Colorado § 10-16-103.5 - Payment of premiums - required term in contract - rules - definition.

§ 10-16-103.5. Payment of premiums - required term in contract - rules - definition.

(1) (a) Every contract for a health benefit plan between a carrier and a policyholder shall require the policyholder to pay premiums for each individual covered under the policyholder's policy:

(I) Through the date that the policyholder notifies the carrier that the individual covered under the policy is no longer eligible or covered;

(II) Through the date that the policyholder notifies the carrier that the policyholder no longer intends to maintain coverage for the group through the carrier; or

(III) Through the date that the individual covered under the policy is no longer eligible or covered if the policyholder notifies the carrier within ten business days after the date that the individual is no longer eligible or covered because the individual left employment without notice to the employer or the individual is an employee whose employment was terminated for gross misconduct.

(b) Subsection (1)(a)(III) of this section does not apply if a dependent is no longer covered because the dependent becomes enrolled in the children's basic health plan, established pursuant to article 8 of title 25.5. If the dependent becomes enrolled in the children's basic health plan, the policyholder shall notify the carrier of the change in coverage at least thirty days prior to the date that the dependent is no longer covered.

(c) If the policyholder notifies the carrier within the ten-day period pursuant to subsection (1)(a)(III) of this section, the carrier is not required to provide benefits to the individual after the date that the individual is no longer eligible or covered under the policy, unless the individual elects to continue health insurance coverage pursuant to the federal "Consolidated Omnibus Budget Reconciliation Act of 1985", 29 U.S.C. sec. 1161 et seq., as amended, or section 10-16-108.

(d) Nothing in this subsection (1) precludes a carrier and policyholder from agreeing to a date other than a date specified in subsection (1)(a)(III) of this section.

(e) The commissioner may promulgate rules concerning the eligibility notifications in this subsection (1) in order to ensure consistency among policyholders and carriers.

(f) For the purposes of this subsection (1), "gross misconduct" means a deliberate wrongdoing by the employee that fundamentally undermines the relationship of trust and confidence between the employer and employee.

(2) Premiums shall be paid according to the premium payment provisions of the contract. The carrier shall include in the contract, in the billing notice, or in the application process for coverage, an option for the policyholder to make monthly premium payments and an option to make premium payments by automatic electronic transfer.

Source: L. 2002: Entire section added, p. 887, § 3, effective January 1, 2003. L. 2005: (2) amended, p. 345, § 2, effective December 31. L. 2007: (1)(a) amended, p. 471, § 3, effective July 1. L. 2019: (1) amended, (SB 19-041), ch. 85, p. 300, § 1, effective August 2.