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2020 Colorado Revised Statutes
Title 10 - Insurance
Article 16. Health Care Coverage
Editor's note: This article was numbered as article 24 of chapter 72, C.R.S. 1963. The substantive provisions of this article were repealed and reenacted in 1992, resulting in the addition, relocation, and elimination of sections as well as subject matter. For amendments to this article prior to 1992, consult the Colorado statutory research explanatory note and the table itemizing the replacement volumes and supplements to the original volume of C.R.S. 1973 beginning on page vii in the front of this volume. Former C.R.S. section numbers are shown in editor's notes following those sections that were relocated. For a detailed comparison of this article, see the comparative tables located in the back of the index.
Cross references: For the "Uniform Unincorporated Nonprofit Association Act", see
article 30 of title 7.
PART 1 GENERAL PROVISIONS
- Section 10-16-101. Short title.
- Section 10-16-102. Definitions.
- Section 10-16-103. Proposal of mandatory health care coverage provisions.
- Section 10-16-103.3. Commission on mandated health insurance benefits - cash fund purpose - creation - duties - repeal. (Repealed)
- Section 10-16-103.4. Essential health benefits - requirements - rules.
- Section 10-16-103.5. Payment of premiums - required term in contract - rules - definition.
- Section 10-16-104. Mandatory coverage provisions - rules - definitions.
- Section 10-16-104.2. Coverage for contraception - definitions.
- Section 10-16-104.3. Health coverage for persons under twenty-six years of age - coverage for students who take medical leave of absence.
- Section 10-16-104.4. Child-only plans - legislative declaration - open enrollment - reporting requirements - repeal. (Repealed)
- Section 10-16-104.5. Autism - treatment - not mental illness - repeal. (Repealed)
- Section 10-16-104.6. Off-label use of cancer drugs.
- Section 10-16-104.7. Substance use disorders - court-ordered treatment coverage.
- Section 10-16-104.8. Behavioral, mental health, or substance use disorder services coverage - court-ordered.
- Section 10-16-104.9. Geographic areas for small employers.
- Section 10-16-105. Guaranteed issuance of health insurance coverage - individual and small employer health benefit plans.
- Section 10-16-105.1. Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules.
- Section 10-16-105.2. Small employer health insurance availability program.
- Section 10-16-105.3. Health benefit plans - not prohibited.
- Section 10-16-105.5. Individual health plans - federally eligible individual - limited guarantee issue. (Repealed)
- Section 10-16-105.6. Rate usage.
- Section 10-16-105.7. Health benefit plan open enrollment periods - special enrollment periods - rules.
- Section 10-16-106. Group replacement - extension of benefits.
- Section 10-16-106.3. Uniform claims - billing codes - electronic claim forms.
- Section 10-16-106.5. Prompt payment of claims - legislative declaration - rules.
- Section 10-16-106.7. Assignment of health insurance benefits.
- Section 10-16-107. Rate filing regulation - benefits ratio - rules.
- Section 10-16-107.1. False or misleading information - penalties.
- Section 10-16-107.2. Filing of health policies - rules.
- Section 10-16-107.3. Health insurance policies - plain language required - rules.
- Section 10-16-107.5. Uniform application form - use by all carriers - rules.
- Section 10-16-107.7. Nondiscrimination against providers.
- Section 10-16-108. Continuation privileges.
- Section 10-16-108.3. Continuation privileges - special election period - notice requirements definitions - repeal. (Repealed)
- Section 10-16-108.5. Fair marketing standards - rules.
- Section 10-16-109. Rules.
- Section 10-16-110. Fees paid by health coverage entities.
- Section 10-16-111. Annual statements and reports - rules.
- Section 10-16-112. Private utilization review - health care coverage entity responsibility definitions.
- Section 10-16-112.5. Prior authorization for health care services - disclosures and notice determination deadlines - criteria - limits and exceptions - definitions - rules.
- Section 10-16-113. Procedure for denial of benefits - internal review - rules - definitions.
- Section 10-16-113.5. Independent external review of adverse determinations - legislative declaration - definitions - rules.
- Section 10-16-113.7. Reporting the denial of benefits to division.
- Section 10-16-114. Short title. (Repealed)
- Section 10-16-115. Definitions. (Repealed)
- Section 10-16-116. Catastrophic health insurance - coverage - premium payments reporting requirements - definitions - short title.
- Section 10-16-116.5. State innovation waiver for nonemployer catastrophic health plans notice of decision by secretary - effect of secretary's decision - notice to revisor of statutes definitions - rules - state measurement for accountable, responsive, and transparent (SMART) government act report - repeal.
- Section 10-16-117. Premium payments - pre-tax - election - reporting requirements. (Repealed)
- Section 10-16-118. Prohibition against preexisting condition exclusions.
- Section 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.
- Section 10-16-119.5. Stop-loss health insurance for small employers of not more than fifty employees - requirements - definitions - rules.
- Section 10-16-120. Legislative review of requirements for guaranteed issue of basic and standard health benefit plans. (Repealed)
- Section 10-16-121. Required contract provisions in contracts between carriers and providers - definitions.
- Section 10-16-121.5. Prohibited contract provisions in contracts between carriers and providers for dental services - definition.
- Section 10-16-121.7. Prohibited contract provisions in contracts between carriers and eye care providers - definitions.
- Section 10-16-122. Access to prescription drugs.
- Section 10-16-122.3. Pharmacy benefit management firm payments - retroactive reduction prohibited - enforcement - rules - definitions. [Editor's note: For the applicability of this section on or after January 1, 2021, see the editor's note following this section.]
- Section 10-16-122.5. Pharmacy benefit manager - audit of pharmacies.
- Section 10-16-122.7. Disclosures between pharmacists and patients - carrier prohibitions short title - legislative declaration - preemption by federal law.
- Section 10-16-123. Telehealth - definitions.
- Section 10-16-124. Prescription information cards - legislative declaration.
- Section 10-16-124.5. Prior authorization form - drug benefits - rules of commissioner definitions.
- Section 10-16-124.7. Opioid analgesics with abuse-deterrent properties - study - definitions.
- Section 10-16-124.8. Colorado consortium for prescription drug abuse prevention - create process for recovery - report.
- Section 10-16-125. Reimbursement to nurses.
- Section 10-16-126. Fee-for-service dental plans.
- Section 10-16-127. Coinsurance and deductibles.
- Section 10-16-128. Annual report to general assembly.
- Section 10-16-129. Health savings accounts.
- Section 10-16-130. Disclosure of rate increases to public entities - legislative declaration definitions.
- Section 10-16-131. Health care reform project - blue ribbon commission for health care reform - repeal. (Repealed)
- Section 10-16-132. Study of factors driving health care costs in Pueblo county - repeal. (Repealed)
- Section 10-16-133. Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rules.
- Section 10-16-134. Health care transparency - information required - website - definition.
- Section 10-16-135. Health benefit plan information cards - rules - standardization contents.
- Section 10-16-136. Wellness and prevention programs - individual and small group health coverage plans - voluntary participation - incentives or rewards - rules - definitions legislative declaration - repeal. (Repealed)
- Section 10-16-137. Policy forms - explanation of benefits - standardization of forms - rules.
- Section 10-16-138. Pathology services - direct billing required.
- Section 10-16-139. Access to care - rules - definitions.
- Section 10-16-140. Grace periods - premium payments - rules.
- Section 10-16-141. Medication synchronization services - cost-sharing for partial refills dispensing fees.
- Section 10-16-142. Physical rehabilitation services - copayments and coinsurance research.
- Section 10-16-143. Single geographic rating area - individual plans - study - report - repeal.
- Section 10-16-143.5. Pharmacy reimbursement - substance use disorders - injections patient counseling.
- Section 10-16-144. Health care services provided by pharmacists.
- Section 10-16-145. Step therapy - prohibited - definition.
- Section 10-16-145.5. Step therapy prohibited - stage four advanced metastatic cancer definition.
- Section 10-16-146. Periodic updates to provider directory.
- Section 10-16-147. Parity reporting - commissioner - carriers - rules - examination of complaints.
- Section 10-16-148. Medication-assisted treatment - limitations on carriers - rules definition.
- Section 10-16-149. Commissioner report - parity effects on premiums - repeal.
- Section 10-16-150. Primary care payment reform collaborative - created - powers and duties - report - definition - repeal.
- Section 10-16-151. Cost sharing in prescription insulin drugs - limits - definition - rules.
- Section 10-16-152. HIV prevention medication - limitations on carriers - step therapy prior authorization.
- Section 10-16-153. Coverage for opiate antagonists provided by a hospital - definition.
- Section 10-16-201. Form and content of individual sickness and accident insurance policies.
- Section 10-16-201.5. Renewability of health benefit plans - modification of health benefit plans. (Repealed)
- Section 10-16-202. Required provisions in individual sickness and accident policies.
- Section 10-16-203. Optional provisions in individual sickness and accident insurance policies.
- Section 10-16-204. Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance.
- Section 10-16-205. Order of certain policy provisions in individual policies of sickness and accident insurance.
- Section 10-16-206. Third-party ownership of individual sickness and accident insurance policies.
- Section 10-16-207. Requirements of other jurisdictions.
- Section 10-16-208. Conforming to statute.
- Section 10-16-209. Application for policy.
- Section 10-16-210. Notice - waiver.
- Section 10-16-211. Age limit.
- Section 10-16-212. Exemption from attachment and execution.
- Section 10-16-213. Industrial sickness and accident insurance.
- Section 10-16-214. Group sickness and accident insurance.
- Section 10-16-215. Blanket sickness and accident insurance.
- Section 10-16-216. Examinations.
- Section 10-16-216.5. Hearing procedure and judicial review - violations - penalty.
- Section 10-16-217. Application of part 1 of this article and part 2.
- Section 10-16-218. Judicial review.
- Section 10-16-219. Benefits for care in tax-supported institutions - behavioral health disorders - mental health disorders - intellectual and developmental disabilities.
- Section 10-16-220. Minimum standards for sickness and accident plans.
- Section 10-16-221. Statewide health care review committee - creation - membership - duties - repeal.
- Section 10-16-222. Termination of policies.
- Section 10-16-301. Legislative declaration.
- Section 10-16-302. Incorporation and organization - exemptions.
- Section 10-16-303. Filing of articles of incorporation.
- Section 10-16-304. Contents of articles.
- Section 10-16-305. Directors.
- Section 10-16-306. Contracts - benefits for long-term care insurance.
- Section 10-16-307. Authority to do business.
- Section 10-16-308. Automatic extension of certificate.
- Section 10-16-309. Requirements for certificate of authority.
- Section 10-16-310. Surplus - guarantee fund deposit - regulations.
- Section 10-16-311. Group benefits for depositors of banks - benefits for subscribers in public institutions.
- Section 10-16-312. Contracts with other organizations.
- Section 10-16-313. Licensing of representatives. (Repealed)
- Section 10-16-314. Payment for examinations of corporations.
- Section 10-16-315. Revocation of certificate - appeal.
- Section 10-16-316. Complaints.
- Section 10-16-317. Exemption of direct payment methods.
- Section 10-16-317.5. Assignment of benefits.
- Section 10-16-318. Prospective reimbursement.
- Section 10-16-319. Effective date.
- Section 10-16-320. Investment of funds.
- Section 10-16-321. Medicare supplement benefit standards.
- Section 10-16-322. Filing of health policies.
- Section 10-16-323. Conversion of corporation to mutual insurance company. (Repealed)
- Section 10-16-324. Conversion of corporation to a stock insurance company.
- Section 10-16-325. Termination of health policies.
- Section 10-16-401. Establishment of health maintenance organizations.
- Section 10-16-403. Powers of health maintenance organizations.
- Section 10-16-404. Governing body.
- Section 10-16-405. Fiduciary responsibilities.
- Section 10-16-406. Evidence of coverage - rules.
- Section 10-16-407. Information to enrollees.
- Section 10-16-408. Open enrollment.
- Section 10-16-409. Complaint system.
- Section 10-16-410. Investments.
- Section 10-16-411. Protection against insolvency.
- Section 10-16-412. Statutory deposit.
- Section 10-16-413. Prohibited practices.
- Section 10-16-413.5. Return to home - legislative declaration - definitions.
- Section 10-16-414. Regulation of agents.
- Section 10-16-415. Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations.
- Section 10-16-416. Examination.
- Section 10-16-417. Suspension or revocation of certificate of authority.
- Section 10-16-418. Rehabilitation, liquidation, or conservation of health maintenance organization.
- Section 10-16-419. Administrative procedures.
- Section 10-16-420. Penalties and enforcement.
- Section 10-16-421. Statutory construction and relationship to other laws.
- Section 10-16-421.5. Acquisition of control of or merger of a health maintenance organization.
- Section 10-16-422. Filings and reports as public documents.
- Section 10-16-424. Commissioner's authority to contract.
- Section 10-16-425. Applicability of provisions.
- Section 10-16-426. Medicare supplement benefit standards.
- Section 10-16-427. Contractual relations.
- Section 10-16-428. Prohibition concerning state-funded medical assistance. (Repealed)
- Section 10-16-429. Termination of contract.
- Section 10-16-501. Legislative declaration.
- Section 10-16-502. Establishment of prepaid dental care plan organizations.
- Section 10-16-503. Application for certificate of authority.
- Section 10-16-504. Issuance of certificate of authority.
- Section 10-16-505. Guarantee fund deposit.
- Section 10-16-506. Reserve requirement - exception.
- Section 10-16-507. Enrollee coverage by prepaid dental care plan organizations - form filing requirements.
- Section 10-16-508. Examination of prepaid dental care plan organization.
- Section 10-16-510. Suspension or revocation of certificate of authority.
- Section 10-16-511. Rehabilitation, liquidation, or conservation of prepaid dental care plan organization.
- Section 10-16-512. Other laws applicable.
- Section 10-16-601. Legislative declaration.
- Section 10-16-602. Definitions.
- Section 10-16-603. Independent medical examinations - governing standard.
- Section 10-16-604. Financial interest in future care of patient prohibited.
- Section 10-16-605. Independence of examiners.
- Section 10-16-606. Applicability.
- Section 10-16-701. Short title.
- Section 10-16-702. Legislative declaration.
- Section 10-16-703. Applicability.
- Section 10-16-704. Network adequacy - rules - legislative declaration - definitions.
- Section 10-16-705. Requirements for carriers and participating providers.
- Section 10-16-705.5. Participating provider networks - definitions - selection standards informal reconsideration - enforcement - legislative declaration.
- Section 10-16-706. Intermediaries.
- Section 10-16-707. Enforcement.
- Section 10-16-708. Rule-making authority of commissioner.
- Section 10-16-709. Evaluation - nonparticipating health care providers - legislative declaration - rules.
- Section 10-16-710. Reporting to commissioner - medication-assisted treatment - rules.
Cross references: For provisions relating to health care coverage cooperatives prior to 2004, see article 18 of title 6 as contained in Colorado Revised Statutes 2003.
Law reviews: For article, "H.B. 94-1193: Health Care Purchasing Reform", see 23 Colo. Law. 2763 (1994).
- Section 10-16-1001. Legislative declaration.
- Section 10-16-1002. Definitions.
- Section 10-16-1003. Privacy of health information.
- Section 10-16-1004. Health care coverage cooperatives - establishment - fees.
- Section 10-16-1005. Issuance of certificate of authority by commissioner for cooperative to purchase health care coverage.
- Section 10-16-1006. Authority to deny application for, revoke, or suspend certificate of authority.
- Section 10-16-1007. Prohibition on cooperatives transacting insurance business.
- Section 10-16-1008. Administrative structure of cooperatives - board of directors - officers employees.
- Section 10-16-1009. Powers, duties, and responsibilities of cooperatives.
- Section 10-16-1010. Marketing requirements of cooperatives.
- Section 10-16-1011. Requirements for waivered health care coverage cooperatives - rules.
- Section 10-16-1012. Application of rating factors inside a waivered cooperative. (Repealed)
- Section 10-16-1013. Violations of article by persons involved with operations of cooperatives - enforcement - penalties.
- Section 10-16-1014. Technical assistance to authorized cooperatives from division of insurance.
- Section 10-16-1015. Health care cooperatives - rule-making authority.
- Section 10-16-1016. State innovation waiver - authority to apply.
- Section 10-16-1101. Short title.
- Section 10-16-1102. Legislative declaration.
- Section 10-16-1103. Definitions.
- Section 10-16-1104. Commissioner powers and duties - rules - study and report.
- Section 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.
- Section 10-16-1106. Accounting - reports - audits.
- Section 10-16-1107. Funding for reinsurance program - sources - permitted uses reinsurance program cash fund - calculation of total funding for program.
- Section 10-16-1108. Special assessments against hospitals and carriers - rules enforcement. (Repealed)
- Section 10-16-1109. State innovation waiver - federal funding - Colorado reinsurance program.
- Section 10-16-1110. Repeal of part - notice to revisor of statutes.
- Section 10-16-1201. Short title.
- Section 10-16-1202. Legislative declaration.
- Section 10-16-1204. Health insurance affordability enterprise - creation - powers and duties - assess and allocate health insurance affordability fee and special assessment.
- Section 10-16-1205. Health insurance affordability fee - special assessment on hospitals allocation of revenues.
- Section 10-16-1206. Health insurance affordability cash fund - creation.
- Section 10-16-1207. Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - commissioner rules.
- Section 10-16-1208. Limitation on authority - public option.
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