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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

1,275 sections·Filtered byTitle 10✕

Colo. Rev. Stat. § 10-16-409 Complaint system
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(1) (a) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health-care services. (b) Each heal…
Colo. Rev. Stat. § 10-16-410 Investments
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With the exception of investments made in accordance with section 10-16-403 (1)(a) and (2), the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constit…
Colo. Rev. Stat. § 10-16-411 Protection against insolvency
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(1) (a) Before issuing any certificate of authority, the commissioner shall require that the health maintenance organization have an initial minimum surplus of one million five hundred thousand dollars. "Surplus" means total assets less all liabilities with the exception of long-…
Colo. Rev. Stat. § 10-16-412 Statutory deposit
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(1) Unless otherwise provided in subsections (2) and (3) of this section, each health maintenance organization shall furnish cash or securities acceptable to the commissioner to be held by the commissioner under joint control in the same manner as prescribed in sections 10-3-206,…

Colo. Rev. Stat. § 10-16-413 Prohibited practices

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(1) No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of part 1 of thi…

Colo. Rev. Stat. § 10-16-413.5 Return to home - legislative declaration - definitions

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(1) The general assembly hereby finds that: (a) As individuals "age in place" in their own homes or other settings, they frequently contract with continuing care retirement communities, assisted living facilities, nursing facilities, or facilities for persons with dementia diseas…

Colo. Rev. Stat. § 10-16-414 Regulation of agents

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The commissioner may, after notice and hearing, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents. An agent means a person directly or indirectly associated with a health-care plan who engages in solicitation or enrollment. S…

Colo. Rev. Stat. § 10-16-415 Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations

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(1) An insurance company licensed in this state, or a nonprofit hospital, medical-surgical, and health service corporation authorized to do business in this state, may either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization und…

Colo. Rev. Stat. § 10-16-416 Examination

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(1) The commissioner may make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements pursuant to its health-care plan as often as the commissioner deems it necessary for the p…

Colo. Rev. Stat. § 10-16-417 Suspension or revocation of certificate of authority

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(1) The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to part 1 of this article 16 and this part 4 if the commissioner finds that any of the following conditions exist: (a) The health maintenance organization …

Colo. Rev. Stat. § 10-16-418 Rehabilitation, liquidation, or conservation of health maintenance organization

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(1) Any rehabilitation, liquidation, or conservation of a health maintenance organization is deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the re…

Colo. Rev. Stat. § 10-16-419 Administrative procedures

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(1) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall notify the health maintenance organizati…

Colo. Rev. Stat. § 10-16-420 Penalties and enforcement

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(1) The commissioner may, in lieu of suspension or revocation of a certificate of authority under section 10-16-417 and pursuant to the provisions of article 4 of title 24, C.R.S., levy an administrative penalty in an amount not less than one hundred dollars nor more than five hu…

Colo. Rev. Stat. § 10-16-421 Statutory construction and relationship to other laws

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(1) Except for sections 10-1-102, 10-1-116, 10-1-117, 10-1-118, 10-3-128, and 10-3-208, part 2 of article 1 of this title, and parts 4 to 8 of article 3 of this title, and as otherwise provided in this article, the provisions of the insurance law and provisions of nonprofit hospi…

Colo. Rev. Stat. § 10-16-421.5 Acquisition of control of or merger of a health maintenance organization

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No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the co…

Colo. Rev. Stat. § 10-16-422 Filings and reports as public documents

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All applications, filings, and reports required under part 1 of this article and this part 4 shall be treated as public documents. Source: L. 92: Entire article R&RE, p. 1712, § 1, effective July 1.

Colo. Rev. Stat. § 10-16-423 Confidentiality of health information

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Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent t…

Colo. Rev. Stat. § 10-16-424 Commissioner's authority to contract

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The commissioner, in carrying out his or her obligations pursuant to sections 10-16-402 (1)(b) and 10-16-417 (1), may contract with qualified persons concerning the determinations required to be made by the commissioner. Source: L. 92: Entire article R&RE, p. 1713, § 1, effective…

Colo. Rev. Stat. § 10-16-425 Applicability of provisions

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Nothing contained in part 1 of this article or this part 4 shall be construed to affect or apply to any trust, association, or nonprofit corporation which is established and administered by an employer, a labor organization or labor organizations, or jointly by an employer and a …

Colo. Rev. Stat. § 10-16-426 Medicare supplement benefit standards

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Except for the requirements of section 10-18-105, the provisions of article 18 of this title shall not apply to all health maintenance organizations granted a certificate of authority under part 1 of this article or this part 4. Source: L. 92: Entire article R&RE, p. 1713, § 1, e…

Colo. Rev. Stat. § 10-16-427 Contractual relations

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(1) Every contract between a health maintenance organization and a medical group, independent practice association, or health professional employed by a health maintenance organization shall be written and include a hold harmless provision which shall provide that in the event a …

Colo. Rev. Stat. § 10-16-429 Termination of contract

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A health maintenance organization shall not retroactively terminate a policy or contract issued pursuant to this part 4 except for fraud or intentional misrepresentation. For any termination other than for fraud or intentional misrepresentation, the health maintenance organizatio…

Colo. Rev. Stat. § 10-16-501 Legislative declaration

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It is the policy of the general assembly and the intent and purpose of this part 5 to promote the availability and assure the competent quality of dental care on a prepaid basis, and to thereby promote the health and welfare of the people of Colorado. The general assembly recogni…

Colo. Rev. Stat. § 10-16-502 Establishment of prepaid dental care plan organizations

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(1) No person, unless otherwise authorized pursuant to this title, may establish or operate a prepaid dental care plan organization in this state or sell or offer to sell, or solicit offers to purchase, or receive advanced or periodic consideration in conjunction with a prepaid d…

Colo. Rev. Stat. § 10-16-503 Application for certificate of authority

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(1) An application for a certificate of authority to operate as a prepaid dental care plan organization formed under part 1 of this article 16 and this part 5 shall be filed with the commissioner on a form prescribed by the commissioner. Such application shall be verified by an o…

Colo. Rev. Stat. § 10-16-504 Issuance of certificate of authority

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(1) Issuance of a certificate of authority shall be granted by the commissioner if the commissioner is satisfied that the following conditions are met: (a) The requirements of section 10-16-503 have been fulfilled; (b) The prepaid dental care plan organization is financially resp…

Colo. Rev. Stat. § 10-16-505 Guarantee fund deposit

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(1) A prepaid dental care plan organization subject to the provisions of part 1 of this article and this part 5 shall place on deposit with the commissioner a guarantee fund of cash, approved securities, or letter of credit approved by the commissioner in the amount of two dollar…

Colo. Rev. Stat. § 10-16-506 Reserve requirement - exception

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(1) A prepaid dental care plan organization formed under part 1 of this article and this part 5 at all times shall maintain for protection of enrollees a financial reserve consisting of two percent of prepaid charges collected from enrollees for the plan, until such reserve total…

Colo. Rev. Stat. § 10-16-507 Enrollee coverage by prepaid dental care plan organizations - form filing requirements

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(1) Every enrollee in a prepaid dental care plan shall be issued an enrollee coverage form by the prepaid dental care plan organization. (2) (a) No contract issued, renewed, or reinstated by a prepaid dental care plan organization shall contain any provision which limits or exclu…

Colo. Rev. Stat. § 10-16-508 Examination of prepaid dental care plan organization

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(1) The commissioner may visit once in each six months for the first three years after organization and once each year thereafter, or more often if deemed necessary by the commissioner, each prepaid dental care plan organization organized under part 1 of this article and this par…

Colo. Rev. Stat. § 10-16-509 Operational expenses

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No more than thirty percent of prepaid charges in the first year of any contract, twenty-five percent of prepaid charges in the second year of any contract, and twenty percent of prepaid charges in any subsequent contract year shall be used for the marketing and administrative ex…

Colo. Rev. Stat. § 10-16-510 Suspension or revocation of certificate of authority

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(1) The commissioner may suspend or revoke any certificate of authority issued to a prepaid dental care plan organization pursuant to part 1 of this article and this part 5 if the commissioner finds that any of the following conditions exist: (a) The prepaid dental care plan orga…

Colo. Rev. Stat. § 10-16-511 Rehabilitation, liquidation, or conservation of prepaid dental care plan organization

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Any rehabilitation, liquidation, or conservation of a prepaid dental care plan organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be conducted pursuant to part 5 of article 3 of this title. Source: L. 92: Entire article R&R…

Colo. Rev. Stat. § 10-16-512 Other laws applicable

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In addition to the provisions of part 1 of this article and this part 5, the laws governing insurance companies, except as they are inconsistent with the provisions or purposes of this article, shall apply to prepaid dental care plans regulated pursuant to the provisions of part …

Colo. Rev. Stat. § 10-16-601 Legislative declaration

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The general assembly declares that the intent of this part 6, which shall only apply to this title and not to articles 40 to 47 of title 8, C.R.S., is to ensure that patients have access to the best possible health-care decisions and information and to increase the confidence of …

Colo. Rev. Stat. § 10-16-602 Definitions

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As used in this part 6, unless the context otherwise requires: (1) "Doctor" means a person licensed as a doctor under title 12, C.R.S., to provide health care to a patient. (2) "Insurer" means a sickness and accident insurer and any health maintenance organization; fraternal bene…

Colo. Rev. Stat. § 10-16-603 Independent medical examinations - governing standard

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All independent medical examinations performed by a doctor shall be performed in accordance with generally accepted professional standards of practice or care. It shall be unprofessional conduct for a doctor to perform an independent medical examination not in accordance with gen…

Colo. Rev. Stat. § 10-16-604 Financial interest in future care of patient prohibited

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No doctor that performs an independent medical examination shall have a financial or economic interest in the type or duration of treatment or the results of the examination. Source: L. 96: Entire part added, p. 567, § 1, effective April 24.

Colo. Rev. Stat. § 10-16-605 Independence of examiners

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No insurer, employer, employee, patient, or agent or representative thereof shall attempt to dictate to any doctor performing an independent medical examination the type or duration of treatment or the results of the examination. Source: L. 96: Entire part added, p. 567, § 1, eff…

Colo. Rev. Stat. § 10-16-606 Applicability

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Nothing in this part 6 shall be construed to apply to any action under articles 40 to 47 of title 8, C.R.S. Source: L. 96: Entire part added, p. 567, § 1, effective April 24.

Colo. Rev. Stat. § 10-16-701 Short title

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This part 7 shall be known and may be cited as the "Consumer Protection Standards Act for the Operation of Managed Care Plans". Source: L. 97: Entire part added, p. 1325, § 2, effective July 1. ANNOTATION Law reviews. For article, "Managed Health Care in Colorado: Current Consume…

Colo. Rev. Stat. § 10-16-702 Legislative declaration

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(1) The general assembly hereby finds, determines, and declares that the purposes of this part 7 are: (a) To incorporate consumer protections in the creation and maintenance of provider networks by carriers; (b) To establish standards to assure the adequacy, accessibility, and qu…

Colo. Rev. Stat. § 10-16-703 Applicability

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This part 7 applies to all managed care plans, except for workers' compensation and automobile insurance contracts, that are issued, renewed, extended, or modified on or after January 1, 1998. Source: L. 97: Entire part added, p. 1325, § 2, effective July 1.

Colo. Rev. Stat. § 10-16-704 Network adequacy - required disclosures - balance billing - rules - legislative declaration - definitions

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(1) A carrier providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all covered benefits to covered persons will be accessible without unreasonable delay. In the case of emergency services, covered persons shall…

Colo. Rev. Stat. § 10-16-705 Requirements for carriers and participating providers - definitions - rules

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(1) In addition to any other applicable requirements of this part 7, a carrier offering a managed care plan shall satisfy all the requirements of this section. (2) A carrier shall maintain a mechanism by which providers can access information on the covered health services for wh…

Colo. Rev. Stat. § 10-16-705.5 Participating provider networks - definitions - selection standards - informal reconsideration - enforcement - legislative declaration

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(1) The general assembly finds and declares that: (a) Carriers create networks of providers that ensure consumers have access to an adequate number of providers to meet their needs; (b) In the current marketplace, carriers offer consumers a multitude of plan options, some of whic…

Colo. Rev. Stat. § 10-16-705.7 Timely credentialing of providers by carriers - notice of receipt required - notice of incomplete applications required - delegated credentialing agreements - discrepancies - denials of claims prohibited - disclosures - recredentialing - enforcement - rules - definitions

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(1) As used in this section, unless the context otherwise requires: (a) "Applicant" means a physician, mental health provider, substance use provider, or psychiatric nurse who submits an application to a carrier to become a participating provider in the carrier's provider network…

Colo. Rev. Stat. § 10-16-706 Intermediaries

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(1) In addition to any other applicable requirements of this part 7, a contract between a carrier and an intermediary shall satisfy all the requirements of this section. (2) Intermediaries and participating providers with whom they contract shall comply with all the applicable re…

Colo. Rev. Stat. § 10-16-707 Enforcement

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(1) If it is determined that a carrier has not contracted with enough participating providers to assure that covered persons have accessible health-care services in a geographic area, that a carrier's access plan does not assure reasonable access to covered benefits, that a carri…

Colo. Rev. Stat. § 10-16-708 Rule-making authority of commissioner

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The commissioner may promulgate rules as necessary for carrying out the commissioner's duties under this part 7. Source: L. 97: Entire part added, p. 1332, § 2, effective July 1.