by contract one or more entities that have experience in actuarial reviews, health-care policy, and health equity, referred to in this section as the "contractors", for the purpose of performing actuarial reviews of leg…

Colo. Rev. Stat. § 10-16-155.5 Actuarial review of doula services - report - definition

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(1) The division shall contract with an independent entity to conduct an actuarial review of the potential health-care costs and benefits of including coverage for doula services for pregnant and postpartum persons covered by health benefit plans. (2) The division shall present t…

Colo. Rev. Stat. § 10-16-156 Prescription drugs - rebates - consumer cost reduction - point of sale - study - report - rules - definitions

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(1) As used in this section, unless the context otherwise requires: (a) "Discount" means price reductions or concessions, including base price concessions or other contractual agreements made by a manufacturer or its affiliate, that reduce payment or liability for prescription dr…

Colo. Rev. Stat. § 10-16-157 Alternative payment model parameters - parameters to include an aligned quality measure set - primary care providers - requirement for carriers to submit alternative payment models to the division - legislative declaration - report - rules - definitions

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(1) Legislative declaration. The general assembly hereby finds and declares that: (a) Fee-for-service health-care payment models have long been criticized for incentivizing a higher volume of health-care services rather than a greater value, perpetuating health disparities by fai…

Colo. Rev. Stat. § 10-16-158 Treatment of sexually transmitted infection - cost sharing - rules - definition

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(1) For health benefit plans issued or renewed on or after January 1, 2025, if the treatment of a sexually transmitted infection, as defined in section 25-4-402 (10), is a covered service, the health benefit plan must provide the coverage without deductibles, copayments, coinsura…

Colo. Rev. Stat. § 10-16-159 Coverage for sterilization services - cost sharing

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(1) For health benefit plans issued or renewed on or after January 1, 2025, if sterilization services are a covered service, the health benefit plan must provide the coverage regardless of the covered person's sex or gender and without deductibles, copayments, coinsurance, annual…

Colo. Rev. Stat. § 10-16-160 Cost sharing - prescription epinephrine - limits - rules - definition

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(1) As used in this section, unless the context otherwise requires, "epinephrine auto-injector" has the same meaning as set forth in section 12-280-142 (1)(c). (2) For health coverage plans issued or renewed on or after January 1, 2024, if a carrier provides coverage for prescrip…

Colo. Rev. Stat. § 10-16-161 Calculation of contribution to out-of-pocket and cost-sharing requirements - exception - definition - rules

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(1) (a) When calculating a covered person's overall contribution to an out-of-pocket maximum or cost-sharing requirement under the covered person's health benefit plan, a carrier or PBM shall include any amount paid by the covered person or by another person on behalf of the cove…

Colo. Rev. Stat. § 10-16-162 Prohibition on discrimination for coverage based solely on natural medicine consumption - definitions

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(1) A carrier that offers, issues, or renews a health benefit plan shall not, solely on the basis of a person's consumption of natural medicine or natural medicine product: (a) Decline or limit coverage of a person; or (b) Penalize a covered person or reduce or limit coverage for…

Colo. Rev. Stat. § 10-16-163 Contracts - health benefit plans - pharmacy benefit managers - policyholders - transparency requirements - rules - definitions

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(1) For a contract between a carrier or pharmacy benefit manager and a certificate holder or policyholder that is issued or renewed on or after January 1, 2025, the amount charged by the carrier or PBM to the certificate holder or policyholder for a prescription drug dispensed to…

Colo. Rev. Stat. § 10-16-164 Hospital facility fee report - data collection

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The commissioner is authorized to collect from a carrier offering a health benefit plan information specified in section 25.5-4-216, if available, for purposes of facilitating the development of the report relating to facility fees. Source: L. 2023: Entire section added, (HB 23-1…

Colo. Rev. Stat. § 10-16-165 Dental coverage plans - dental loss ratio - rules - definitions

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(1) As used in this section, unless the context otherwise requires: (a) "Community benefit expenditure" means an expenditure for an activity or program, or to an organization that seeks to achieve the objectives of improving access to dental services and enhancing dental public h…

Colo. Rev. Stat. § 10-16-166 Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules

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(1) (a) Every health benefit plan subject to part 2, 3, or 4 of this article 16, except those described in section 10-16-102 (32)(b), shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or…

Colo. Rev. Stat. § 10-16-167 Medical aid-in-dying - carrier prohibitions

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(1) A carrier shall not: (a) Deny or alter benefits otherwise available to a covered individual with a terminal disease based on the availability of medical aid-in-dying pursuant to article 48 of title 25. (b) Attempt to coerce an individual with a terminal disease to make a requ…

Colo. Rev. Stat. § 10-16-168 Carriers - health care - price transparency - rules - legislative declaration - definitions

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(1) Legislative declaration. (a) The general assembly finds and declares that: (I) The federal "Patient Protection and Affordable Care Act", Pub.L. 111-148, was enacted on March 23, 2010, and the federal "Health Care and Education Reconciliation Act of 2010", Pub.L. 111-152, was …

Colo. Rev. Stat. § 10-16-169 Carriers - prescription drug coverage - transparency

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Beginning July 1, 2025, and on or before each July 1 thereafter, each carrier shall submit to the commissioner, in the same form and manner as submitted to the United States secretary of health and human services, information required by federal pharmacy benefit and drug cost rep…

Colo. Rev. Stat. § 10-16-170 Delivery of notices and documents by electronic means - definitions - consent required - withdrawal of consent - employers - immunity from liability - posting of plans and endorsements on carrier website - applicability - rules

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(1) As used in this section, unless the context otherwise requires: (a) "Delivered by electronic means" means: (I) Delivery to an electronic mail address at which a party has consented to receive notices or documents; or (II) Posting on an electronic network, site, or consumer po…

Colo. Rev. Stat. § 10-16-200.3 Definitions

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As used in this part 2, unless the context otherwise requires: (1) "Industrial sickness and accident insurance" means sickness and accident insurance under individual policies for which the premium is payable weekly and includes any such policy which covers sickness only or accid…

Colo. Rev. Stat. § 10-16-201 Form and content of individual sickness and accident insurance policies

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(1) No such policy shall be delivered or issued for delivery in this state unless: (a) The entire money and other considerations therefor are expressed therein; and (b) The time at which insurance takes effect and terminates is expressed therein; and (c) It purports to insure onl…

Colo. Rev. Stat. § 10-16-202 Required provisions in individual sickness and accident policies

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(1) Except as provided in section 10-16-204, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this section in the words in which the same appear in this section; except that the insurer, at its option, may sub…

Colo. Rev. Stat. § 10-16-203 Optional provisions in individual sickness and accident insurance policies

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(1) Except as provided in section 10-16-204, no individual sickness and accident insurance policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth below unless such provisions are in the words in which the same…

Colo. Rev. Stat. § 10-16-204 Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance

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If any provision of part 1 of this article or this part 2 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision o…

Colo. Rev. Stat. § 10-16-205 Order of certain policy provisions in individual policies of sickness and accident insurance

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The provisions which are the subject of sections 10-16-202 and 10-16-203, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections, or, at the option of the insure…

Colo. Rev. Stat. § 10-16-206 Third-party ownership of individual sickness and accident insurance policies

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The word "insured", as used in part 1 of this article and this part 2, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a po…

Colo. Rev. Stat. § 10-16-207 Requirements of other jurisdictions

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(1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of part 1 of this article and this part 2 and which is pres…

Colo. Rev. Stat. § 10-16-208 Conforming to statute

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(1) No policy provision which is not subject to section 10-16-202 or 10-16-203 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to part 1 of this article and this part 2. (2)…

Colo. Rev. Stat. § 10-16-209 Application for policy

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(1) The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof. If any such policy delivered or issued for delivery to any person in this state is rei…

Colo. Rev. Stat. § 10-16-210 Notice - waiver

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The acknowledgment by any insurer of the receipt of notice given under any policy covered by part 1 of this article or this part 2, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim under such policy shall no…

Colo. Rev. Stat. § 10-16-211 Age limit

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If any such policy contains a provision establishing, as an age limit or otherwise, a date after which coverage provided by the policy will not be effective, and if such date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium …

Colo. Rev. Stat. § 10-16-212 Exemption from attachment and execution

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So much of any benefits under all policies of sickness and accident insurance as does not exceed two hundred dollars for each month during any period of disability covered by such policy shall not be liable to attachment, trustee process, or other process, or to be seized, taken,…

Colo. Rev. Stat. § 10-16-213 Industrial sickness and accident insurance

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(1) Repealed. (2) Any insurer authorized to write sickness and accident insurance in this state has the power to issue industrial sickness and accident policies. (3) No policy of industrial sickness and accident insurance may be delivered or issued for delivery in this state unle…

Colo. Rev. Stat. § 10-16-214 Group sickness and accident insurance

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(1) Group sickness and accident insurance is declared to be that form of sickness and accident insurance covering groups of persons, with or without their dependents, and issued upon the following bases: (a) Under a policy issued to an employer, who shall be deemed the policyhold…

Colo. Rev. Stat. § 10-16-215 Blanket sickness and accident insurance

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(1) Blanket sickness and accident insurance is declared to be that form of sickness and accident insurance covering special groups of not less than ten persons as enumerated under a policy or contract issued: (a) To any common carrier, which shall be deemed the policyholder, cove…

Colo. Rev. Stat. § 10-16-216 Examinations

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(1) The commissioner may, at any reasonable time, make or cause to be made an examination of every admitted health insurer transacting any insurance to which the provisions of part 1 of this article and this part 2 are applicable to ascertain whether each insurer and every rate u…

Colo. Rev. Stat. § 10-16-216.5 Hearing procedure and judicial review - violations - penalty

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(1) Any person aggrieved by any rate charged, underwriting rule, policy form, certificate, contract of insurance, or rider followed or adopted by a health insurer may request the insurer to review the manner in which the rate, underwriting rule, policy form, certificate, contract…

Colo. Rev. Stat. § 10-16-217 Application of part 1 of this article and part 2

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(1) Nothing in part 1 of this article or this part 2 shall apply to or affect any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage in said policy; or life insurance, endowment, or annuity contracts, or c…

Colo. Rev. Stat. § 10-16-218 Judicial review

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Any final action of the commissioner pursuant to part 1 of this article and this part 2 shall be subject to judicial review by the court of appeals pursuant to section 24-4-106 (11), C.R.S. Source: L. 92: Entire article R&RE, p. 1680, § 1, effective July 1; entire section amended…