Title 10, Insurance
0 chapters · 1,354 sections in this title.
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.
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 benefit …
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.
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. 10-16-704. Network ad…
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 physicians 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 who submits an application to a carrier to become a participating physician in the carrier’s network. (b) “Application” means an applicant’s application to become credentialed by…
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. 10-16-709. Evaluation - nonparticipating health-care providers - legislative declaration - rules. (1)…
Colo. Rev. Stat. § 10-16-709 Evaluation - nonparticipating health-care providers - legislative declaration - rules
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(1) (a) The general assembly hereby finds and determines that not all health-care providers contract with all health insurers and therefore not all are participating providers. Health-care providers who do not contract with a carrier are considered to be nonparticipating provider…
Colo. Rev. Stat. § 10-16-710 Reporting to commissioner - medication-assisted treatment - rules
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(1) A carrier shall report to the commissioner: (a) The number of in-network providers who are federally licensed to prescribe medication-assisted treatment for substance use disorders, including buprenorphine; and (b) The number of prescriptions filled by enrollees for medicatio…
Colo. Rev. Stat. § 10-16-801 (Repealed)
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Source: L. 2003: Entire part repealed, p. 1785, � 17, effective July 1. Editor's note: This part 8 was added in 2001 and was not amended prior to its repeal in 2003. For the text of this part 8 prior to 2003, consult the 2002 Colorado Revised Statutes.
Colo. Rev. Stat. § 10-18-101 Definitions
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As used in this article, unless the context otherwise requires: (1) Applicant means: (a) In the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; or (b) In the case of a group medicare supplement poli…
Colo. Rev. Stat. § 10-18-102 Applicability and scope
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(1) Except as otherwise specifically provided, this article shall apply to: (a) All medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after July 1, 1989; and (b) All certificates issued under group medicare supplement polic…
Colo. Rev. Stat. § 10-18-103 Standards for policy provisions - guarantee issue
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(1) No medicare supplement insurance policy, contract, or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare. (2) The commissioner shall issue reasonable regulations to establish specific standards for policy provisions of medic…
Colo. Rev. Stat. § 10-18-104 Minimum standards for benefits and claims payment
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The commissioner shall issue reasonable regulations to establish minimum standards for benefits and payment of claims under medicare supplement policies. Source: L. 89: Entire article R&RE, p. 500, � 1, effective July 1. Editor's note: This section is similar to former � 10-18-10…
Colo. Rev. Stat. § 10-18-105 Loss ratio standards and filing requirements
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(1) Every insurer providing group or individual medicare supplement insurance benefits to a resident of this state pursuant to section 10-18-102 shall file a copy of the group master policy or individual policy and any certificate used in this state in accordance with the filing …
Colo. Rev. Stat. § 10-18-106 Disclosure standards - regulations necessary for compliance with federal law
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(1) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no individual medicare supplement policy or certificate shall be delivered or issued for delivery in this state unless the outline of coverage as described in subsection (2) of this …
Colo. Rev. Stat. § 10-18-107 Right to examine policy - right to refund of premium
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Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within…
Colo. Rev. Stat. § 10-18-108 Advertising - copy provided to commissioner
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Every insurer, health-care service plan, or other entity providing medicare supplement insurance or benefits in this state that advertises medicare supplement insurance shall provide the commissioner a written copy of the medicare supplement advertisement used in this state. If t…
Colo. Rev. Stat. § 10-18-109 Penalties
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In addition to any other applicable penalties for violations of this title, the commissioner may order insurers violating any provision of this article or regulations promulgated pursuant to this article to cease marketing any medicare supplement policy or certificate in this sta…
Colo. Rev. Stat. § 10-19-101 Short title
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This article shall be known and may be cited as the Long-term Care Insurance Act. Source: L. 90: Entire article R&RE, p. 643, � 1, effective July 1.
Colo. Rev. Stat. § 10-19-102 Legislative declaration
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The general assembly hereby declares that the purpose of this article is to promote the public interest and the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establi…
Colo. Rev. Stat. § 10-19-103 Definitions
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As used in this article 19, unless the context otherwise requires: (1) Applicant means: (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (b) In the case of a group long-term care insurance policy, the proposed ce…
Colo. Rev. Stat. § 10-19-104 Scope and applicability of article
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The requirements of this article shall apply to policies delivered or issued for delivery in this state on or after July 1, 1990. This article is not intended to supersede the obligations of entities subject to this article to comply with the substance of other applicable insuran…
Colo. Rev. Stat. § 10-19-105 Extraterritorial jurisdiction - group long-term care insurance
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A group long-term care insurance coverage shall not be offered to a resident of this state under a group policy issued in another state to a group described in section 10-19-103 (4)(d), unless this state or another state having statutory and regulatory long-term care insurance re…
Colo. Rev. Stat. § 10-19-106 Rules on disclosure
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The commissioner may adopt rules and regulations that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibil…
Colo. Rev. Stat. § 10-19-107 Performance standards
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(1) A long-term care insurance policy may not: (a) Be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or (b) Contain a provision establishing a new waiti…
Colo. Rev. Stat. § 10-19-108 Requirements for preexisting conditions
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(1) A long-term care insurance policy or certificate, other than a policy or certificate thereunder, issued to a group as defined in section 10-19-103 (4)(a), shall not use a definition of preexisting condition that is more restrictive than the following: Preexisting condition me…
Colo. Rev. Stat. § 10-19-109 Requirements for prior hospitalization or institutionalization
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(1) A long-term care insurance policy shall not be delivered or issued for delivery in this state if such policy: (a) Conditions the eligibility for any benefits on a prior hospitalization requirement; (b) Conditions the eligibility for benefits provided in an institutional care …
Colo. Rev. Stat. § 10-19-110 Loss ratio standards
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The commissioner may adopt rules and regulations establishing loss-ratio standards for long-term care insurance policies if a specific reference to long-term care insurance policies is contained in the regulation. Such rules and regulations shall be in accordance with the State A…
Colo. Rev. Stat. § 10-19-111 Right to return policy - free look
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A long-term care insurance applicant has the right to return the policy or certificate within thirty days after its delivery and to have the premium refunded if, after examination of the policy or certificate, other than a certificate issued pursuant to a policy issued to a group…
Colo. Rev. Stat. § 10-19-112 Outline of coverage - certificate
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(1) (a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purpose. (b) The commissioner shall prescrib…
Colo. Rev. Stat. § 10-19-113 Option for inflation adjustment - renewability
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(1) No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations…