Title 10, Insurance
0 chapters · 1,354 sections in this title.
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…
Colo. Rev. Stat. § 10-16-122.4 Pharmacy benefits - formulary change prohibition - exceptions - enforcement - definition - rules
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(1) (a) Starting in 2024, except as provided in subsection (2) of this section, a carrier or, if a carrier uses a PBM for claims processing services or other prescription drug or device services, as those terms are defined in section 10-16-122.1, under a health benefit plan offer…
Colo. Rev. Stat. § 10-16-122.5 Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rules
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(1) A pharmacy benefit manager, a carrier, or an entity acting on behalf of a pharmacy benefit manager or a carrier that audits a pharmacy shall: (a) Give the pharmacy at least seven days’ written notice prior to commencing an audit; (b) Conduct the audit by or in consultation wi…
Colo. Rev. Stat. § 10-16-122.6 Pharmacy benefit managers - contracts with pharmacies - maximum allowable cost pricing - enforcement - rules
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(1) (a) In each contract between a pharmacy benefit manager and a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit manager, within ten days after any request, a current list of the sources used to determine maximum allowable cost pricing. The ph…
Colo. Rev. Stat. § 10-16-122.7 Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules
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(1) The short title of this section is the “Patient Drug Costs Savings Act”. (2) The general assembly hereby finds and declares that: (a) Consumers have the right to know about options to reduce the amount of money they pay at a pharmacy for prescription drugs; and (b) This secti…
Colo. Rev. Stat. § 10-16-122.8 Pharmacy benefit manager practices - agreements - fees - documentation - rules
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(1) [Editor’s note: This section is effective January 1, 2027.](1) A pharmacy benefit manager may earn income derived from the assessment of a single, flat-dollar service fee for the provision of a prescription drug, which service fee is transparently expressed in a written agree…
Colo. Rev. Stat. § 10-16-122.9 Prescription drug benefits - real-time access to benefit information - enforcement - definitions - rules
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(1) (a) Upon request of a covered person, the covered person’s provider, or a third party on behalf of the covered person or provider, a carrier or, if a carrier uses a pharmacy benefit manager for claims processing services or other prescription drug or device services under a h…
Colo. Rev. Stat. § 10-16-123 Telehealth - definitions
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(1) It is the intent of the general assembly to recognize the practice of telehealth as a legitimate means by which an individual may receive health-care services from a provider without in-person contact with the provider. (2) (a) A health benefit plan or dental plan that is iss…
Colo. Rev. Stat. § 10-16-124 Prescription information cards - legislative declaration
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(1) It is the intent of the general assembly to lessen patients' waiting times for prescriptions, to decrease administrative burdens for pharmacies, and to improve care to patients by minimizing confusion, eliminating unnecessary paperwork, and streamlining the dispensing of pres…
Colo. Rev. Stat. § 10-16-124.5 Prior authorization form - drug benefits - program - chronic maintenance drugs - rules of commissioner - definitions - repeal
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(1) (a) Notwithstanding any other provision of law but subject to paragraph (b) of this subsection (1), on and after January 1, 2015, a carrier or, if a carrier contracts with a pharmacy benefit management firm to perform prior authorization services for drug benefits, the pharma…
Colo. Rev. Stat. § 10-16-124.6 Drugs used for substance use disorder - prior authorization prohibited
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A carrier that provides coverage under a health benefit plan for a drug used to treat a substance use disorder shall not require prior authorization, as defined in section 10-16-112.5 (7)(d), for the drug based solely on the dosage amount.
Colo. Rev. Stat. § 10-16-124.7 Opioid analgesics with abuse-deterrent properties - study - definitions
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(1) The governor shall direct the Colorado consortium for prescription drug abuse prevention to study the barriers to the use of abuse-deterrent opioid analgesic drug products as a way to reduce abuse and diversion of opioid drug products. On or before January 15, 2017, the conso…
Colo. Rev. Stat. § 10-16-124.8 Colorado consortium for prescription drug abuse prevention - create process for recovery - report
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(1) The governor shall direct the Colorado consortium for prescription drug abuse prevention within the university of Colorado to: (a) Create a process with the substance abuse recovery community to develop a strategic plan that addresses the full continuum of recovery services, …
Colo. Rev. Stat. § 10-16-125 Reimbursement to nurses
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(1) In counties of the state that are neither part of a metropolitan statistical area nor a primary statistical area, a carrier offering a health benefit plan shall not discriminate between a physician and an advanced practice registered nurse not practicing under the direction o…
Colo. Rev. Stat. § 10-16-126 Fee-for-service dental plans
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(1) Notwithstanding any provision of this title to the contrary, a fee-for-service dental plan for which premiums are not charged is not subject to the provisions of this title and the offering of such a plan shall not be considered transacting the business of insurance pursuant …
Colo. Rev. Stat. § 10-16-127 Coinsurance and deductibles
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A carrier subject to the provisions of parts 2, 3, and 4 of this article may offer one or more health coverage plans that contain deductibles or coinsurance without any limitation or restriction on the maximum out-of-pocket payable by the insured. Source: L. 2003: Entire section …
Colo. Rev. Stat. § 10-16-128 Annual report to general assembly
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Notwithstanding section 24-1-136 (11)(a)(I), the commissioner shall report to the business affairs and labor committee of the house of representatives and the business, labor, and technology committee of the senate, or any successor committees, no later than October 1, 2004, and …
Colo. Rev. Stat. § 10-16-129 Health savings accounts
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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,…
Colo. Rev. Stat. § 10-16-130 Disclosure of rate increases to public entities - legislative declaration - definitions
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(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 promo…
Colo. Rev. Stat. § 10-16-1301 Short title
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The short title of this part 13 is the Colorado Standardized Health Benefit Plan Act. Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1278, � 1, effective June 16.
Colo. Rev. Stat. § 10-16-1302 Legislative declaration - intent
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(1) The general assembly, through the exercise of its powers to protect the health, peace, safety, and general welfare of the people of Colorado, hereby finds that: (a) Health insurance coverage has been demonstrated to have a positive impact on people's health outcomes as well a…
Colo. Rev. Stat. § 10-16-1303 Definitions
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As used in this part 13, unless the context otherwise requires: (1) Advisory board means the board established in section 10-16-1307. (2) Critical access hospital means a hospital that is federally certified or undergoing federal certification as a critical access hospital pursua…
Colo. Rev. Stat. § 10-16-1304 Standardized health benefit plan - established - components - rules - independent analysis - repeal
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(1) On or before January 1, 2022, the commissioner shall establish, by rule, a standardized health benefit plan to be offered by carriers in this state in the individual and small group markets. The standardized plan must: (a) Offer health-care coverage at the bronze, silver, and…
Colo. Rev. Stat. § 10-16-1305 Standardized health benefit plan - carriers required to offer - premium rates - rules
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(1) Beginning January 1, 2023, a carrier that offers: (a) An individual health benefit plan in Colorado is required to offer the standardized plan in the individual market in each county where the carrier offers an individual health benefit plan and shall offer the standardized p…
Colo. Rev. Stat. § 10-16-1305.5 Rate filings
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(1) In the rate filings required pursuant to section 10-16-107, each carrier must file rates for the standardized plan at the premium rates required in section 10-16-1305 (2). (2) In reviewing the rates for the standardized plans, the commissioner may establish uniform limits on …
Colo. Rev. Stat. § 10-16-1306 Failure to meet premium rate requirements - notice - public hearing - rules
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(1) (a) Repealed. (b) If a carrier or health-care provider anticipates that the carrier will be unable to meet network adequacy standards or the premium rate requirements in section 10-16-1305 due to a reimbursement rate dispute for the standardized plan, the carrier or health-ca…
Colo. Rev. Stat. § 10-16-1307 Advisory board - members - rules
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(1) (a) The commissioner shall consult with an advisory board to implement this part 13. The governor shall appoint the members of the advisory board on or before July 1, 2022, and shall ensure that the membership of the advisory board has demonstrated experience and expertise in…
Colo. Rev. Stat. § 10-16-1308 Federal waiver - commissioner application - use of money
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(1) On or after June 16, 2021, the commissioner may apply to the secretary of the United States department of health and human services for a state innovation waiver to waive one or more requirements of the federal act as authorized by section 1332 of the federal act to capture a…
Colo. Rev. Stat. § 10-16-1309 Standardized plan - cost shift
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(1) If the administrator of a self-funded health insurance plan voluntarily provides to the commissioner its contracted rates and any other information deemed necessary and agreed upon by the administrator and the commissioner, the commissioner may evaluate whether the rates of t…
Colo. Rev. Stat. § 10-16-131 Health care reform project - blue ribbon commission for health care reform - repeal. (Repealed)
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C.R.S. 10-16-131Statutes 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. § 10-16-1310 Reports required - repeal
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(1) (a) The commissioner shall contract with an independent third-party organization to prepare three separate reports as specified in subsection (1)(d) of this section, to the extent that information is available regarding the implementation of this part 13 as it relates to the …
Colo. Rev. Stat. § 10-16-1311 State measurement for accountable, responsive, and transparent (SMART) government act report
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(1) The commissioner shall report during the hearings conducted pursuant to the “State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act”, part 2 of article 7 of title 2: (a) Beginning in January 2022 and each year thereafter, on the progress of the …
Colo. Rev. Stat. § 10-16-1312 Rules
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The commissioner may promulgate rules as necessary to develop, implement, and operate this part 13, including rules necessary to align state law with any federal program requirements and applicable rules. Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1293, � 1, ef…