Article
16
Health-care Coverage
Sections
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
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