Colorado § 10-15-123 - Repeal of article.

§ 10-15-123. Repeal of article.

This article 15 is repealed, effective September 1, 2029. Before the repeal, the department of regulatory agencies shall review the regulation of preneed funeral contracts in accordance with section 24-34-104.

Source: L. 2017: Entire section added, (SB 17-249), ch. 283, p. 1544, § 6, effective June 1. L. 2022: Entire section amended, (HB 22-1228), ch. 309, p. 2222, § 2, effective August 10.

HEALTH-CARE COVERAGE

ARTICLE 16

Health-care Coverage

PART 1

GENERAL PROVISIONS

10-16-101. Short title.

10-16-102. Definitions.

10-16-103. Proposal of mandatory health-care coverage provisions.

10-16-103.3. Commission on mandated health insurance benefits - cash fund - purpose - creation - duties - repeal. (Repealed)

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 - applicability - rules - legislative declaration - definitions.

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.

10-16-104.4. Child-only plans - legislative declaration - open enrollment - reporting requirements - repeal. (Repealed)

10-16-104.5. Autism - treatment - not mental illness - repeal. (Repealed)

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 - notice to revisor of statutes - repeal.

10-16-105.2. Small employer health insurance availability program.

10-16-105.3. Health benefit plans - not prohibited.

10-16-105.5. Individual health plans - federally eligible individual - limited guarantee issue. (Repealed)

10-16-105.6. Rate usage.

10-16-105.7. Health benefit plan open enrollment periods - special enrollment periods - rules.

10-16-105.9. Health benefit plan - carrier insolvency - covered persons - deductible amounts - rules - definition.

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.

10-16-108.3. Continuation privileges - special election period - notice requirements - definitions - repeal. (Repealed)

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 - enforcement - definitions - rules.

10-16-112.7. Use of artificial intelligence systems - utilization review - prohibition on payment for AI-delivered psychotherapy services - definitions.

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.

10-16-114. Short title. (Repealed)

10-16-115. Definitions. (Repealed)

10-16-116. Catastrophic health insurance - coverage - premium payments - reporting requirements - definitions - short title - rules - repeal.

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. (Repealed)

10-16-117. Premium payments - pre-tax - election - reporting requirements. (Repealed)

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.

10-16-120. Legislative review of requirements for guaranteed issue of basic and standard health benefit plans. (Repealed)

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 - definitions.

10-16-121.5. Prohibited contract provisions in contracts between carriers and providers for dental care services - definitions.

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 - dispensing fees - 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.

10-16-122.8. Pharmacy benefit manager practices - agreements - fees - documentation - 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 - program - chronic maintenance drugs - rules of commissioner - definitions - repeal.

10-16-124.6. Drugs used for substance use disorder - prior authorization prohibited.

10-16-124.7. Opioid analgesics with abuse-deterrent properties - study - definitions. (Repealed)

10-16-124.8. Colorado consortium for prescription drug abuse prevention - create process for recovery - report. (Repealed)

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.

10-16-131. Health care reform project - blue ribbon commission for health care reform - repeal. (Repealed)

10-16-132. Study of factors driving health care costs in Pueblo county - repeal. (Repealed)

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. (Repealed)

10-16-135. Health coverage plan information cards - rules - standardization - contents.

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)

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. Single geographic rating area - individual plans - study - report - repeal. (Repealed)

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 - non-opioid pain management drug - 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.

10-16-149. Commissioner report - parity effects on premiums - repeal. (Repealed)

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 opioid 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 - rate filings - 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 - definition - 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.

10-16-167. Medical aid-in-dying - carrier prohibitions.

10-16-168. Carriers - health care - price transparency - rules - legislative declaration - definitions.

10-16-169. Carriers - prescription drug coverage - transparency.

10-16-170. Delivery of notices and documents by electronic means - definitions - consent required - withdrawal of consent - employers - immunity from liability - posting of plans and endorsements on carrier website - applicability - rules.

PART 2

SICKNESS AND ACCIDENT INSURANCE

10-16-200.3. Definitions.

10-16-201. Form and content of individual sickness and accident insurance policies.

10-16-201.5. Renewability of health benefit plans - modification of health benefit plans. (Repealed)

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. (Repealed)

10-16-222. Termination of policies.

PART 3

NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS

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.

10-16-313. Licensing of representatives. (Repealed)

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.

10-16-323. Conversion of corporation to mutual insurance company. (Repealed)

10-16-324. Conversion of corporation to a stock insurance company.

10-16-325. Termination of health policies.

PART 4

HEALTH MAINTENANCE ORGANIZATIONS

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.

10-16-428. Prohibition concerning state-funded medical assistance. (Repealed)

10-16-429. Termination of contract.

PART 5

PREPAID DENTAL CARE PLANS

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.

PART 6

ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS

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.

PART 7

CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS

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 - rules.

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

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

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.

PART 8

TASK FORCE TO EVALUATE HEALTH CARE NEEDS FOR COLORADO

10-16-801. (Repealed)

PART 9

MULTIPLE EMPLOYER WELFARE ARRANGEMENT PILOT PROGRAM

10-16-901 to

10-16-910. (Repealed)

PART 10

HEALTH-CARE COVERAGE COOPERATIVES

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.

10-16-1011. Requirements for waivered health care coverage cooperatives - rules. (Repealed)

10-16-1012. Application of rating factors inside a waivered cooperative. (Repealed)

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.

PART 11

COLORADO REINSURANCE PROGRAM

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.

10-16-1108. Special assessments against hospitals and carriers - rules - enforcement. (Repealed)

10-16-1109. State innovation waiver - federal funding - Colorado reinsurance program.

10-16-1110. Repeal of part - notice to revisor of statutes. (Repealed)

PART 12

HEALTH INSURANCE AFFORDABILITY ACT

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 enterprise fees and assessments.

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 - annual report - commissioner rules.

10-16-1208. Limitation on authority - public option.

10-16-1209. Repeal of certain provisions - notice to the revisor.

10-16-1210. Regulatory agenda - division review of regulation - repeal.

10-16-1211. Performance audit of the enterprise - repeal.

10-16-1212. Study concerning optimization of health insurance affordability programs - repeal.

10-16-1213. Bonds - investments - bonds eligible for investment and exempt from taxation.

10-16-1214. Report to joint budget committee - annual briefing.

10-16-1215. Rules.

10-16-1216. Tax credit for contributions to the enterprise - allocation notice - rules.

PART 13

COLORADO STANDARDIZED HEALTH BENEFIT PLAN

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.

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. (Repealed)

10-16-1311. State measurement for accountable, responsive, and transparent (SMART) government act report.

10-16-1312. Rules.

10-16-1313. Severability.

PART 14

COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD

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.

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.

PART 15

340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT

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.

PART 1

GENERAL PROVISIONS