Colorado § 10-16-1002 - Definitions.

§ 10-16-1002. Definitions.

As used in this part 10, unless the context otherwise requires:

(1) Repealed.

(2) "Cooperative" or "health-care coverage cooperative" means a health-care coverage cooperative created pursuant to this part 10 as an entity that provides to its members health coverage and health-care purchasing services, including but not limited to detailed information on comparative prices, usage, outcomes, quality, and member satisfaction with provider networks. "Cooperative" does not include a cooperative association organized without capital stock in accordance with article 55 of title 7, C.R.S., that is subject to articles 121 to 137 of title 7, C.R.S., and that had filed articles of incorporation with the secretary of state on or before March 15, 1991.

(3) "Health information" has the same meaning as "medical information", as set forth in section 18-4-412 (2)(b), C.R.S. "Health information" also includes information that relates to the past, present, or future physical or mental health of the member and its eligible employees and to payment for the provision of health care to the member and its eligible employees.

(4) "Licensed provider network" shall have the same meaning as in section 6-18-301.5 (1), C.R.S.

(5) "Managed care" has the same meaning as "managed care plan", as defined in section 10-16-102 (43).

(6) (a) "Member" means any public or private employer that has employees covered for health benefits through a cooperative.

(b) If, pursuant to section 10-16-1009 (3)(l), a cooperative provides coverage to individuals and allows individuals to join the cooperative, "member" may also include an individual who is covered by a plan purchased through a cooperative and any dependent of the individual, including a dependent child who is under twenty-six years of age.

(6.5) "Member class" means the class of member based on whether the member would qualify for coverage in the individual market, the small employer fully insured market, the large employer fully insured market, or the employer self-insured market.

(7) "Person with financial interest in the cooperative's business" means one of the following or an immediate family member of one of the following:

(a) A health-care provider who is contracting or attempting to contract, directly or indirectly, with the cooperative;

(b) An individual who is an employee or member of the board of directors of, has a substantial ownership interest in, or derives substantial income from an entity or person that is contracting or attempting to contract, directly or indirectly, with the cooperative; or

(c) An employee of an association, law firm, or other institution or organization that represents the interests of one or more entities or persons that are contracting or attempting to contract, directly or indirectly, with the cooperative.

(8) "Provider network" means a group of health-care providers formed to provide health-care services to individuals.

(9) "Purchaser" means an individual, an organization, or a governmental entity that makes health benefit purchasing decisions on behalf of a group of individuals.

(9.5) "Self-insured" means not insured under a plan underwritten by a carrier.

(10) "Utilization management" means programs designed to assure appropriate utilization of health services relative to established standards or norms.

(11) Repealed.

Source: L. 2004: Entire part added, p. 993, § 14, effective August 4. L. 2013: (5) amended, (HB 13-1266), ch. 217, p. 989, § 52, effective May 13. L. 2019: (1) and (11) repealed, (5) and (6)(b) amended, and (6.5) added, (SB 19-004), ch. 205, p. 2190, § 3, effective August 2. L. 2025: (9.5) added, (SB 25-275), ch. 377, p. 2038, § 46, effective August 6.

Cross references: For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.