Colorado § 10-16-1305 - Standardized health benefit plan - carriers required to offer - premium rates - rules.

§ 10-16-1305. Standardized health benefit plan - carriers required to offer - premium rates - rules.

(1) Beginning January 1, 2023, a carrier that offers:

(a) An individual health benefit plan in Colorado is required to offer the standardized plan in the individual market in each county where the carrier offers an individual health benefit plan and shall offer the standardized plan throughout the entire county; and

(b) A small group health benefit plan in Colorado is required to offer the standardized plan in the small group market in each county where the carrier offers a small group health benefit plan and shall offer the standardized plan throughout the entire county.

(2) (a) (I) In the individual market, for the plan year beginning January 1, 2023, and in the small group market, beginning January 1, 2023, each carrier shall offer the standardized plan at a premium rate that is at least five percent less than the premium rate for health benefit plans that the carrier offered in the 2021 calendar year, as adjusted for medical inflation, in the individual and small group markets. The commissioner shall calculate the premium rate reduction based on the rates charged in the same county in which the carrier offered health benefit plans in the individual and small group markets in 2021 prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16.

(II) For carriers offering the standardized plan in the 2023 plan year in a county in which the carrier did not offer a health benefit plan in the individual or small group market in the 2021 calendar year, each carrier that offers the standardized plan shall offer the standardized plan:

(A) In the individual market at a premium rate that is at least five percent less than the average premium rate for individual health benefit plans offered in that county in 2021, calculated based on the average premium rate for individual health benefit plans offered in that county, as adjusted for medical inflation, prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16; and

(B) In the small group market at a premium rate that is at least five percent less than the average premium rate for small group plans offered in that county in 2021, as adjusted for medical inflation.

(b) (I) In the individual market, for the plan year beginning January 1, 2024, and in the small group market, beginning January 1, 2024, each carrier shall offer the standardized plan at a premium rate that is at least ten percent less than the premium rate for health benefit plans that the carrier offered in the 2021 calendar year, as adjusted for medical inflation, in the individual and small group markets. The commissioner shall calculate the premium rate reduction based on the rates charged in the same county in which the carrier offered health benefit plans in the individual and small group markets in 2021 prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16.

(II) For carriers offering the standardized plan in the 2024 plan year in a county in which the carrier did not offer a health benefit plan in the individual or small group market in the 2021 calendar year, each carrier that offers the standardized plan shall offer the standardized plan:

(A) In the individual market at a premium rate that is at least ten percent less than the average premium rate for individual plans offered in that county in 2021, calculated based on the average premium rate for individual plans offered in that county, as adjusted for medical inflation, prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16; and

(B) In the small group market at a premium rate that is at least ten percent less than the average premium rate for small group plans offered in that county in 2021, as adjusted for medical inflation.

(c) (I) In the individual market, for the plan year beginning January 1, 2025, and in the small group market, beginning January 1, 2025, each carrier shall offer the standardized plan at a premium rate that is at least fifteen percent less than the premium rate for health benefit plans that the carrier offered in the 2021 calendar year, as adjusted for medical inflation, in the individual and small group markets. The commissioner shall calculate the premium rate reduction based on the rates charged in the same county in which the carrier offered health benefit plans in the individual and small group markets in 2021 prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16.

(II) For carriers offering the standardized plan in the 2025 plan year in a county in which the carrier did not offer a health benefit plan in the individual or small group market in the 2021 calendar year, each carrier that offers the standardized plan shall offer the standardized plan:

(A) In the individual market at a premium rate that is at least fifteen percent less than the average premium rate for individual plans offered in that county in 2021, calculated based on the average premium rate for individual plans offered in that county, as adjusted for medical inflation, prior to the application of the Colorado reinsurance program pursuant to part 11 of this article 16; and

(B) In the small group market at a premium rate that is at least fifteen percent less than the average premium rate for small group plans offered in that county in 2021, as adjusted for medical inflation.

(d) For the plan year beginning on or after January 1, 2026, and each year thereafter, each carrier and health-care coverage cooperative shall limit any annual percentage increase in the premium rate for the standardized plan in both the individual and small group markets to a rate that is no more than medical inflation, relative to the previous year.

(3) The premium rate requirements in subsections (2)(a), (2)(b), and (2)(c) of this section for the standardized plan offered in the individual and small group markets must account for policy adjustments adopted consistent with the requirements in section 10-16-107 (8) to prevent people with low and moderate incomes from experiencing net increases in premium costs, such as adopting the induced demand factors utilized as part of the federal risk adjustment program under 42 U.S.C. sec. 18063.

(4) The commissions paid to insurance producers for the sale of the standardized plan must be comparable to the average commissions paid for the sale of other plans offered in the individual and small group markets.

Source: L. 2021: Entire part added, (HB 21-1232), ch. 241, p. 1283, § 1, effective June 16.