C.R.S. Section 10-16-107
Rate filing regulation

  • benefits ratio
  • rules

(1)

Intentionally left blank —Ed.

(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 delivered to any policyholder, enrollee, subscriber, or member in Colorado that are excessive, inadequate, or unfairly discriminatory. To assure compliance with the requirements of this section that rates are not excessive in relation to benefits, the commissioner shall promulgate rules to require rate filings and, as part of the rules, may require the submission of adequate documentation and supporting information, including actuarial opinions or certifications and set expected benefits ratios. The carrier shall submit expected rate increases to the commissioner at least sixty days prior to the proposed implementation of the rates. If the commissioner does not approve or disapprove the rate filings within a sixty-day period, the carrier may implement and reasonably rely upon the rates on the condition that the commissioner may require correction of any deficiencies in the rate filing upon later review if the rate the carrier charged is excessive, inadequate, or unfairly discriminatory. A prospective rate adjustment is the sole remedy for rate deficiencies pursuant to this subsection (1). If the commissioner finds deficiencies in the rate filing after a sixty-day period, the commissioner shall provide notice to the carrier, and the carrier shall correct the rate on a prospective basis.

(b)

The commissioner may review expected rate filing increases filed with the commissioner and shall disapprove the rate increase and require the carrier to resubmit for approval if any of the provisions of subsection (3) of this section apply. Rate filings that do not involve a requested rate increase, or that involve a requested rate increase of less than five percent for dental insurance, do not require preapproval, and the carrier may implement the rate upon filing with the commissioner.

(c)

The filing requirements of this subsection (1) do not apply to nondeveloped rates, including rates for medicaid, medicare, and the children’s basic health plan, as defined by the commissioner.

(d)

If the carrier fails to supply the information required by this section, the filing is incomplete. The commissioner shall make a determination of completeness no later than thirty days following submission of the filing for review. All filings not returned on or before the thirtieth day after receipt are considered complete.

(e)

The commissioner may review filings for substantive content and, if reviewed, shall identify and communicate to the filing carrier, on or before the forty-fifth day after receipt, any deficiency in the filing. The carrier shall apply a correction of a deficiency, including a deficiency identified after the forty-fifth day, on a prospective basis, and the commissioner shall not assess a penalty against the carrier if the violation identified was not willful.

(f)

Carriers shall file rate filings for insurance regulated under parts 1 to 5 of this article 16 electronically in a format made available by the division, unless exempted by rule for an emergency situation as determined by the commissioner. The division shall post on its website a rate filing summary for insurance regulated under parts 1 to 5 of this article 16 in order to provide notice to the public.

(g)

This section does not:

(I)

Limit the right of the public to inspect a rate filing and any supporting information pursuant to part 2 of article 72 of title 24, C.R.S.; or

(II)

Impair the commissioner’s ability to review rates and determine whether the rates are excessive, inadequate, or unfairly discriminatory.
(2)(a)(I) Rates for an individual health coverage plan issued or delivered to any policyholder, enrollee, subscriber, or member in Colorado by an insurer subject to part 2 of this article 16 or an entity subject to part 3, 4, or 5 of this article 16 shall not be excessive, inadequate, or unfairly discriminatory to assure compliance with the requirements of this section that rates are not excessive in relation to benefits. Rates are excessive if they are likely to produce a long run profit that is unreasonably high for the insurance provided or if expenses are unreasonably high in relation to services rendered. In determining if rates are excessive, the commissioner may consider:

(A)

The expected filed rates in relation to the actual rates charged;

(B)

Whether the carrier’s products are affordable; and

(C)

Whether the carrier has implemented effective strategies to enhance the affordability of its products.

(II)

Rates are not inadequate unless clearly insufficient to sustain projected losses and expenses, or the use of the rates, if continued, will tend to create a monopoly in the market.

(III)

Rates are unfairly discriminatory if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses.

(b)

Notwithstanding any other provision of this article 16, a carrier subject to part 2, 3, 4, or 5 of this article 16 shall not vary the premium rate for an individual health coverage plan due to the gender of the individual policyholder, enrollee, subscriber, or member. Any premium rate based on the gender of the individual policyholder, enrollee, subscriber, or member is unfairly discriminatory and is not allowed.

(3)

Intentionally left blank —Ed.

(a)

The commissioner shall disapprove the requested rate increase if any of the following apply:

(I)

The benefits provided are not reasonable in relation to the premiums charged;

(II)

The requested rate increase contains a provision or provisions that are excessive, inadequate, unfairly discriminatory, or otherwise do not comply with the provisions of this title;

(III)

The requested rate increase is excessive or inadequate. In determining if the rate is excessive or inadequate, the commissioner may consider profits, dividends, annual rate reports, annual financial statements, subrogation funds credited, investment income or losses, unearned premium reserve and reserve for losses, surpluses, executive salaries, expected benefits ratios, any factors in section 10-16-111, and any other appropriate actuarial factors as determined by current actuarial standards of practice.

(IV)

The actuarial reasons and data based upon Colorado claims experience and data, when available, do not justify the necessity for the requested rate increase;

(V)

The rate filing is incomplete;

(VI)

The rate filing fails to demonstrate compliance with the MHPAEA. The commissioner shall adopt rules to establish the process and timeline for carriers to demonstrate compliance with the MHPAEA in establishing their rates.

(VII)

The rate filing reflects a cost shift between the standardized plan, as defined in section 10-16-1303 (14), offered by the carrier and the health benefit plan for which rate approval is being sought. The commissioner may consider the total cost of health care in making this determination.

(b)

In determining whether to approve or disapprove a rate filing, the commissioner may consider, without limitation, the expected benefits ratio for a health benefit plan or any other cost category determined appropriate by the commissioner. If the carrier achieves a benefits ratio of eighty-five percent or higher for large group insurance, eighty percent for small group insurance, and eighty percent for individual insurance, the commissioner may expedite the review of the approval process for the carrier.

(c)

The commissioner shall adopt rules that establish the benefits ratio for carriers to use for rate filing purposes for health benefit plans, other than grandfathered health benefit plans. The rules must include, as supplemental criteria that will be considered during review, requirements for carriers to provide information on activities to improve health-care quality as set forth under the authority of section 2718 of the federal “Public Health Service Act”, as amended, and in 45 CFR 158.150 and expenditures related to health information technology and meaningful use as set forth in 45 CFR 158.151.

(3.5)

The commissioner shall promulgate rules establishing affordability standards. These standards must include appropriate targets for carrier investments in primary care. In developing these standards, the commissioner shall consider the recommendations of the primary care payment reform collaborative created in section 10-16-150.

(4)

The commissioner may require the submission of any relevant information the commissioner deems necessary in determining whether to approve or disapprove a filing made pursuant to this section.
(5)(a)(I) With respect to the premium rates charged by a carrier offering an individual or small employer health benefit plan, the carrier shall develop its premium rates based on, and vary the premium rates with respect to the particular plan or coverage only by the following case characteristics:

(A)

Whether the plan or coverage covers an individual or family;

(B)

Geographic rating area, established in accordance with federal law;

(C)

Age, except that the rate must not vary by more than three to one for adults; and

(D)

Tobacco use, except that the rate must not vary by more than one and one-fifteenth to one.

(II)

The carrier shall not vary a premium rate with respect to any particular individual or small employer health benefit plan by any factor other than the factors described in subparagraph (I) of this paragraph (a).

(III)

With respect to family coverage under an individual or small employer health benefit plan, the carrier shall apply the rating variations permitted under sub-subparagraphs (C) and (D) of subparagraph (I) of this paragraph (a) based on the portion of the premium that is attributable to each family member covered under the plan in accordance with rules of the commissioner.

(b)

The carrier shall not adjust the premium charged with respect to any particular individual or small employer health benefit plan more frequently than annually; except that the carrier may change the premium rates to reflect:

(I)

With respect to a small employer health benefit plan, changes to the enrollment of the small employer;

(II)

Changes to the family composition of the policyholder or employee;

(III)

With respect to an individual health benefit plan, changes in geographic rating area of the policyholder, as provided in sub-subparagraph (B) of subparagraph (I) of paragraph (a) of this subsection (5);

(IV)

Changes in tobacco use, as provided in sub-subparagraph (D) of subparagraph (I) of paragraph (a) of this subsection (5);

(V)

Changes to the health benefit plan requested by the policyholder or small employer; or

(VI)

Other changes required by federal law or regulations or otherwise expressly permitted by state law or commissioner rule.

(c)

Intentionally left blank —Ed.

(I)

A carrier shall consider all individuals in all individual health benefit plans, other than grandfathered health benefit plans, offered by the carrier, including those individuals who do not enroll in the plans through an exchange established under article 22 of this title, to be members of a single risk pool.

(II)

A carrier shall consider all covered persons in all small employer health benefit plans, other than grandfathered health benefit plans, offered by the carrier, including those covered persons who do not enroll in the plans through an exchange established under article 22 of this title, to be members of a single risk pool.

(d)

Any individual who does not qualify for a lower rate based on tobacco use may be offered the option of participating in a bona fide wellness program, as defined under the federal “Health Insurance Portability and Accountability Act of 1996”, as amended. A carrier may allow any individual who participates in a bona fide wellness program the lower rate. The carrier shall disclose the availability of a tobacco rating adjustment and any bona fide wellness program to each potential insured. The provisions of this paragraph (d) are applicable only if allowed under federal law.

(e)

The commissioner may adopt rules to implement and administer this subsection (5) and to assure that rating practices used by carriers are consistent with the purposes of this article.

(f)

A carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:

(I)

How premium rates are established;

(II)

The provisions of the coverage concerning the carrier’s right to change premium rates, the factors that may affect changes in premium rates, and the frequency with which the carrier may change premium rates; and

(III)

Intentionally left blank —Ed.

(A)

With respect to individual health benefit plans, a listing of and descriptive information about, including benefits and premiums, all individual health benefit plans offered by the carrier and the availability of the plans for which the individual is qualified; and

(B)

With respect to small employer health benefit plans, a listing of and descriptive information about, including benefits and premiums, all small employer health benefit plans for which the small employer is qualified.

(g)

Intentionally left blank —Ed.

(I)

Each carrier shall maintain at its principal place of business a complete and detailed description of its rating practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.

(II)

Each carrier shall annually file with the commissioner, on or before March 15, an actuarial certification certifying that the carrier is in compliance with this article and that the rating methods of the carrier are actuarially sound. The certification must be in a form and manner and must contain information as specified by the commissioner. The carrier shall retain a copy of the certification at its principal place of business.

(III)

Intentionally left blank —Ed.

(A)

A carrier shall make the information and documentation described in subparagraph (I) of this paragraph (g) available to the commissioner upon request.

(B)

Except in cases of violations of this section, the information is considered proprietary and trade secret information and is not subject to disclosure by the commissioner to persons outside of the division except as agreed to by the carrier or as ordered by a court of competent jurisdiction.

(6)

Intentionally left blank —Ed.

(a)

The carrier shall use the applicable index rate for the premium rate for all of the carrier’s individual and small group health benefit plans and shall adjust the applicable index rate for total expected market-wide payments and charges under the risk adjustment and reinsurance programs in the state, subject only to the adjustments permitted in federal and state law. The commissioner may establish, by rule, the components and adjustments that carriers are able to use and make to the index rate.

(b)

A carrier shall treat all health benefit plans issued or renewed in the same calendar month as having the same rating period.

(c)

For the purposes of this subsection (6), a health benefit plan that contains a restricted network provision is not similar coverage to a health benefit plan that does not contain a restricted network provision if the restriction of benefits to network providers results in substantial differences in claim costs.

(7)

Starting in 2021, as part of the rate filing required pursuant to this section, each carrier shall provide to the commissioner, in a form and manner determined by the commissioner, information concerning the utilization of out-of-network providers and facilities and the aggregate cost savings as a result of the implementation of section 10-16-704 (3)(d)(I) and (5.5)(b)(I).

(8)

Intentionally left blank —Ed.

(a)

The commissioner may adopt rules designed to:

(I)

Maximize the purchasing power of exchange consumers whose household income is up to four hundred percent of the federal poverty line; and

(II)

Assure premium pricing that complies with the requirements in the federal act for modified community rating.

(b)

In adopting these rules, the commissioner may consider the results of the evaluation and study of the reinsurance program conducted pursuant to section 10-16-1104 (2).

Source: Section 10-16-107 — Rate filing regulation - benefits ratio - rules, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-10.­pdf (accessed Oct. 20, 2023).

10‑16‑101
Short title
10‑16‑102
Definitions
10‑16‑103
Proposal of mandatory health-care coverage provisions
10‑16‑103.4
Essential health benefits - requirements - rules
10‑16‑103.5
Payment of premiums - required term in contract - rules - definition
10‑16‑103.6
Copayment-only prescription payment structures - required inclusion in health benefit plans - rules
10‑16‑104
Mandatory coverage provisions - definitions - rules - applicability
10‑16‑104.1
Prohibition on discrimination for organ transplants based solely on disability - definition
10‑16‑104.2
Coverage for contraception - rules - definitions
10‑16‑104.3
Health coverage for persons under twenty-six years of age - coverage for students who take medical leave of absence
10‑16‑104.6
Off-label use of cancer drugs
10‑16‑104.7
Substance use disorders - court-ordered treatment coverage
10‑16‑104.8
Behavioral, mental health, or substance use disorder services coverage - court-ordered
10‑16‑104.9
Geographic areas for small employers
10‑16‑105
Guaranteed issuance of health insurance coverage - individual and small employer health benefit plans
10‑16‑105.1
Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules
10‑16‑105.2
Small employer health insurance availability program
10‑16‑105.3
Health benefit plans - not prohibited
10‑16‑105.6
Rate usage
10‑16‑105.7
Health benefit plan open enrollment periods - special enrollment periods - rules
10‑16‑106
Group replacement - extension of benefits
10‑16‑106.3
Uniform claims - billing codes - electronic claim forms
10‑16‑106.5
Prompt payment of claims - legislative declaration - rules
10‑16‑106.7
Assignment of health insurance benefits
10‑16‑107
Rate filing regulation - benefits ratio - rules
10‑16‑107.1
False or misleading information - penalties
10‑16‑107.2
Filing of health policies - rules
10‑16‑107.3
Health insurance policies - plain language required - rules
10‑16‑107.4
Health-care sharing plan or arrangement - required reporting and certification - noncompliance - information posted on division website - rules
10‑16‑107.5
Uniform application form - use by all carriers - rules
10‑16‑107.7
Nondiscrimination against providers
10‑16‑108
Continuation privileges
10‑16‑108.5
Fair marketing standards - rules
10‑16‑109
Rules
10‑16‑110
Fees paid by health coverage entities
10‑16‑111
Annual statements and reports - rules
10‑16‑112
Private utilization review - health-care coverage entity responsibility - definitions
10‑16‑112.5
Prior authorization for health-care services - disclosures and notice - determination deadlines - criteria - limits and exceptions - definitions - rules
10‑16‑113
Procedure for denial of benefits - internal review - rules - definitions
10‑16‑113.5
Independent external review of adverse determinations - legislative declaration - definitions - rules
10‑16‑113.7
Reporting the denial of benefits to division
10‑16‑116
Catastrophic health insurance - coverage - premium payments - reporting requirements - definitions - short title
10‑16‑118
Prohibition against preexisting condition exclusions
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
10‑16‑119.5
Stop-loss health insurance for small employers of not more than fifty employees - requirements - definitions - rules
10‑16‑121
Required contract provisions in contracts between carriers and providers - definitions
10‑16‑121.3
Limitations on provisions in contracts between carriers and licensed health-care providers - methods of payment - fees
10‑16‑121.5
Prohibited contract provisions in contracts between carriers and providers for dental services - definition
10‑16‑121.7
Prohibited contract provisions in contracts between carriers and eye care providers - definitions
10‑16‑122
Access to prescription drugs
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
10‑16‑122.3
Pharmacy benefit management firm payments - retroactive reduction prohibited - enforcement - rules - definitions
10‑16‑122.4
Pharmacy benefits - formulary change prohibition - exceptions - enforcement - definition - rules
10‑16‑122.5
Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rules
10‑16‑122.6
Pharmacy benefit managers - contracts with pharmacies - maximum allowable cost pricing - enforcement - rules
10‑16‑122.7
Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules
10‑16‑122.9
Prescription drug benefits - real-time access to benefit information - enforcement - definitions - rules
10‑16‑123
Telehealth - definitions
10‑16‑124
Prescription information cards - legislative declaration
10‑16‑124.5
Prior authorization form - drug benefits - rules of commissioner - definitions - repeal
10‑16‑124.7
Opioid analgesics with abuse-deterrent properties - study - definitions
10‑16‑124.8
Colorado consortium for prescription drug abuse prevention - create process for recovery - report
10‑16‑125
Reimbursement to nurses
10‑16‑126
Fee-for-service dental plans
10‑16‑127
Coinsurance and deductibles
10‑16‑128
Annual report to general assembly
10‑16‑129
Health savings accounts
10‑16‑130
Disclosure of rate increases to public entities - legislative declaration - definitions
10‑16‑133
Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rules
10‑16‑134
Health-care transparency - information required - website - definition
10‑16‑135
Health coverage plan information cards - rules - standardization - contents
10‑16‑137
Policy forms - explanation of benefits - standardization of forms - rules
10‑16‑138
Pathology services - direct billing required
10‑16‑139
Access to care - rules - definitions
10‑16‑140
Grace periods - premium payments - rules
10‑16‑141
Medication synchronization services - cost sharing for partial refills - dispensing fees
10‑16‑142
Physical rehabilitation services - copayments and coinsurance - research
10‑16‑143.5
Pharmacy reimbursement - substance use disorders - injections - patient counseling
10‑16‑144
Health-care services provided by pharmacists
10‑16‑145
Step therapy - limitations - exceptions - definitions - rules
10‑16‑145.5
Step therapy - prior authorization - prohibited - stage four advanced metastatic cancer - opioid prescription - definitions
10‑16‑146
Periodic updates to provider directory
10‑16‑147
Parity reporting - commissioner - carriers - rules - examination of complaints
10‑16‑148
Medication-assisted treatment - limitations on carriers - rules
10‑16‑150
Primary care payment reform collaborative - created - powers and duties - report - definition - repeal
10‑16‑151
Cost sharing in prescription insulin drugs - limits - definition - rules
10‑16‑152
HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal
10‑16‑153
Coverage for opiate antagonists provided by a hospital - definition
10‑16‑154
Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcement
10‑16‑155
Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - repeal
10‑16‑155.5
Actuarial review of doula services - report - definition
10‑16‑156
Prescription drugs - rebates - consumer cost reduction - point of sale - study - report - rules - definitions
10‑16‑157
Alternative payment model parameters - parameters to include an aligned quality measure set - primary care providers - requirement for carriers to submit alternative payment models to the division - legislative declaration - report - rules - definitions
10‑16‑158
Treatment of sexually transmitted infection - cost sharing - rules - definition
10‑16‑159
Coverage for sterilization services - cost sharing
10‑16‑160
Cost sharing - prescription epinephrine - limits - rules - definition
10‑16‑161
Calculation of contribution to out-of-pocket and cost-sharing requirements - exception - definitions - rules
10‑16‑162
Prohibition on discrimination for coverage based solely on natural medicine consumption - definitions
10‑16‑163
Contracts - health benefit plans - pharmacy benefit managers - policyholders - transparency requirements - rules - definitions
10‑16‑164
Hospital facility fee report - data collection
10‑16‑165
Dental coverage plans - dental loss ratio - rules - definitions
10‑16‑166
Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules
10‑16‑201
Form and content of individual sickness and accident insurance policies
10‑16‑202
Required provisions in individual sickness and accident policies
10‑16‑203
Optional provisions in individual sickness and accident insurance policies
10‑16‑204
Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance
10‑16‑205
Order of certain policy provisions in individual policies of sickness and accident insurance
10‑16‑206
Third-party ownership of individual sickness and accident insurance policies
10‑16‑207
Requirements of other jurisdictions
10‑16‑208
Conforming to statute
10‑16‑209
Application for policy
10‑16‑210
Notice - waiver
10‑16‑211
Age limit
10‑16‑212
Exemption from attachment and execution
10‑16‑213
Industrial sickness and accident insurance
10‑16‑214
Group sickness and accident insurance
10‑16‑215
Blanket sickness and accident insurance
10‑16‑216
Examinations
10‑16‑216.5
Hearing procedure and judicial review - violations - penalty
10‑16‑217
Application of part 1 of this article and part 2
10‑16‑218
Judicial review
10‑16‑219
Benefits for care in tax-supported institutions - behavioral health disorders - mental health disorders - intellectual and developmental disabilities
10‑16‑220
Minimum standards for sickness and accident plans
10‑16‑221
Statewide health care review committee - creation - membership - duties - repeal
10‑16‑222
Termination of policies
10‑16‑301
Legislative declaration
10‑16‑302
Incorporation and organization - exemptions
10‑16‑303
Filing of articles of incorporation
10‑16‑304
Contents of articles
10‑16‑305
Directors
10‑16‑306
Contracts - benefits for long-term care insurance
10‑16‑307
Authority to do business
10‑16‑308
Automatic extension of certificate
10‑16‑309
Requirements for certificate of authority
10‑16‑310
Surplus - guarantee fund deposit - regulations
10‑16‑311
Group benefits for depositors of banks - benefits for subscribers in public institutions
10‑16‑312
Contracts with other organizations
10‑16‑314
Payment for examinations of corporations
10‑16‑315
Revocation of certificate - appeal
10‑16‑316
Complaints
10‑16‑317
Exemption of direct payment methods
10‑16‑317.5
Assignment of benefits
10‑16‑318
Prospective reimbursement
10‑16‑319
Effective date
10‑16‑320
Investment of funds
10‑16‑321
Medicare supplement benefit standards
10‑16‑322
Filing of health policies
10‑16‑324
Conversion of corporation to a stock insurance company
10‑16‑325
Termination of health policies
10‑16‑401
Establishment of health maintenance organizations
10‑16‑402
Issuance of certificate of authority - denial
10‑16‑403
Powers of health maintenance organizations
10‑16‑404
Governing body
10‑16‑405
Fiduciary responsibilities
10‑16‑406
Evidence of coverage - rules
10‑16‑407
Information to enrollees
10‑16‑408
Open enrollment
10‑16‑409
Complaint system
10‑16‑410
Investments
10‑16‑411
Protection against insolvency
10‑16‑412
Statutory deposit
10‑16‑413
Prohibited practices
10‑16‑413.5
Return to home - legislative declaration - definitions
10‑16‑414
Regulation of agents
10‑16‑415
Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations
10‑16‑416
Examination
10‑16‑417
Suspension or revocation of certificate of authority
10‑16‑418
Rehabilitation, liquidation, or conservation of health maintenance organization
10‑16‑419
Administrative procedures
10‑16‑420
Penalties and enforcement
10‑16‑421
Statutory construction and relationship to other laws
10‑16‑421.5
Acquisition of control of or merger of a health maintenance organization
10‑16‑422
Filings and reports as public documents
10‑16‑423
Confidentiality of health information
10‑16‑424
Commissioner’s authority to contract
10‑16‑425
Applicability of provisions
10‑16‑426
Medicare supplement benefit standards
10‑16‑427
Contractual relations
10‑16‑429
Termination of contract
10‑16‑501
Legislative declaration
10‑16‑502
Establishment of prepaid dental care plan organizations
10‑16‑503
Application for certificate of authority
10‑16‑504
Issuance of certificate of authority
10‑16‑505
Guarantee fund deposit
10‑16‑506
Reserve requirement - exception
10‑16‑507
Enrollee coverage by prepaid dental care plan organizations - form filing requirements
10‑16‑508
Examination of prepaid dental care plan organization
10‑16‑509
Operational expenses
10‑16‑510
Suspension or revocation of certificate of authority
10‑16‑511
Rehabilitation, liquidation, or conservation of prepaid dental care plan organization
10‑16‑512
Other laws applicable
10‑16‑601
Legislative declaration
10‑16‑602
Definitions
10‑16‑603
Independent medical examinations - governing standard
10‑16‑604
Financial interest in future care of patient prohibited
10‑16‑605
Independence of examiners
10‑16‑606
Applicability
10‑16‑701
Short title
10‑16‑702
Legislative declaration
10‑16‑703
Applicability
10‑16‑704
Network adequacy - required disclosures - balance billing - rules - legislative declaration - definitions
10‑16‑705
Requirements for carriers and participating providers - definitions
10‑16‑705.5
Participating provider networks - definitions - selection standards - informal reconsideration - enforcement - legislative declaration
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
10‑16‑706
Intermediaries
10‑16‑707
Enforcement
10‑16‑708
Rule-making authority of commissioner
10‑16‑709
Evaluation - nonparticipating health-care providers - legislative declaration - rules
10‑16‑710
Reporting to commissioner - medication-assisted treatment - rules
10‑16‑1001
Legislative declaration
10‑16‑1002
Definitions
10‑16‑1003
Privacy of health information
10‑16‑1004
Health-care coverage cooperatives - establishment - fees
10‑16‑1005
Issuance of certificate of authority by commissioner for cooperative to purchase health-care coverage
10‑16‑1006
Authority to deny application for, revoke, or suspend certificate of authority
10‑16‑1007
Prohibition on cooperatives transacting insurance business
10‑16‑1008
Administrative structure of cooperatives - board of directors - officers - employees
10‑16‑1009
Powers, duties, and responsibilities of cooperatives
10‑16‑1010
Marketing requirements of cooperatives
10‑16‑1013
Violations of article by persons involved with operations of cooperatives - enforcement - penalties
10‑16‑1014
Technical assistance to authorized cooperatives from division of insurance
10‑16‑1015
Health-care cooperatives - rule-making authority
10‑16‑1016
State innovation waiver - authority to apply
10‑16‑1101
Short title
10‑16‑1102
Legislative declaration
10‑16‑1103
Definitions
10‑16‑1104
Commissioner powers and duties - rules - study and report
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
10‑16‑1106
Accounting - reports - audits
10‑16‑1107
Funding for reinsurance program - sources - permitted uses - reinsurance program cash fund - calculation of total funding for program
10‑16‑1109
State innovation waiver - federal funding - Colorado reinsurance program
10‑16‑1110
Repeal of part - notice to revisor of statutes
10‑16‑1201
Short title
10‑16‑1202
Legislative declaration
10‑16‑1203
Definitions
10‑16‑1204
Health insurance affordability enterprise - creation - powers and duties - assess and allocate health insurance affordability fee and special assessment
10‑16‑1205
Health insurance affordability fee - special assessment on hospitals - allocation of revenues
10‑16‑1206
Health insurance affordability cash fund - creation
10‑16‑1207
Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - commissioner rules
10‑16‑1208
Limitation on authority - public option
10‑16‑1301
Short title
10‑16‑1302
Legislative declaration - intent
10‑16‑1303
Definitions
10‑16‑1304
Standardized health benefit plan - established - components - rules - independent analysis - repeal
10‑16‑1305
Standardized health benefit plan - carriers required to offer - premium rates - rules
10‑16‑1305.5
Rate filings
10‑16‑1306
Failure to meet premium rate requirements - notice - public hearing - rules
10‑16‑1307
Advisory board - members - rules
10‑16‑1308
Federal waiver - commissioner application - use of money
10‑16‑1309
Standardized plan - cost shift
10‑16‑1310
Reports required - repeal
10‑16‑1311
State measurement for accountable, responsive, and transparent (SMART) government act report
10‑16‑1312
Rules
10‑16‑1313
Severability
10‑16‑1401
Definitions
10‑16‑1402
Colorado prescription drug affordability review board - created - membership - terms - conflicts of interest
10‑16‑1403
Colorado prescription drug affordability review board - powers and duties - rules
10‑16‑1404
Colorado prescription drug affordability review board meetings - required to be public - exceptions
10‑16‑1405
Colorado prescription drug affordability review board - reports from carriers and pharmacy benefit management firms required - confidential materials
10‑16‑1406
Colorado prescription drug affordability review board - affordability reviews of prescription drugs - repeal
10‑16‑1407
Colorado prescription drug affordability review board - upper payment limits for certain prescription drugs - rules - severability
10‑16‑1408
Colorado prescription drug affordability review board - judicial review
10‑16‑1409
Colorado prescription drug affordability advisory council - created - membership - powers and duties
10‑16‑1410
Use of savings - report - rules
10‑16‑1411
Unlawful acts - enforcement - penalties
10‑16‑1412
Notice of withdrawal of prescription drugs with upper payment limits required - rules - penalty
10‑16‑1413
Optional participating plans - notice of election to participate required
10‑16‑1414
Reports
10‑16‑1415
Exemption - prescription drugs derived from cannabis
10‑16‑1416
Repeal of part
10‑16‑1501
Short title
10‑16‑1502
Legislative declaration
10‑16‑1503
Definitions
10‑16‑1504
Applicability - exclusions
10‑16‑1505
Prohibition on 340B discrimination
10‑16‑1506
Enforcement - rules
Green check means up to date. Up to date

Current through Fall 2024

§ 10-16-107’s source at colorado​.gov