Colorado § 10-16-1103 - Definitions.

§ 10-16-1103. Definitions.

As used in this part 11, unless the context otherwise requires:

(1) "Attachment point" means the amount set by the commissioner pursuant to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a covered person's covered benefits in a benefit year, above which the claims costs for benefits are eligible for reinsurance payments under the reinsurance program.

(2) "Benefit year" means the calendar year for which an eligible carrier provides coverage through an individual health benefit plan.

(3) "Coinsurance rate" means the rate set by the commissioner pursuant to section 10-16-1105 (2) at which the reinsurance program will reimburse an eligible carrier for claims incurred for a covered person's covered benefits in a benefit year, which claims exceed the attachment point but are below the reinsurance cap.

(4) "Commissioner" means the commissioner of insurance, the commissioner's deputies, or the division of insurance, as appropriate.

(5) "Eligible carrier" means a carrier that:

(a) Offers individual health benefit plans that comply with the federal act; and

(b) Incurs claims costs for a covered person's covered benefits in the applicable benefit year.

(6) "Hospital" means a hospital licensed or certified by the department of public health and environment pursuant to section 25-1.5-103 (1)(a).

(7) "Medicaid" means federal insurance or assistance as provided by Title XIX of the federal "Social Security Act", as amended, and the "Colorado Medical Assistance Act", articles 4, 5, and 6 of title 25.5.

(8) "Medicare" means federal insurance or assistance provided by the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", as amended, 42 U.S.C. sec. 1395 et seq.

(9) "Payment parameters" means the attachment point, reinsurance cap, and coinsurance rate for the reinsurance program.

(10) "Reinsurance cap" means the amount set by the commissioner pursuant to section 10-16-1105 (2) for claims costs incurred by an eligible carrier for a covered person's covered benefits, above which amount the claims costs for benefits are no longer eligible for reinsurance payments.

(11) "Reinsurance payment" means an amount paid to an eligible carrier under the reinsurance program.

(12) "Reinsurance program" or "program" means the Colorado reinsurance program established under section 10-16-1105.

(13) "State innovation waiver" means a waiver of one or more requirements of the federal act authorized by section 1332 of the federal act, codified in 42 U.S.C. sec. 18052, and applicable federal regulations.

Source: L. 2019: Entire part added, (HB 19-1168), ch. 204, p. 2177, § 1, effective May 17.