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Colorado Statutes, Title 10

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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. § 10-16-1001 Legislative declaration
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(1) The general assembly hereby recognizes that, through the sunset review for the division of insurance within the department of regulatory agencies in October 2001, the general assembly adopted a recommendation to consolidate and relocate the regulatory functions concerning hea…
Colo. Rev. Stat. § 10-16-1002 Definitions
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As used in this part 10, unless the context otherwise requires: (1) Repealed. (2) "Cooperative" or "health-care coverage cooperative" means a health-care coverage cooperative created pursuant to this part 10 as an entity that provides to its members health coverage and health-car…
Colo. Rev. Stat. § 10-16-1003 Privacy of health information
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(1) Individually identifiable health information collected for or by a cooperative is subject to HIPAA. (2) (a) All disclosures of individually identifiable health information shall be restricted to the minimum amount of information necessary to accomplish the purpose for which t…
Colo. Rev. Stat. § 10-16-1004 Health-care coverage cooperatives - establishment - fees

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(1) (a) There is hereby authorized the creation of entities to be known as health-care coverage cooperatives. A health-care coverage cooperative may be created as any lawful entity under articles 55, 56, 58, 101 to 117, or 121 to 137 of title 7, C.R.S., so long as such entity ope…

Colo. Rev. Stat. § 10-16-1005 Issuance of certificate of authority by commissioner for cooperative to purchase health-care coverage

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(1) (a) (I) (A) On and after August 4, 2004, an unlicensed cooperative conducting business pursuant to this part 10 shall file an application with the commissioner for issuance of a certificate of authority to purchase health-care coverage for members and their eligible employees…

Colo. Rev. Stat. § 10-16-1006 Authority to deny application for, revoke, or suspend certificate of authority

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(1) On and after August 4, 2004, the commissioner may deny an application for a certificate of authority pursuant to section 10-16-1005 or revoke or suspend a certificate of authority of any cooperative found to be in violation of this part 10. (2) (a) Any party may request a hea…

Colo. Rev. Stat. § 10-16-1007 Prohibition on cooperatives transacting insurance business

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A cooperative shall not perform any activity included in the definition of transacting insurance business in this state, as provided in section 10-3-903, except as otherwise authorized in the powers, duties, and responsibilities of cooperatives as set forth in section 10-16-1009.…

Colo. Rev. Stat. § 10-16-1008 Administrative structure of cooperatives - board of directors - officers - employees

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(1) (a) (I) The affairs of the cooperative shall be managed in accordance with the legal structure required of the entity and, except as provided in subsection (1)(a)(II) of this section, governed by persons elected by the members from their own number. The governing body of the …

Colo. Rev. Stat. § 10-16-1009 Powers, duties, and responsibilities of cooperatives

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(1) Each cooperative organized pursuant to this part 10 shall: (a) Establish the conditions of cooperative membership; (b) Provide to cooperative members and their eligible employees clear, standardized information about each provider network, licensed provider network, carrier, …

Colo. Rev. Stat. § 10-16-101 Short title

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This article shall be known and may be cited as the "Colorado Health Care Coverage Act". Source: L. 92: Entire article R&RE, p. 1617, § 1, effective July 1. ANNOTATION Law reviews. For article, "H.B. 94-1210: Health Insurance Reform", see 24 Colo. Law. 2331 (1994). For article, "…

Colo. Rev. Stat. § 10-16-1010 Marketing requirements of cooperatives

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(1) A cooperative shall use appropriate, efficient, and standardized means to notify members and prospective members and their eligible employees of the availability of sponsored health-care coverage from the cooperative. (2) A cooperative shall make available to members and pros…

Colo. Rev. Stat. § 10-16-1013 Violations of article by persons involved with operations of cooperatives - enforcement - penalties

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(1) As used in this section, unless the context otherwise requires, "responsible party" means a member of the governing body or an executive officer of a cooperative. (2) (a) After notice and the opportunity for a hearing pursuant to article 4 of title 24, C.R.S., the commissione…

Colo. Rev. Stat. § 10-16-1014 Technical assistance to authorized cooperatives from division of insurance

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(1) Subject to available appropriations, the commissioner may provide technical assistance to any cooperative that: (a) to (c) Repealed. (d) Establishes rules that specify that employer members shall take no action to limit their employees' choice of plans offered through the coo…

Colo. Rev. Stat. § 10-16-1015 Health-care cooperatives - rule-making authority

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The commissioner may promulgate rules consistent with this part 10 for purposes of carrying out the commissioner's duties under this part 10. Source: L. 2004: Entire part added, p. 1009, § 14, effective August 4. L. 2019: Entire section amended, (SB 19-004), ch. 205, p. 2197, § 1…

Colo. Rev. Stat. § 10-16-1016 State innovation waiver - authority to apply

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As necessary to implement this part 10, the commissioner may apply to the secretary of the United States department of health and human services for a five-year state innovation waiver in accordance with section 1332 of the federal act, codified at 42 U.S.C. sec. 18052, and 45 CF…

Colo. Rev. Stat. § 10-16-102 Definitions

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As used in this article 16, unless the context otherwise requires: (1) "Actuarial certification" means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with the p…

Colo. Rev. Stat. § 10-16-103 Proposal of mandatory health-care coverage provisions

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(1) Every person or organization which seeks legislative action which would mandate a health coverage or offering of a health coverage by an insurance carrier, nonprofit hospital and health-care service corporation, health maintenance organization, or prepaid dental care plan org…

Colo. Rev. Stat. § 10-16-103.4 Essential health benefits - requirements - rules

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(1) Carriers offering individual or small group health benefit plans in this state shall ensure that the coverage includes the essential health benefits package. This subsection (1) does not apply to grandfathered health benefit plans. (2) Except as provided in subsection (3) of …

Colo. Rev. Stat. § 10-16-103.5 Payment of premiums - required term in contract - rules - definition

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(1) (a) Every contract for a health benefit plan between a carrier and a policyholder shall require the policyholder to pay premiums for each individual covered under the policyholder's policy: (I) Through the date that the policyholder notifies the carrier that the individual co…

Colo. Rev. Stat. § 10-16-103.6 Copayment-only prescription payment structures - required inclusion in health benefit plans - rules

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(1) (a) In addition to the requirements in section 10-16-103.4 (2), for health benefit plans issued or renewed on or after January 1, 2023, each carrier that offers an individual or small group health benefit plan shall offer at least twenty-five percent of its health benefit pla…

Colo. Rev. Stat. § 10-16-104 Mandatory coverage provisions - applicability - rules - legislative declaration - definitions

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(1) Newborn children. (a) All group and individual 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 provide coverage for a dependent newborn child of the insured or subscriber from th…

Colo. Rev. Stat. § 10-16-104.1 Prohibition on discrimination for organ transplants based solely on disability - definition

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(1) A carrier that offers, issues, or renews a health benefit plan that provides coverage for anatomical gifts, organ transplants, or related treatments or services shall not, solely on the basis of a covered person's disability: (a) Deny coverage to a covered person for an organ…

Colo. Rev. Stat. § 10-16-104.2 Coverage for contraception - rules - definitions

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(1) As used in this section, unless the context otherwise requires: (a) "Carrier" means a carrier offering a health benefit plan. (b) "Contraception" has the same meaning as "contraceptive" or "contraception" set forth in section 2-4-401 (1.5). (c) "Dispensing entity" means a pha…

Colo. Rev. Stat. § 10-16-104.3 Health coverage for persons under twenty-six years of age - coverage for students who take medical leave of absence

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(1) (a) A carrier that offers a health benefit plan in the state and that makes dependent coverage for children available under the health benefit plan shall make the coverage available for a child who is under twenty-six years of age. The carrier shall not deny or restrict cover…

Colo. Rev. Stat. § 10-16-104.6 Off-label use of cancer drugs

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(1) A health benefit plan that provides coverage for prescription drugs shall not limit or exclude coverage for any drug approved by the FDA for use in the treatment of cancer on the basis that the drug has not been approved by the FDA for the treatment of the specific type of ca…

Colo. Rev. Stat. § 10-16-104.7 Substance use disorders - court-ordered treatment coverage

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(1) An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for treatment of a substance use disorder must provide coverage for such treatment…

Colo. Rev. Stat. § 10-16-104.8 Behavioral, mental health, or substance use disorder services coverage - court-ordered

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(1) An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for behavioral, mental health, or substance use disorder services must provide cov…

Colo. Rev. Stat. § 10-16-104.9 Geographic areas for small employers

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(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 …

Colo. Rev. Stat. § 10-16-105 Guaranteed issuance of health insurance coverage - individual and small employer health benefit plans

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(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 premi…

Colo. Rev. Stat. § 10-16-105.1 Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules - notice to revisor of statutes - repeal

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(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 pl…

Colo. Rev. Stat. § 10-16-105.2 Small employer health insurance availability program

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(1) (a) Except as provided in paragraphs (b) and (d) of this subsection (1), this article applies to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met: (I) Any portion of the premium or ben…

Colo. Rev. Stat. § 10-16-105.3 Health benefit plans - not prohibited

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(1) A carrier shall not be prohibited from offering to a small employer additional options of health benefit plans that: (a) Provide for different benefits for insureds and dependents of such insureds covered by the same policy; and (b) Encourage appropriate health-care condition…

Colo. Rev. Stat. § 10-16-105.6 Rate usage

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(1) A carrier offering an individual or group health benefit plan shall not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or, for group plans, a contribution that is greater than the premium or contribution for a sim…

Colo. Rev. Stat. § 10-16-105.7 Health benefit plan open enrollment periods - special enrollment periods - rules

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(1) (a) A carrier offering an individual health benefit plan in this state shall permit an individual to purchase an individual health benefit plan during the initial and annual open enrollment periods. (b) The initial open enrollment period begins October 1, 2013, and extends th…

Colo. Rev. Stat. § 10-16-105.9 Health benefit plan - carrier insolvency - covered persons - deductible amounts - rules - definition

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(1) As used in this section: (a) "Out-of-pocket expenses" means expenses paid toward a health benefit plan: (I) Deductible for medical services and prescription drugs that were credited under the covered person's health benefit plan; and (II) Out-of-pocket maximum for medical ser…

Colo. Rev. Stat. § 10-16-106 Group replacement - extension of benefits

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(1) This section shall indicate which carrier is liable where one carrier's group contract replaces a plan of similar benefits of another carrier within thirty-one days after the termination, cancellation, or expiration of the contract that is being replaced. (2) The prior carrie…

Colo. Rev. Stat. § 10-16-106.3 Uniform claims - billing codes - electronic claim forms

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(1) On or before July 1, 2002, all carriers shall accept the claim form adopted by the American dental association for use by all dental providers and carriers in the state, and the federal centers for medicare and medicaid services' claim forms CMS-1500 and CMS-1450, otherwise k…

Colo. Rev. Stat. § 10-16-106.5 Prompt payment of claims - legislative declaration - rules

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(1) The general assembly finds, determines, and declares that: (a) Patients and health-care providers often do not receive the reimbursements to which they are entitled from health insurance entities in a timely manner, even in the case of claims that are submitted on standard fo…

Colo. Rev. Stat. § 10-16-106.7 Assignment of health insurance benefits

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(1) (a) Any carrier that provides health coverage to a covered person shall allow, but not require, such covered person under the policy to assign, in writing, payments due under the policy to a licensed hospital or other licensed health-care provider; an occupational therapist, …

Colo. Rev. Stat. § 10-16-107 Rate filing regulation - benefits ratio - rules

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(1) (a) A carrier subject to part 2, 3, 4, or 5 of this article 16 shall not establish rates for any sickness, accident, or health insurance policy, contract, certificate, or other evidence of coverage or dental coverage plan, as defined in section 10-16-165 (1)(b), issued or del…

Colo. Rev. Stat. § 10-16-107.1 False or misleading information - penalties

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(1) A person or organization shall not knowingly withhold information that will affect the rates or premiums chargeable under this part 1 or knowingly give false or misleading information to the commissioner or any statistical agent, advisory organization, or carrier. A person or…

Colo. Rev. Stat. § 10-16-107.2 Filing of health policies - rules

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(1) All carriers authorized by the commissioner to conduct business in Colorado shall submit an annual report to the commissioner listing any policy form, endorsement, or rider for any sickness, accident, nonprofit hospital and health service corporation, health maintenance organ…

Colo. Rev. Stat. § 10-16-107.3 Health insurance policies - plain language required - rules

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(1) (a) A carrier issuing or renewing a health benefit plan, limited benefit health insurance, dental plan, or long-term care plan subject to this article shall not issue or renew the plan unless the text of the plan does not exceed the tenth-grade level as measured by the Flesch…

Colo. Rev. Stat. § 10-16-107.4 Health-care sharing plan or arrangement - required reporting and certification - noncompliance - information posted on division website - rules

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(1) A person not authorized by the commissioner pursuant to article 3 of this title 10 to offer insurance in this state that offers or intends to offer a plan or arrangement to facilitate payment or reimbursement of health-care costs or services for residents of this state, regar…

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. § 10-16-108.5 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…