Title 10, Insurance
0 chapters · 1,354 sections in this title.
Colo. Rev. Stat. § 10-16-107.5 Uniform application form - use by all carriers - rules
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(1) The commissioner, by rule, shall develop a uniform application form for health benefit plans and shall require all carriers providing health benefit plans that are authorized by the commissioner to conduct business in Colorado to exclusively use the uniform application form f…
Colo. Rev. Stat. § 10-16-107.7 Nondiscrimination against providers
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(1) A carrier offering an individual or group health benefit plan in this state shall not discriminate with respect to participation under the plan or coverage against any provider who is acting within the scope of his or her license or certification under applicable state law. (…
Colo. Rev. Stat. § 10-16-108 Continuation privileges
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(1) Group health benefit plans. (a) Every employer group health benefit plan issued by a carrier must contain a provision specifying that if a covered employee's employment is terminated and the health benefit plan remains in force for active employees of the employer, the covere…
Colo. Rev. Stat. § 10-16-108.3 Continuation privileges - special election period - notice requirements - definitions - repeal. (Repealed)
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C.R.S. 10-16-108.3Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Servic…
Colo. Rev. Stat. § 10-16-108.5 Fair marketing standards - rules
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(1) Each carrier offering individual or small employer health benefit plans shall actively market health benefit plan coverage to eligible individuals or small employers in the state, as applicable. (2) (a) Except as provided in paragraph (b) of this subsection (2), no carrier or…
Colo. Rev. Stat. § 10-16-109 Rules
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Pursuant to article 4 of title 24, C.R.S., the commissioner may promulgate reasonable rules consistent with this article that are necessary or proper for implementing and administering this article, including rules necessary to align state law with the requirements imposed by fed…
Colo. Rev. Stat. § 10-16-110 Fees paid by health coverage entities
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(1) (a) There shall be paid to the division of insurance by every corporation subject to the provisions of this part 1 and part 3 of this article such fees as are prescribed pursuant to sections 10-3-207 and 24-31-104.5, C.R.S. (b) Every nonprofit hospital and health service corp…
Colo. Rev. Stat. § 10-16-1101 Short title
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The short title of this part 11 is the Colorado Reinsurance Program Act. Source: L. 2019: Entire part added, (HB 19-1168), ch. 204, p. 2176, � 1, effective May 17.
Colo. Rev. Stat. § 10-16-1102 Legislative declaration
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(1) The general assembly hereby finds and declares that: (a) All Coloradans deserve access to high-quality, affordable health care to help support their well-being and economic security; (b) Increasing costs of health care in Colorado have led to premium increases for health insu…
Colo. Rev. Stat. § 10-16-1103 Definitions
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As used in this part 11, unless the context otherwise requires: (1) Attachment point means the amount set by the commissioner pursuant to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a covered person's covered benefits in a benefit year, above which…
Colo. Rev. Stat. § 10-16-1104 Commissioner powers and duties - rules - study and report
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(1) The commissioner has all powers necessary to implement this part 11 and is specifically authorized to: (a) Enter into contracts as necessary or proper to carry out the provisions and purposes of this part 11, including contracts for the administration of the reinsurance progr…
Colo. Rev. Stat. § 10-16-1105 Reinsurance program - creation - enterprise status - subject to waiver or funding approval - operation - payment parameters - calculation of reinsurance payments - eligible carrier requests - definition
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(1) (a) There is hereby created in the division the Colorado reinsurance program to provide reinsurance payments to eligible carriers. Implementation and operation of the reinsurance program is contingent upon approval of a state innovation waiver, an extension of a state innovat…
Colo. Rev. Stat. § 10-16-1106 Accounting - reports - audits
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(1) The commissioner shall maintain an accounting for each benefit year of all: (a) Money expended for reinsurance payments and administrative and operational expenses; (b) Requests for reinsurance payments received from eligible carriers; (c) Reinsurance payments made to eligibl…
Colo. Rev. Stat. § 10-16-1107 Funding for reinsurance program - sources - permitted uses - reinsurance program cash fund - calculation of total funding for program
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(1) (a) There is hereby created in the state treasury the reinsurance program cash fund referred to in this section as the “fund”, which consists of: (I) Federal pass-through funding granted pursuant to 42 U.S.C. sec. 18052 (a)(3) or any other federal funds that are made availabl…
Colo. Rev. Stat. § 10-16-1108 Special assessments against hospitals and carriers - rules - enforcement. (Repealed)
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C.R.S. 10-16-1108Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Service…
Colo. Rev. Stat. § 10-16-1109 State innovation waiver - federal funding - Colorado reinsurance program
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(1) (a) For purposes of implementing and operating the reinsurance program as set forth in this part 11 for plan years starting on or after January 1, 2021, the commissioner may apply to the secretary of the United States department of health and human services for: (I) In accord…
Colo. Rev. Stat. § 10-16-111 Annual statements and reports - rules
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(1) Nonprofit hospital, medical-surgical, and health service corporations. (a) All corporations subject to the provisions of this part 1 and part 3 of this article doing business in this state on July 1, 1967, or which may thereafter do business in this state, shall make and file…
Colo. Rev. Stat. § 10-16-1110 Repeal of part - notice to revisor of statutes. (Repealed)
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Source: L. 2019: Entire part added, (HB 19-1168), ch. 204, p. 2187, � 1, effective May 17. L. 2020: (2) repealed, (SB 20-215), ch. 201, p. 1001, � 9, effective June 30. Editor's note: Section 1 of chapter 204, Session Laws of Colorado 2019, provided for the repeal of subsection (…
Colo. Rev. Stat. § 10-16-112 Private utilization review - health-care coverage entity responsibility - definitions
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(1) As used in this section, unless the context otherwise requires: (a) “Private utilization review organization” means an entity, other than a hospital or public reviewer following federal guidelines, that conducts utilization review or reviews and makes determinations on prior …
Colo. Rev. Stat. § 10-16-112.5 Prior authorization for health-care services - disclosures and notice - determination deadlines - criteria - limits and exceptions - enforcement - definitions - rules
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(1) Applicability. (a) On or after January 1, 2020, a carrier or, if a carrier contracts with a private utilization review organization to perform prior authorization for health-care services, the organization shall use the prior authorization process and comply with the requirem…
Colo. Rev. Stat. § 10-16-113 Procedure for denial of benefits - internal review - rules - definitions
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(1) (a) A carrier shall not make an adverse determination, in whole or in part, with respect to a health coverage plan unless the determination is made pursuant to this section. (b) For the purposes of this section: (I) “Adverse determination” means: (A) A denial of a preauthoriz…
Colo. Rev. Stat. § 10-16-113.5 Independent external review of adverse determinations - legislative declaration - definitions - rules
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(1) The general assembly hereby finds, determines, and declares that, in the interest of improving accountability for health-care coverage decisions, individuals should have the option of an independent external review by qualified experts when there has been an adverse determina…
Colo. Rev. Stat. § 10-16-113.7 Reporting the denial of benefits to division
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Each carrier shall report the number and outcome of second-level internal appeals pursuant to section 10-16-113 to the division by February 1 of each year. On at least an annual basis, the division shall compile the information reported by each carrier along with the number and o…
Colo. Rev. Stat. § 10-16-114 Short title. (Repealed)
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Source: L. 94: Entire section added, p. 742, � 1, effective January 1, 1995. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, � 27, effective May 13. Editor's note: This section was relocated to � 10-16-116 (1) in 2013.
Colo. Rev. Stat. § 10-16-115 Definitions. (Repealed)
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Source: L. 94: Entire section added, p. 742, � 1, effective January 1, 1995. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, � 27, effective May 13. Editor's note: This section was relocated to � 10-16-116 (6) in 2013. 10-16-116. Catastrophic health insurance - c…
Colo. Rev. Stat. § 10-16-116 Catastrophic health insurance - coverage - premium payments - reporting requirements - definitions - short title - rules - repeal
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(1) This section shall be known and may be cited as the “Colorado Catastrophic Health Insurance Coverage Act”. (2) (a) An employer may offer catastrophic health insurance to its employees pursuant to this section. (b) Prior to January 1, 2025, employees who elect the coverage sha…
Colo. Rev. Stat. § 10-16-116.5 State innovation waiver for nonemployer catastrophic health plans - notice of decision by secretary - effect of secretary’s decision - notice to revisor of statutes - definitions - rules - state measurement for accountable, responsive, and transparent (SMART) government act report - repeal. (Repealed)
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C.R.S. 10-16-116.5Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Servic…
Colo. Rev. Stat. § 10-16-117 Premium payments - pre-tax - election - reporting requirements. (Repealed)
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C.R.S. 10-16-117Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-118 Prohibition against preexisting condition exclusions
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A carrier offering an individual or small employer health benefit plan in this state shall not impose any preexisting condition exclusion with respect to coverage under the plan. Source: L. 94: Entire section added, p. 1913, � 9, effective July 1. L. 97: Entire section amended, p…
Colo. Rev. Stat. § 10-16-119 Requirements for excess loss or stop-loss health insurance used in conjunction with self-insured employer benefit plans under the federal “Employee Retirement Income Security Act” - data collection 2013-18 - rules
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(1) Any entity issuing excess loss insurance shall file all policy forms with the division and certify compliance with the provisions of this title. (2) All excess loss insurance shall be issued to cover the employer’s liability under the employer’s self-insured obligation. Exces…
Colo. Rev. Stat. § 10-16-119.5 Stop-loss health insurance for small employers of not more than fifty employees - requirements - definitions - rules
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(1) Notwithstanding section 10-16-119, the purpose of this section is to establish criteria for the issuance of stop-loss health insurance policies to any person, firm, corporation, partnership, or association actively engaged in business that employed an average of at least one …
Colo. Rev. Stat. § 10-16-120 Legislative review of requirements for guaranteed issue of basic and standard health benefit plans. (Repealed)
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C.R.S. 10-16-120Statutes current through Chapter 65 of the 2026 Regular Session, effective as of April 20, 2026. The text of this section is not final. It will not be final until compared to, and updated from, the text provided by the Colorado Office of Legislative Legal Services…
Colo. Rev. Stat. § 10-16-1201 Short title
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The short title of this part 12 is the Health Insurance Affordability Act. Source: L. 2020: Entire part added, (SB 20-215), ch. 201, p. 986, � 1, effective June 30.
Colo. Rev. Stat. § 10-16-1202 Legislative declaration
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(1) The general assembly finds and declares that: (a) The state, carriers, and hospitals share a common commitment to ensuring all Coloradans have access to affordable health care coverage because access to coverage improves health outcomes and provides financial security for Col…
Colo. Rev. Stat. § 10-16-1203 Definitions
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As used in this part 12, unless the context otherwise requires: (1) Board means the health insurance affordability board created in section 10-16-1207. (2) Children's basic health plan has the meaning set forth in section 25.5-8-103 (2). (2.5) Enhanced premium tax credit means th…
Colo. Rev. Stat. § 10-16-1204 Health insurance affordability enterprise - creation - powers and duties - assess and allocate health insurance affordability fee and special assessment
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(1) (a) There is hereby created in the division the Colorado health insurance affordability enterprise. The enterprise is and operates as a government-owned business within the division for the purpose of assessing and collecting the health insurance affordability fee from carrie…
Colo. Rev. Stat. § 10-16-1205 Health insurance affordability fees - special assessment on hospitals - allocation of revenues
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(1) (a) (I) Starting in the 2021 calendar year, the enterprise shall assess and collect from carriers, by July 15 each year, a health insurance affordability fee. The fee amount is based on the following percentages of premiums collected by the following carriers in the immediate…
Colo. Rev. Stat. § 10-16-1206 Health insurance affordability cash fund - creation - repeal
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(1) There is created in the state treasury the health insurance affordability cash fund. The fund consists of: (a) The fees collected from carriers pursuant to section 10-16-1205 (1)(a)(I); (b) The special assessments collected from hospitals pursuant to section 10-16-1205 (1)(a)…
Colo. Rev. Stat. § 10-16-1207 Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - annual report - commissioner rules
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(1) (a) There is hereby created the health insurance affordability board, which board is responsible for governance of the enterprise established in this part 12. The board consists of the following eleven voting members: (I) The executive director of the exchange or the executiv…
Colo. Rev. Stat. § 10-16-1208 Limitation on authority - public option
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Nothing in this part 12 authorizes the enterprise, the board, or the commissioner to establish, administer, operate, or require participation by carriers or hospitals in a state or public option health coverage plan. Source: L. 2020: Entire part added, (SB 20-215), ch. 201, p. 99…
Colo. Rev. Stat. § 10-16-1209 Repeal of certain provisions - notice to the revisor - repeal
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(1) Sections 10-16-1205 (2)(e), 10-16-1206 (1.5), and 24-75-201.1 (1)(d)(XXVII)(A) will take effect only if, by December 31, 2025, the United States congress does not enact and the president does not sign federal legislation that extends, recreates, or otherwise reinstates the en…
Colo. Rev. Stat. § 10-16-121 Required contract provisions in contracts between carriers and providers - definitions
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(1) A contract between a carrier and a provider or its representative concerning the delivery, provision, payment, or offering of care or services covered by a managed care plan must make provisions for the following requirements: (a) The contract must contain a provision stating…
Colo. Rev. Stat. § 10-16-121.3 Limitations on provisions in contracts between carriers and licensed health-care providers - methods of payment - fees - definitions
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(1) As used in this section, unless the context otherwise requires: (a) “Billing service” means a person or entity that contracts with a licensed health-care provider to: (I) Process bills for health-care services provided by the licensed health-care provider; and (II) Pursuant t…
Colo. Rev. Stat. § 10-16-121.5 Prohibited contract provisions in contracts between carriers and providers for dental services - definition
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(1) A contract between a carrier and a dentist licensed to practice under article 220 of title 12 must not require, directly or indirectly, that a dentist who is a participating provider provide services to a covered person at a fee set by, or subject to the approval of, the carr…
Colo. Rev. Stat. § 10-16-121.7 Prohibited contract provisions in contracts between carriers and eye care providers - definitions
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(1) A carrier or entity that offers a vision care plan shall not require that an eye care provider with whom the carrier or entity contracts: (a) Provide services or materials to a covered person at a fee set by, or subject to the approval of, the carrier or entity unless the ser…
Colo. Rev. Stat. § 10-16-1210 Regulatory agenda - division review of regulation - repeal
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(1) (a) The division shall conduct a review of regulation 4-2-76, concerning the health insurance affordability fee assessment and collection process, codified in 3 CCR 702-4, in accordance with section 24-4-103.3. The department of regulatory agencies shall include the division'…
Colo. Rev. Stat. § 10-16-1211 Performance audit of the enterprise - repeal
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(1) By December 31, 2027, the state auditor shall complete a performance audit of the enterprise. In conducting the audit, the state auditor shall: (a) Determine whether the enterprise and the board are in compliance with the purpose and responsibilities of the enterprise and the…
Colo. Rev. Stat. § 10-16-122 Access to prescription drugs
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(1) Except as provided in section 25.5-5-406.1 (1)(s), any pharmacy benefit management firm or intermediary whose contract with a carrier includes an open network shall allow participation by each pharmacy provider in the contract service area. If a pharmacy benefit management fi…
Colo. Rev. Stat. § 10-16-122.1 Contracts between PBMs and pharmacies - carrier submit list of PBMs - PBM registration - fees - prohibited practices - exception - rules - enforcement - short title - definitions
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(1) The short title of this section is the “Pharmacy Fairness Act”. (2) (a) Starting in 2022, each carrier shall submit to the commissioner, contemporaneously with its rate filing pursuant to section 10-16-107 and in a form and manner specified by the commissioner by rule, a list…
Colo. Rev. Stat. § 10-16-122.3 Pharmacy benefit management firm payments - retroactive reduction prohibited - enforcement - rules - dispensing fees - definitions
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(1) (a) A pharmacy benefit management firm shall not reimburse a pharmacy in an amount less than the amount that the pharmacy benefit management firm reimburses any affiliate for the same pharmacy services. (b) This subsection (1) does not prohibit a pharmacy benefit management f…