Title 10, Insurance
0 chapters · 1,354 sections in this title.
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
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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. § 10-16-105.5 Individual health plans - federally eligible individual - limited guarantee issue. (Repealed)
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C.R.S. 10-16-105.5Statutes 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. § 10-16-105.6 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. § 10-16-108.3 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…