C.R.S. § 10-3-105 — CO Code / Title 10 / Article 3 / Part 1 / Section 10-3-105
10-3-105. Certificate of authority to do business - companies prohibited - definitions
Status: in_force

10-3-105. Certificate of authority to do business - companies prohibited - definitions. (1) Except pursuant to the provisions of article 5 of this title, no foreign or domestic insurance company shall transact any insurance business in this state, unless it first procures from the commissioner a certificate of authority stating that the requirements of the laws of this state have been complied with and authorizing it to do business. The certificate of authority shall expire on June 30 each year and shall be renewed annually if the company has continued to comply with the laws of the state.

(2) Except as provided by subsection (3) of this section, no certificate of authority to transact any kind of insurance business in this state shall be issued or renewed to any company which is owned, or financially controlled in whole or in part, by another state of the United States, or by a foreign government, or by any political subdivision, instrumentality, or agency of either, unless such company was so owned, controlled, or constituted prior to January 1, 1955, and also authorized to do business in this state on or prior to January 1, 1955.

(3) (a) The ownership or financial control, in part, of any insurer by any state of the United States, or by a foreign government, or by any political subdivision, instrumentality, or agency of either shall not restrict the commissioner from issuing, renewing, or continuing in effect the license of that insurer to transact in this state the kinds of insurance business for which that insurer is otherwise qualified under the provisions of this title and under its charter, if the insurer has satisfied the commissioner that:

(I) It is not subject to any form of subsidy;

(II) It does not engage in practices that discriminate in violation of section 24-34-402, C.R.S.;

(III) The ownership or financial control will not create the presence of any sovereign immunity in the insurer;

(IV) Appropriate measures and controls exist to avoid security problems resulting from the insurer's access to confidential information and data of its insured; and

(V) The ownership or financial control will not result in substantial or undue influence being asserted over the insurer.

(b) The provisions of paragraph (a) of this subsection (3) are a clarification of the provisions of subsection (2) of this section and not a substantive change in the provisions of said subsection (2) as said subsection (2) existed prior to March 11, 1991.

(4) (a) The commissioner may order an insurer to pay restitution to a person, if, after notice to the insurer and after a hearing held in accordance with sections 24-4-104 and 24-4-105, C.R.S., the commissioner finds that the insurer has violated this title or that the insurer is financially responsible for the unfair business practices of an insurance producer pursuant to section 10-3-131.

(b) As used in this subsection (4), "insurance producer" shall have the same meaning as set forth in section 10-2-103 (6).

(c) For the purposes of this subsection (4), "restitution" means benefits or moneys owed due to the regulated entity's violation of this title, including, but not limited to, costs and expenses for lost time from work and attorney fees.
C.R.S. § 10-3-607 — CO Code / Title 10 / Article 3 / Part 6 / Section 10-3-607
10-3-607. Authorized insurance business and regulatory authority
Status: in_force

10-3-607. Authorized insurance business and regulatory authority. Nothing contained in this part 6 shall be construed to authorize any insurance company to engage in any kind of insurance business not authorized by its articles of incorporation or to authorize any acquiring corporation which is not an insurance company to engage directly in the business of insurance.
C.R.S. § 10-1-302 — CO Code / Title 10 / Article 1 / Part 3 / Section 10-1-302
10-1-302. Definitions
Status: in_force

10-1-302. Definitions. As used in this part 3, unless the context otherwise requires:

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

(2) "Company" means any person or group of persons engaging in or proposing or attempting to engage in any transaction or kind of insurance or surety business or any person or group of persons who may otherwise be subject to any administrative, regulatory, or taxing authority of the commissioner, as well as any advisory organization or rating organization as defined in section 10-4-402.

(3) "Complaint" means any written communication, or oral communication that is subsequently converted to a written form, that expresses a grievance or dissatisfaction with a specific person or entity subject to regulation by the division.

(4) "Division" means the division of insurance, the commissioner of insurance, or a government official or agency of a state other than Colorado exercising powers and duties substantially equivalent to those of the commissioner or the division.

(5) "Market analysis" means a process whereby market conduct surveillance personnel collect and analyze information from filed schedules, surveys, required reports, and other sources in order to develop a baseline understanding of the marketplace and to identify patterns or practices of companies that deviate from the norm or that may pose risk to the insurance consumer.

(6) "Market conduct examination" includes any type of examination as set forth in the Market Regulation Handbook that assesses a company's compliance with the laws, rules, and regulations applicable to the company. Market conduct examinations include desk examinations, on-site examinations, follow up examinations, and targeted examinations.

(7) "Market conduct surveillance" means any of the full range of activities that the commissioner may initiate to assess and address the market practices of any company licensed or registered pursuant to this title 10 to conduct business in this state, including market analysis, interrogatories, and market conduct examinations.

(8) "Market conduct surveillance personnel" means those individuals employed by or under contract with the commissioner to collect, analyze, review, or act on information about the insurance marketplace that identifies patterns or practices of companies.

(9) "Market Regulation Handbook" means the guidelines developed and issued by the NAIC that are designed to be used to conduct uniform, standardized market conduct surveillance.

(10) "NAIC" or "national association of insurance commissioners" means the organization of insurance regulators from the fifty states, the District of Columbia, and the five United States territories.

(11) "Person" means any individual, aggregation of individuals, trust, association, partnership, or corporation, or any agent or affiliate thereof.

(12) "Standard data request" means the set of field names and descriptions developed and adopted by the NAIC for use by market conduct surveillance personnel in an examination.

(13) "Third-party model or product" means a model or product provided by an entity separate from and not under direct or indirect corporate control of the company using the model or product.
C.R.S. § 10-11-103 — CO Code / Title 10 / Article 11 / Part 1 / Section 10-11-103
10-11-103. Compliance with article required
Status: in_force

10-11-103. Compliance with article required. On and after July 1, 1969, no company shall underwrite or issue a policy of title insurance or otherwise engage in the business of title insurance in this state unless authorized by the provisions of this article to transact such a business.
C.R.S. § 10-4-503 — CO Code / Title 10 / Article 4 / Part 5 / Section 10-4-503
10-4-503. Definitions
Status: in_force

10-4-503. Definitions. As used in this part 5, unless the context otherwise requires:

(1) "Account" means any one of the three accounts created by section 10-4-506.

(2) "Association" means the Colorado insurance guaranty association created under section 10-4-506.

(3) "Commissioner" means the commissioner of insurance of this state.

(4) (a) "Covered claim" means an unpaid claim, including one for unearned premiums:

(I) That arises out of and is within the coverage and not in excess of the applicable limits of an insurance policy to which this part 5 applies issued by an insurer if such insurer becomes an insolvent insurer after July 1, 1971; and

(II) With respect to which the claimant or insured is a resident of this state at the time of the insured event or the claim is a first-party claim for damage to property with a permanent location in this state.

(b) "Covered claim" does not include:

(I) Any amount due any reinsurer, insurer, insurance pool, or underwriting association, as subrogation recoveries or otherwise; except that:

(A) A claim for any such amount asserted against a person insured under a policy issued by an insurer that has become insolvent and which claim would be a covered claim if it were not a claim by or for the benefit of a reinsurer, insurer, insurance pool, or underwriting association may be filed directly with the receiver or the insolvent insurer; and

(B) In no event may any such claim be asserted in any legal action against the insured of such insolvent insurer.

(II) A first-party claim by an insured whose net worth exceeds ten million dollars on December 31 of the year immediately preceding the date the insurer becomes an insolvent insurer. An insured's net worth on such date includes the aggregate net worth of the insured and all of its subsidiaries as calculated on a consolidated basis.

(III) Any claim for incurred but not reported losses; except that nothing in this subparagraph (III) affects any covered claims or rights under this part 5.

(5) "Insolvent insurer" means an insurer licensed to transact insurance business in this state, either at the time the policy was issued or when the insured event occurred, and against whom an order of liquidation with a finding of insolvency has been entered by a court of competent jurisdiction in the insurer's state of domicile or of this state and which order of liquidation has not been stayed or been the subject of a writ of supersedeas or other comparable order.

(6) "Member insurer" means any person who writes any kind of insurance to which this part 5 applies under section 10-4-504, including the exchange of reciprocal or interinsurance contracts, and who is licensed to transact insurance business in this state.

(7) "Net direct written premiums" means direct gross premiums written in this state on insurance policies to which this part 5 applies, less return premiums thereon and dividends paid or credited to policyholders on such direct business. "Net direct written premiums" does not include premiums on contracts between insurers and reinsurers.

(8) "Person" means any individual, corporation, partnership, association, or voluntary organization.
C.R.S. § 10-2-1101 — CO Code / Title 10 / Article 2 / Part 11 / Section 10-2-1101
10-2-1101. Effective date - applicability
Status: in_force

10-2-1101. Effective date - applicability. This article shall take effect January 1, 1995. Insurance agent and broker licenses issued pursuant to part 2 of this article prior to said date shall expire at such time as the commissioner shall determine by rule promulgated under the authority of this article. The holders of such licenses may obtain comparable licenses under this article by complying with the rules promulgated by the commissioner under the authority of this article.
C.R.S. § 10-4-1204 — CO Code / Title 10 / Article 4 / Part 12 / Section 10-4-1204
10-4-1204. Penalties
Status: in_force

10-4-1204. Penalties. (1) (a) If the commissioner believes that the controlling producer or any other person has not materially complied with this part 12 or with any regulation or order promulgated pursuant thereto, after notice and opportunity to be heard, the commissioner may order the controlling producer to cease placing business with the controlled insurer.

(b) If it was found that, because of such material noncompliance, the controlled insurer or any policyholder thereof has suffered any loss or damage, the commissioner may maintain a civil action or intervene in an action brought by or on behalf of the insurer or policyholder for recovery of compensatory damages for the benefit of the insurer or policyholder or for other appropriate relief.

(2) If an order for liquidation or rehabilitation of the controlled insurer has been entered pursuant to part 5 of article 3 of this title, and the receiver appointed under such order believes that the controlling producer or any other person has not materially complied with this part 12 or with any regulation or order promulgated pursuant thereto and that, as a result, the insurer suffered any loss or damage, the receiver may maintain a civil action for recovery of damages or other appropriate sanctions for the benefit of the insurer.

(3) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided for in the laws of this state governing insurance.

(4) Nothing contained in this section is intended to or shall in any manner alter or affect the rights of policyholders, claimants, creditors, or other third parties.
C.R.S. § 10-5-113 — CO Code / Title 10 / Article 5 / Section 10-5-113
10-5-113. Revocation of broker's license
Status: in_force

10-5-113. Revocation of broker's license. (1) The commissioner may revoke any surplus line broker's license:

(a) If the broker fails to file the annual statement or to remit the tax as required by this article; or

(b) If the broker fails to keep the records, or to allow the commissioner to examine the broker's records as required by this article; or

(c) For any of the causes for which a general broker's license may be revoked.

(2) The commissioner may suspend or revoke any such license whenever the commissioner deems suspension or revocation to be for the best interest of the people of this state.

(3) The procedures provided by law for the suspension or revocation of general brokers' licenses shall be applicable to suspension or revocation of a surplus line broker's license.

(4) No broker whose license has been so revoked or suspended shall again be so licensed within one year thereafter or until any fines or delinquent taxes owing by the broker have been paid.
C.R.S. § 10-16-113.7 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-113.7
10-16-113.7. Reporting the denial of benefits to division
Status: in_force

10-16-113.7. Reporting the denial of benefits to division. Each carrier shall report the number and outcome of second-level internal appeals pursuant to section 10-16-113 to the division by February 1 of each year. On at least an annual basis, the division shall compile the information reported by each carrier along with the number and outcome of third-level external appeals of each health coverage plan and make such information available on the division website and for public inspection. The commissioner may specify the format in which the information shall be submitted by a carrier.
C.R.S. § 10-6-109 — CO Code / Title 10 / Article 6 / Section 10-6-109
10-6-109. Increase of capital
Status: repealed

10-6-109. Increase of capital. (Repealed)
C.R.S. § 10-3-201 — CO Code / Title 10 / Article 3 / Part 2 / Section 10-3-201
10-3-201. Cash capital - guaranty fund - deposit
Status: repealed

10-3-201. Cash capital - guaranty fund - deposit.

(1) (a) (I) to (IV) Repealed.

(V) No insurance company, issued a certificate of authority on or after July 1, 1995, shall be permitted to do any business in this state, unless, in addition to the other requirements of law, it possesses the minimum capital or guaranty fund and an accumulated surplus in the form of cash or marketable securities which combined are at least equal to:

TYPE OF COMPANYTOTAL CAPITAL

OR GUARANTY FUND

PLUS SURPLUS

Life ...................................$1,500,000.00

Fire ...................................1,500,000.00

Casualty ............................1,500,000.00

Multiple Line ....................2,000,000.00

Title Insurance ..................750,000.00

(b) To avoid situations where an insurer's transactions would create undue financial risks to its enrollees, subscribers, or policyholders or to the people of this state, the regulations specified in this paragraph (b) are authorized. The commissioner may by regulation establish standards consistent with those of the national association of insurance commissioners which require any insurer to maintain a greater minimum surplus level than the specific dollar minimums established by paragraph (a) of this subsection (1). Such minimum surplus level shall reflect the type, volume, and nature of the insurance business being transacted and the type of entity for which the surplus levels are being established. Such regulation may additionally require the submission of an opinion by a qualified actuary which states whether or not the surplus level of the entity is sufficient for the authority requested.

(c) Companies already licensed on July 1, 1991, may continue to transact business and shall have until December 31, 1992, to increase their total capital or guaranty fund and surplus or file a plan with the commissioner. The commissioner may, upon showing of adequate justification by the company, extend the date for the company to attain the new levels specified in paragraph (a) of this subsection (1), or waive or reduce such new levels.

(d) An insurance company subject to this section shall increase its capital and surplus to those limits set forth in paragraph (a) of this subsection (1) within thirty days after any change of control of the insurance company. Any extension granted pursuant to paragraph (c) of this subsection (1) shall be automatically rescinded in the event of such a change of control. The insurance company is not required to increase its capital and surplus if the transfer of ownership occurs because of death and the ownership is transferred solely to one or more natural persons, each of whom would be an heir of the decedent if the decedent had died intestate.

(2) The cash or securities representing the minimum capital or guaranty fund and surplus required by paragraph (a) of subsection (1) of this section shall be deposited, in the case of domestic companies, with the commissioner in the manner provided by law and, in the case of foreign or alien companies, with the commissioner or with the duly authorized officer of some other state of the United States; except that the guaranty fund of mutual companies shall be construed to include deposits held for the benefit of policyholders as provided in this title (except article 15) and article 14 of title 24, C.R.S.

(3) The deposit shall be held by the commissioner for the benefit of all policyholders wherever located. For a foreign or alien insurer to be allowed credit for deposits in other jurisdictions, such deposits must be held for the benefit of all policyholders wherever located and not solely or with preference for those in the depository jurisdiction.
C.R.S. § 10-15-108 — CO Code / Title 10 / Article 15 / Section 10-15-108
10-15-108. Standard for investments by trustees
Status: in_force

10-15-108. Standard for investments by trustees. (1) Savings and loan associations acting as trustees under the terms of this article shall invest trust funds as otherwise authorized under the laws of this state relating to the investment of funds by savings and loan associations and the federal law governing such investments, but savings and loan associations shall accept trust funds only to the extent that the full amount thereof is insured by the federal deposit insurance corporation or its successor.

(2) Banks and trust companies acting as trustees under the terms of this article shall be subject to the following investment standards: In acquiring, investing, reinvesting, exchanging, retaining, selling, and managing property for the benefit of others, trustees shall be required to have in mind the responsibilities which are attached to such offices and the size, nature, and needs of the estates entrusted to their care and shall exercise the judgment and care under the circumstances then prevailing which men of prudence, discretion, and intelligence exercise in the management of their own affairs, not in regard to speculation but in regard to the permanent disposition of their funds, considering the probable income as well as the probable safety of their capital. Within the limitations of the standards set forth in this subsection (2), trustees are authorized to acquire and retain every kind of property, real, personal, and mixed, and every kind of investment, specifically including, but not by way of limitation, bonds, debentures, and other corporate obligations, savings accounts in insured savings and loan associations, stocks, preferred or common, securities of any open-end or closed-end management type investment company or investment trust, and participations in common trust funds, which men of prudence, discretion, and intelligence would acquire or retain for their own account.

(3) Credit unions acting as trustees under the terms of this article shall invest funds received under an account agreement as authorized under the laws of this state or the United States relating to the investment of funds by credit unions, but a credit union shall accept trust funds only to the extent that the full amount thereof is insured by the national credit union share insurance fund or other insurer approved by the commissioner of financial services.
C.R.S. § 10-7-617 — CO Code / Title 10 / Article 7 / Part 6 / Section 10-7-617
10-7-617. Application
Status: in_force

10-7-617. Application. A viatical settlement provider lawfully transacting business in this state may continue to do so pending approval or disapproval of the person's application for a license as long as the application is filed with the commissioner not later than thirty days after publication by the commissioner of an application form for licensure of viatical settlement providers. If the publication of the application form is prior to January 1, 2006, the filing of the application shall not be later than thirty days after January 1, 2006.
C.R.S. § 10-4-118 — CO Code / Title 10 / Article 4 / Part 1 / Section 10-4-118
10-4-118. Severability
Status: in_force

10-4-118. Severability. If any provision or clause of this part 1 or application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of this part 1 that can be given effect without the invalid provision or application, and to this end the provisions of this title are declared to be severable.
C.R.S. § 10-2-101 — CO Code / Title 10 / Article 2 / Part 1 / Section 10-2-101
10-2-101. Short title
Status: in_force

10-2-101. Short title. This article shall be known and may be cited as the "Colorado Producer Licensing Model Act".
C.R.S. § 10-10-112 — CO Code / Title 10 / Article 10 / Section 10-10-112
10-10-112. Claims
Status: in_force

10-10-112. Claims. (1) All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract.

(2) All claims shall be paid either by draft drawn upon the insurer or by check of the insurer to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions or upon direction of such claimant to one specified.

(3) No plan or arrangement shall be used whereby any person, firm, or corporation, other than the insurer or its designated claim representative, is authorized to settle or adjust claims. The creditor shall not be designated as claim representative for the insurer in adjusting claims, but a group policyholder may, by arrangement with the group insurer, draw drafts or checks in payment of claims due to the group policyholder subject to audit and review by the insurer.
C.R.S. § 10-1-118 — CO Code / Title 10 / Article 1 / Part 1 / Section 10-1-118
10-1-118. Foreign companies - unsatisfied judgments - suspension
Status: in_force

10-1-118. Foreign companies - unsatisfied judgments - suspension. (1) If a judgment against a foreign insurance company is unsatisfied, and execution has issued on said judgment, and the return of the sheriff discloses that the sheriff cannot fully satisfy such judgment, the judgment creditor or judgment creditor's attorney may file with the commissioner, in triplicate, a complaint setting forth such facts. The commissioner shall mail a copy of such complaint to the home office of such insurance company, at the address shown in the records of the division of insurance, and a copy to the Colorado office or the Colorado general agent of such insurance company.

(2) If said insurance company does not, within thirty days after such mailing, pay and discharge said judgment or show good cause to the commissioner for the failure to pay such judgment, the commissioner, upon satisfactory proof of the allegations of the complaint, shall forthwith suspend the license or right of such insurance company to do business in this state. If good cause, previously shown, ceases to exist and the judgment remains unpaid, the commissioner shall suspend such license or right.

(3) The commissioner shall reinstate the license or right to do business in this state when the insurance company has fully paid such judgment.
C.R.S. § 10-3-542 — CO Code / Title 10 / Article 3 / Part 5 / Section 10-3-542
10-3-542. Liquidator's recommendations to the court
Status: in_force

10-3-542. Liquidator's recommendations to the court. (1) The liquidator shall review all claims duly filed in the liquidation and shall make such further investigation as deemed necessary. The liquidator may compound, compromise, or in any other manner negotiate the amount for which claims will be recommended to the court except where the liquidator is required by law to accept claims as settled by any person or organization, including any guaranty association or foreign guaranty association. Unresolved disputes shall be determined under section 10-3-538. As soon as practicable, the liquidator shall present to the court a report of the claims against the insurer with the liquidator's recommendations. The report shall include the name and address of each claimant and the amount of the claim finally recommended, if any. If the insurer has issued annuities or life insurance policies, the liquidator shall report the persons to whom, according to the records of the insurer, amounts are owed as cash surrender values or other investment value and the amounts owed.

(2) The court may approve, disapprove, or modify the liquidator's report on claims. Claims allowed in any report not modified by the court within a period of sixty days after submission by the liquidator shall be treated by the liquidator as allowed claims, subject thereafter to later modification or to rulings made by the court pursuant to section 10-3-538. No claim under a policy of insurance shall be allowed for an amount in excess of the applicable policy limits.
C.R.S. § 10-16-105.3 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-105.3
10-16-105.3. Health benefit plans - not prohibited
Status: in_force

10-16-105.3. Health benefit plans - not prohibited. (1) A carrier shall not be prohibited from offering to a small employer additional options of health benefit plans that:

(a) Provide for different benefits for insureds and dependents of such insureds covered by the same policy; and

(b) Encourage appropriate health-care condition management based on clinical guidelines by providing case management benefits to covered persons.
C.R.S. § 10-4-121 — CO Code / Title 10 / Article 4 / Part 1 / Section 10-4-121
10-4-121. Authority of insurer to protect policyholders' property - emergency
Status: in_force

10-4-121. Authority of insurer to protect policyholders' property - emergency. Notwithstanding any other provision of law, an insurer may provide services protecting the property of its policyholders in the event of an emergency.
C.R.S. § 10-4-1803 — CO Code / Title 10 / Article 4 / Part 18 / Section 10-4-1803
10-4-1803. Definitions
Status: in_force

10-4-1803. Definitions. As used in this part 18, unless the context otherwise requires:

(1) "Board" means the board of directors of the FAIR plan association created in section 10-4-1805.

(2) "Commercial property insurance" means insurance against direct loss to commercial property, including buildings and building contents, resulting from the perils of fire, perils covered under extended coverage, vandalism, or malicious mischief. "Commercial property insurance" does not include commercial automobile insurance or farm risks.

(3) "FAIR plan" or "plan" means the fair access to insurance requirements plan established by the board pursuant to section 10-4-1806.

(4) "FAIR plan association" or "association" means the fair access to insurance requirements plan association created in section 10-4-1804.

(5) "Member insurer" means any admitted company that offers or sells any property insurance, including commercial property insurance.

(6) "Property insurance" means insurance against direct loss to residential property, including buildings and building contents, resulting from the perils of fire, perils covered under extended coverage, vandalism, or malicious mischief. "Property insurance" does not include automobile insurance or farm risks.
C.R.S. § 10-5-103.5 — CO Code / Title 10 / Article 5 / Section 10-5-103.5
10-5-103.5. Producing broker's affidavit
Status: in_force

10-5-103.5. Producing broker's affidavit. Any broker exporting insurance under this article, at the request of any other licensed agent or broker, may accept an affidavit executed by such other agent or broker, in such form as may be prescribed or accepted by the commissioner, as evidence that such insurance was eligible for export under section 10-5-103. Except as the commissioner may otherwise provide, the broker shall file or cause to be filed such affidavit with the commissioner within thirty days after the insurance was so procured.
C.R.S. § 10-4-1810 — CO Code / Title 10 / Article 4 / Part 18 / Section 10-4-1810
10-4-1810. Enforcement - suspension or revocation of certificate of authority - fines
Status: in_force

10-4-1810. Enforcement - suspension or revocation of certificate of authority - fines. (1) After notice and hearing, the commissioner may suspend or revoke the certificate of authority to transact insurance business in this state of any member insurer that fails to timely pay a fee or to comply with the plan of operation.

(2) As an alternative to suspension or revocation of a certificate of authority, as described in subsection (1) of this section, the commissioner may impose a fine on any member insurer that fails to timely pay a fee or to comply with the plan of operation. The fine must be the greater of:

(a) The amount of the fee plus interest and the commissioner's cost of enforcement; or

(b) Five thousand dollars.
C.R.S. § 10-3-1606 — CO Code / Title 10 / Article 3 / Part 16 / Section 10-3-1606
10-3-1606. Retention of third-party consultants - information sharing
Status: in_force

10-3-1606. Retention of third-party consultants - information sharing. (1) The commissioner may retain, at the expense of an insurer or insurance group, one or more third-party consultants, including attorneys, actuaries, accountants, and other experts who are not otherwise members of the commissioner's staff, as may be reasonably necessary to assist the commissioner in reviewing the insurer's or insurance group's CGAD and related information or the insurer's or insurance group's compliance with this part 16.

(2) Any persons retained pursuant to subsection (1) of this section shall act under the direction and control of the commissioner and in a purely advisory capacity.

(3) The NAIC and third-party consultants are subject to the same confidentiality standards and requirements established for the commissioner in section 10-3-1605 and elsewhere in this part 16.

(4) As part of the retention process, a third-party consultant shall verify to the commissioner that the consultant has no conflict of interest, has internal procedures in place to prevent conflicts of interest, and will comply with the confidentiality standards and requirements of this part 16. A third-party consultant shall also provide such verification to the insurer or insurance group whose CGAD the third-party consultant will review.

(5) A written agreement with the NAIC or with a third-party consultant that governs sharing and use of information provided pursuant to this part 16 must contain the following provisions and must expressly require the written consent of the insurer or insurance group before any such information may be publicly disclosed:

(a) Specific procedures and protocols for maintaining the confidentiality and security of CGAD-related information that is shared with the NAIC or with a third-party consultant pursuant to this part 16;

(b) Procedures and protocols for sharing by the NAIC only with other state regulators from states in which an insurance group has domiciled insurers. The agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the CGAD-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality.

(c) A provision specifying that ownership of the CGAD-related information shared with the NAIC or with a third-party consultant remains with the division, and the NAIC's or third-party consultant's use of the information is subject to the direction of the commissioner;

(d) A provision that prohibits the NAIC or third-party consultant from storing the information shared pursuant to this part 16 in a permanent database after the underlying analysis is completed;

(e) A provision requiring the NAIC or third-party consultant to provide prompt notice to the commissioner and to the insurer or insurance group regarding any subpoena, request for disclosure, or request for production of the insurer's CGAD-related information; and

(f) A provision stating that the NAIC or third-party consultant consents to intervention by an insurer or insurance group in any judicial or administrative action in which the NAIC or third-party consultant may be required to disclose confidential information about the insurer or insurance group.
C.R.S. § 10-3-1508 — CO Code / Title 10 / Article 3 / Part 15 / Section 10-3-1508
10-3-1508. Confidentiality
Status: in_force

10-3-1508. Confidentiality. (1) Documents, materials, or other information, including the ORSA summary report, in the possession or control of the division of insurance that are obtained by, created by, or disclosed to the commissioner or any other person under this part 15, are recognized by this state as being proprietary and containing trade secrets. All documents, materials, or other information, including the ORSA summary report, are confidential by law and privileged; are not subject to the "Colorado Open Records Act", part 2 of article 72 of title 24, C.R.S., or other open records, freedom of information, sunshine, or other similar law of this state; are not subject to subpoena; and are not subject to discovery or admissible in evidence in any private civil action. However, the commissioner may use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties. The commissioner shall not otherwise make the documents, materials, or other information public without the prior written consent of the insurer.

(2) Neither the commissioner nor any person who received documents, materials, or other ORSA-related information, through examination or otherwise, while acting under the authority of the commissioner or with whom such documents, materials, or other information are shared pursuant to this part 15 is permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (1) of this section.

(3) In order to assist in the performance of the commissioner's regulatory duties, the commissioner:

(a) May, upon request, share documents, materials, or other ORSA-related information, including the confidential and privileged documents, materials, or information subject to subsection (1) of this section, including proprietary and trade-secret documents and materials, with other state, federal, and international financial regulatory agencies, including members of any supervisory college as defined in section 10-3-807, with the NAIC and with any third-party consultants designated by the commissioner, if the recipient agrees in writing to maintain the confidentiality and privileged status of the ORSA-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality; and

(b) May receive documents, materials, or other ORSA-related information, including otherwise confidential and privileged documents, materials, or information, including proprietary and trade-secret information or documents, from regulatory officials of other foreign or domestic jurisdictions, including members of any supervisory college as defined in section 10-3-807, and from the NAIC, and shall maintain as confidential or privileged any documents, materials, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information;

(c) Shall enter into a written agreement with the NAIC or a third-party consultant governing sharing and use of information provided pursuant to this part 15, consistent with this subsection (3), which agreement must:

(I) Specify procedures and protocols regarding the confidentiality and security of information shared with the NAIC or a third-party consultant pursuant to this part 15, including procedures and protocols for sharing by the NAIC with other state regulators from states in which the insurance group has domiciled insurers. The agreement must provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the ORSA-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality.

(II) Specify that ownership of information shared with the NAIC or a third-party consultant pursuant to this part 15 remains with the commissioner and that the NAIC's or third-party consultant's use of the information is subject to the direction of the commissioner;

(III) Prohibit the NAIC or third-party consultant from storing the information shared pursuant to this part 15 in a permanent database after the underlying analysis is completed;

(IV) Require prompt notice be given to an insurer whose confidential information in the possession of the NAIC or a third-party consultant pursuant to this part 15 is subject to a request or subpoena to the NAIC or third-party consultant for disclosure or production;

(V) Require the NAIC or a third-party consultant to consent to intervention by an insurer in any judicial or administrative action in which the NAIC or third-party consultant may be required to disclose confidential information about the insurer shared with the NAIC or third-party consultant pursuant to this part 15; and

(VI) In the case of an agreement involving a third-party consultant, provide for the insurer's written consent.

(4) The sharing of information and documents by the commissioner under this part 15 does not constitute a delegation of regulatory authority or rule-making, and the commissioner is solely responsible for the administration, execution, and enforcement of this part 15.

(5) No waiver of any applicable privilege or claim of confidentiality in the documents, proprietary and trade-secret materials, or other ORSA-related information may occur as a result of disclosure of such ORSA-related information or documents to the commissioner under this section or as a result of sharing as authorized in this part 15.

(6) Documents, materials, or other information in the possession or control of the NAIC or a third-party consultant under this part 15 is confidential by law and privileged; is not subject to the "Colorado Open Records Act", part 2 of article 72 of title 24, C.R.S., or other open records, freedom of information, sunshine, or other similar law of this state; is not subject to subpoena; and is not subject to discovery or admissible in evidence in any private civil action.
C.R.S. § 10-7-106 — CO Code / Title 10 / Article 7 / Part 1 / Section 10-7-106
10-7-106. Exclusive right of insured in proceeds
Status: in_force

10-7-106. Exclusive right of insured in proceeds. Whenever, under the terms of any annuity or policy of life insurance, or under any written agreement supplemental thereto, issued by any insurance company, domestic or foreign, lawfully doing business in this state, the proceeds are retained by such company at maturity or otherwise, no person, other than the insured, entitled to any part of such proceeds or any installment of interest due or to become due thereon shall be permitted to commute, anticipate, encumber, alienate, or assign the same, or any part thereof, if such permission is expressly withheld by the terms of such policy or supplemental agreement; and, if such policy or supplemental agreement so provides, no payments of interest or of principal shall be in any way subject to such person's debts, contracts, or engagements nor to any judicial processes to levy upon or attach the same for payment thereof.
C.R.S. § 10-7-604 — CO Code / Title 10 / Article 7 / Part 6 / Section 10-7-604
10-7-604. Licensure - refusal to issue - suspension - revocation - refusal to renew
Status: in_force

10-7-604. Licensure - refusal to issue - suspension - revocation - refusal to renew. (1) The commissioner shall refuse to issue, suspend, revoke, or refuse to renew the license of a viatical settlement provider if the commissioner finds after compliance with subsection (3) of this section that:

(a) There was any material misrepresentation in the application for the license;

(b) The licensee or any of its officers, partners, members, or key management personnel has been convicted of fraudulent or dishonest practices, is subject to a final administrative action, or is otherwise shown to be untrustworthy or incompetent;

(c) The licensee demonstrates a pattern of unreasonable payments to viators;

(d) The licensee or any of its officers, partners, members, or key management personnel has been found guilty of, or has pleaded guilty or nolo contendere to, any felony, or to a misdemeanor involving fraud or moral turpitude, regardless of whether a judgment or conviction has been entered by the court;

(e) The licensee has entered into any viatical settlement contract that has not been approved pursuant to this part 6;

(f) The licensee has failed to honor contractual obligations set out in a viatical settlement contract;

(g) The licensee no longer meets the requirements for initial licensure;

(h) The licensee has assigned, transferred, or pledged a viaticated policy to a person other than a viatical settlement provider licensed in this state; an accredited investor or qualified institutional buyer as defined, respectively, in regulation D, rule 501, or rule 144A of the federal "Securities Act of 1933", as amended; a financing entity; a special purpose entity; or a related provider trust; or

(i) The applicant or licensee or any of its officers, partners, members, or key management personnel, or any life insurance producer acting on behalf of the applicant or licensee, has violated this part 6.

(2) The commissioner may suspend, revoke, or refuse to renew the license of a life insurance producer if the commissioner finds that such life insurance producer has violated this part 6.

(3) If the commissioner denies a license application or suspends, revokes, or refuses to renew the license of a viatical settlement provider, or suspends, revokes, or refuses to renew the license of a life insurance producer, the commissioner shall conduct a hearing in accordance with the "State Administrative Procedure Act", article 4 of title 24, C.R.S., and may use a hearing officer pursuant to section 10-1-127.
C.R.S. § 10-3-204 — CO Code / Title 10 / Article 3 / Part 2 / Section 10-3-204
10-3-204. Payment of dividends
Status: in_force

10-3-204. Payment of dividends. (1) The amount of dividend payments by any domestic insurance company is wholly within the discretion of its directors or of the duly constituted executive committee thereof. No dividend shall be paid except from the company's surplus.

(2) It is unlawful for the directors, trustees, managers, or officers of any domestic insurance company, directly or indirectly, to make or pay any dividends or pay any interest, bonus, or other allowance in lieu of dividends, other than premium refunds and deductions guaranteed, except from the company's surplus and from profits arising from the company's business. Any person who is found guilty of violating any provision of this section shall be punished by a fine of not more than one thousand dollars.
C.R.S. § 10-14-203 — CO Code / Title 10 / Article 14 / Part 2 / Section 10-14-203
10-14-203. No personal liability
Status: in_force

10-14-203. No personal liability. (1) The officers and members of the supreme governing body or any subordinate body of a society shall not be personally liable for any benefits provided by a society.

(2) Any person may be indemnified and reimbursed by any society for expenses reasonably incurred by, and liabilities imposed upon, such person in connection with or arising out of any action, suit, or proceeding, whether civil, criminal, administrative, or investigative, or threat thereof, in which the person may be involved by reason of the fact that such person is or was a director, officer, employee, or agent of the society or of any firm, corporation, or organization which such person served in any capacity at the request of the society. A person shall not be so indemnified or reimbursed in relation to any matter in such action, suit, or proceeding as to which such person is finally adjudged to be or have been guilty of breach of a duty as a director, officer, employee, or agent of the society or in relation to any matter in such action, suit, or proceeding, or threat thereof, which has been made the subject of a compromise settlement, unless in either case the person acted in good faith for a purpose the person reasonably believed to be in or not opposed to the best interests of the society and, in a criminal action or proceeding, in addition, had no reasonable cause to believe that such conduct was unlawful. The determination whether the conduct of such person met the standard required to justify indemnification and reimbursement in relation to any matter described in this subsection (2) may only be made by the supreme governing body or board of directors by a majority vote or a quorum consisting of persons who were not parties to such action, suit, or proceeding or by a court of competent jurisdiction. The termination of any action, suit, or proceeding by judgment, order, settlement, conviction, or upon a plea of no contest as to such person shall not in itself create a conclusive presumption that the person did not meet the standard of conduct required to justify indemnification and reimbursement. The right of indemnification and reimbursement pursuant to this subsection (2) shall not be exclusive of other rights to which such person may be entitled as a matter of law and shall inure to the benefit of such person's heirs, executors, and administrators.

(3) A society shall have power to purchase and maintain insurance on behalf of any person who is or was a director, officer, employee, or agent of the society, or who is or was serving at the request of the society as a director, officer, employee, or agent of any other firm, corporation, or organization against any liability asserted against such person and incurred by such person in any such capacity or arising out of such person's status as such, whether or not the society would have the power to indemnify the person against such liability under this section.

(4) No director, officer, employee, member, or volunteer of a society serving without compensation shall be liable, and no cause of action may be brought, for damages resulting from the exercise of judgment or discretion in connection with the duties or responsibilities of such person for the society unless such act or omission involved willful or wanton misconduct.
C.R.S. § 10-2-801 — CO Code / Title 10 / Article 2 / Part 8 / Section 10-2-801
10-2-801. Licenses - denial, suspension, revocation, termination - reporting of actions -
Status: in_force

10-2-801. Licenses - denial, suspension, revocation, termination - reporting of actions - definitions. (1) The commissioner may place an insurance producer on probation; suspend, revoke, or refuse to issue, continue, or renew an insurance producer license; order restitution to be paid from an insurance producer; or assess a civil penalty pursuant to section 10-2-804 or 10-3-1108, if, after notice to the insurance producer licensee and after a hearing held in accordance with sections 24-4-104 and 24-4-105, C.R.S., the commissioner finds that as to the licensee or applicant any one or more of the following conditions exist:

(a) Any incorrect, misleading, incomplete, or materially untrue information in the license application;

(b) Any cause for which issuance of the license could have been refused had it then existed and been known to the commissioner at the time of issuance;

(c) Violation of, or noncompliance with, section 18-13-130, C.R.S., or any insurance law, or violation of any lawful rule, order, or subpoena of the commissioner or of the insurance department of another state;

(d) Obtaining or attempting to obtain any such license through misrepresentation or fraud;

(e) Improperly withholding, misappropriating, or converting to the licensee's or applicant's own use any moneys or property belonging to policyholders, insurers, beneficiaries, or others received in the course of the business of insurance;

(f) Misrepresentation of the terms of any actual or proposed insurance contract or application for insurance;

(g) (I) Conviction of a felony or misdemeanor involving moral turpitude.

(II) For the purposes of this paragraph (g), "moral turpitude" shall include any sexual offense against a child as defined in section 18-3-411, C.R.S.

(h) Commission of any unfair trade practice or fraud;

(i) The use of fraudulent, coercive, or dishonest practices or demonstrating incompetence, untrustworthiness, or financial irresponsibility in this state or elsewhere;

(j) Suspension, revocation, or denial of an insurance license in any other state, province, district, or territory;

(k) Forgery of another's name to an application for insurance or to any document related to an insurance transaction;

(l) Cheating on an examination, including, but not limited to, improperly using notes or any other reference material to complete an examination for an insurance license;

(m) Failure to fully meet the licensing requirements;

(n) Knowingly accepting insurance business from a person who is not licensed;

(o) Failing to comply with an administrative or court order imposing a child support obligation;

(p) Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax; or

(q) Profiting either directly or indirectly from the business of a cash-bonding agent or professional cash-bail agent unless the person profiting is registered as a cash-bonding agent or professional cash-bail agent and the profit is derived from their own business.

(1.5) The commissioner shall revoke the license of an insurance producer licensee if, after notice to the insurance producer licensee and after a hearing held in accordance with sections 24-4-104 and 24-4-105, C.R.S., the commissioner finds that the licensee was convicted under section 18-5-211, C.R.S.

(2) In the event that the action by the commissioner is to not renew or continue or to deny an application for a license, the commissioner shall notify the applicant or licensee of the reasons for such action and advise, in writing, the applicant or licensee of the reason for the denial or nonrenewal of the applicant's or licensee's license.

(3) (a) A producer or business entity shall report to the commissioner any administrative action taken against the producer in another jurisdiction or by another governmental agency in this state within thirty days after the final disposition of the matter. This report shall include a copy of the order, consent to order, or other relevant legal document.

(b) A producer shall report within thirty days after the conviction to the commissioner if he or she is convicted under section 18-5-211, C.R.S.

(4) Within thirty days after the initial pretrial hearing date, a producer or business entity shall report to the commissioner any criminal prosecution of the producer in any jurisdiction. The report shall include a copy of the initial complaint, the order resulting from the hearing, and any other relevant legal documents.

(5) If the commissioner revokes the license of an insurance producer pursuant to this section, or if an insurance producer surrenders its license to avoid discipline by the commissioner, the insurance producer shall not be eligible to apply for a new insurance producer license for two years after the date the license is revoked or surrendered and returned to the commissioner pursuant to section 10-2-802 (1).

(6) For the purposes of this section, "restitution" means benefits or moneys owed due to the regulated entity's violation of this title.
C.R.S. § 10-16-1102 — CO Code / Title 10 / Article 16 / Part 11 / Section 10-16-1102
10-16-1102. Legislative declaration
Status: in_force

10-16-1102. Legislative declaration. (1) The general assembly hereby finds and declares that:

(a) All Coloradans deserve access to high-quality, affordable health care to help support their well-being and economic security;

(b) Increasing costs of health care in Colorado have led to premium increases for health insurance in the individual market that have created a financial burden for some Coloradans purchasing insurance in the individual market;

(c) That burden is heightened in rural areas of the state, where premiums are considerably higher than in metropolitan areas of the state and there is a lack of competition among health-care providers and carriers;

(d) Because of the financial burden high-cost health insurance places on consumers in rural areas, a considerable number of these cost-burdened consumers may not purchase health insurance, exacerbating the problems of few carriers, few plan options, and high health insurance costs in rural regions, as well as increasing the number of uninsured Coloradans; and

(e) Colorado has historically been a national leader in health-care innovation, and it is important to use that innovative spirit to address the rising costs of health care in the state by directing the commissioner of insurance to create a reinsurance program that will:

(I) Make private health insurance in the individual market more accessible and affordable;

(II) Encourage participation and competition by carriers throughout the state, but particularly in rural areas of the state, in order to give consumers the ability to seek value in health insurance coverage;

(III) Decrease costs of care, leading to lower premiums and restraining, if not decreasing, the growth in federal spending commitments in the individual market; and

(IV) Support and empower, and increase access to affordable, high-value health insurance for, consumers who are ineligible for premium tax credit subsidies while minimizing any potential negative effects on access to affordable, high-value insurance for consumers who are eligible for premium tax credit subsidies and cost-sharing reductions.
C.R.S. § 10-7-803 — CO Code / Title 10 / Article 7 / Part 8 / Section 10-7-803
10-7-803. Insurers - duty to compare names of insureds with death master file and to locat
Status: in_force

10-7-803. Insurers - duty to compare names of insureds with death master file and to locate beneficiaries. (1) An insurer shall make a good faith effort to determine the death of an insured upon receipt of knowledge of death.

(2) An insurer shall perform a comparison of its insureds' in-force policies, contracts, and retained asset accounts against a death master file, on at least a semiannual basis, by using the full death master file once and thereafter using the death master file update files for future comparisons to identify potential matches of its insureds. For those potential matches identified as a result of a death master file match, the insurer shall do the following:

(a) Within ninety days of a death master file match, the insurer shall:

(I) Complete a good faith effort, which must be documented by the insurer, to confirm the death of the insured or retained asset account holder against other available records and information; and

(II) Determine whether benefits are due in accordance with the applicable policy or contract, and, if benefits are due in accordance with the applicable policy or contract:

(A) Use good faith efforts, which shall be documented by the insurer, to locate the beneficiary or beneficiaries; and

(B) Provide the appropriate claims forms or instructions to the beneficiary or beneficiaries to make a claim including the need to provide an official death certificate, if applicable under the policy or contract.

(b) With respect to group life insurance, the insurer shall confirm the possible death of an insured if the insurer maintains at least the following information of those covered under a policy or certificate:

(I) Social security number or name and date of birth;

(II) Beneficiary designation information;

(III) Coverage eligibility;

(IV) Benefit amount; and

(V) Premium payment status.

(c) An insurer shall implement procedures to account for:

(I) Common nicknames, initials used in lieu of a first or middle name, use of a middle name, compound first and middle names, and interchanged first and middle names;

(II) Compound last names, maiden or married names, and hyphens, blank spaces, or apostrophes in last names;

(III) Transposition of the "month" and "date" portions of the date of birth; and

(IV) Incomplete social security numbers.

(d) To the extent permitted by law, the insurer may disclose minimum necessary personal information about the insured or beneficiary to a person who the insurer reasonably believes may be able to assist the insurer with locating the beneficiary or person otherwise entitled to payment of the claims proceeds.

(3) An insurer or its service provider shall not charge any beneficiary or other authorized representative for any fees or costs associated with a death master file search or verification of a death master file match conducted pursuant to this section.

(4) The benefits from a policy, contract, or a retained asset account, plus any applicable accrued contractual interest shall first be payable to the designated beneficiaries or owners and in the event said beneficiaries or owners cannot be found, shall be transferred to the Colorado administrator as unclaimed property pursuant to the "Revised Uniform Unclaimed Property Act", article 13 of title 38.

(5) An insurer that fails to comply with this section is subject to the civil penalties in accordance with section 10-1-310. A private cause of action for a violation of this section is not permitted.
C.R.S. § 10-4-519 — CO Code / Title 10 / Article 4 / Part 5 / Section 10-4-519
10-4-519. Termination - distribution of funds
Status: repealed

10-4-519. Termination - distribution of funds. (1) The commissioner shall by order terminate the operation of the association as to any kind of insurance covered by this part 5 with respect to which he has found, after hearing, that there is in effect a statutory or voluntary plan which:

(a) Is a permanent plan which is adequately funded or for which adequate funding is provided; and

(b) Extends, or will extend, to the Colorado policyholders and residents protection and benefits with respect to insolvent insurers not substantially less favorable and effective to such policyholders and residents than the protection and benefits provided with respect to such kinds of insurance under this part 5.

(2) The commissioner shall by the same order authorize discontinuance of future payments by insurers to the association with respect to the same kinds of insurance; but the assessments and payments shall continue, as necessary, to liquidate covered claims of insurers adjudged insolvent prior to said order and the related expenses not covered by such other plan.

(3) In the event the operation of the association is so terminated as to all kinds of insurance otherwise within its scope, the association as soon as possible thereafter shall distribute the balance of moneys and assets remaining after discharge of the functions of the association with respect to prior insurer insolvencies not covered by such other plan, together with related expenses, to the insurers which are then writing in this state policies of the kinds of insurance covered by this part 5 and which have made payments to the association pro rata upon the basis of the aggregate of such payments made by the respective insurers during the period of five years next preceding the date of such order. Upon completion of such distribution with respect to all of the kinds of insurance covered by this part 5, this part 5 shall be deemed to be repealed.
C.R.S. § 10-7-611 — CO Code / Title 10 / Article 7 / Part 6 / Section 10-7-611
10-7-611. Advertising - legislative intent
Status: in_force

10-7-611. Advertising - legislative intent. (1) It is the intent of the general assembly that the purpose of this section is to provide a prospective viator with clear and unambiguous statements in the advertisement of a viatical settlement contract and to assure the clear, truthful, and adequate disclosure of the benefits, risks, limitations, and exclusions of a viatical settlement contract. This purpose is to be accomplished by the establishment of guidelines and standards of permissible and impermissible conduct in the advertising of a viatical settlement contract to assure that a product description is presented in a manner that prevents unfair, deceptive, or misleading advertising and is conducive to accurate presentation and description of a viatical settlement contract through the advertising media and material used by a licensee.

(2) This section applies to an advertising of a viatical settlement contract or a related product or service intended for dissemination in this state, including internet advertising viewed by a person located in this state. Where disclosure requirements are established pursuant to federal regulation, this section shall be interpreted so as to minimize or eliminate conflict with federal regulation wherever possible.

(3) Each viatical settlement licensee shall establish and at all times maintain a system of control over the content, form, and method of dissemination of an advertisement of its contracts, products, and services. An advertisement, regardless of by whom written, created, designed, or presented, is the responsibility of the licensee, as well as of the individual who created or presented the advertisement. A system of control by the licensee shall include regular notification, at least once a year, to agents and others authorized to disseminate advertisements, of the requirements and procedures for approval before the use of an advertisement not furnished by the licensee.

(4) An advertisement shall be truthful and not misleading in fact or by implication. The form and content of an advertisement of a viatical settlement contract shall be sufficiently complete and clear so as to avoid deception. It may not have the capacity or tendency to mislead or deceive. Whether an advertisement has the capacity or tendency to mislead or deceive shall be determined by the commissioner from the overall impression that the advertisement may be reasonably expected to create upon a person of average education or intelligence within the segment of the public to which it is directed.

(5) (a) The information required to be disclosed pursuant to the provisions of this section may not be minimized, rendered obscure, or presented in an ambiguous fashion or intermingled with the text of the advertisement so as to be confusing or misleading.

(b) An advertisement may not omit material information or use words, phrases, statements, references, or illustrations if the omission or use has the capacity, tendency, or effect of misleading or deceiving the public as to the nature or extent of any benefit, loss covered, or state or federal tax consequence. The fact that the viatical settlement contract offered is made available for inspection before consummation of the sale, or that an offer is made to refund the payment if the viator is not satisfied, or that the viatical settlement contract includes a "free look" period that satisfies or exceeds legal requirements, does not remedy misleading statements.

(c) An advertisement may not use the name or title of a life insurance company or a life insurance policy unless the advertisement has been approved in writing by the insurer.

(d) An advertisement may not state or imply that interest charged on an accelerated death benefit or a policy loan is unfair, inequitable, or in any manner an incorrect or improper practice.

(e) The words "free", "no cost", "without cost", "no additional cost", or "at no extra cost", or words of similar import may not be used with respect to a benefit or service unless true. An advertisement may specify the charge for a benefit or service or may state that a charge is included in the payment or use other appropriate language.

(f) (I) Any testimonial, appraisal, or analysis used in an advertisement shall:

(A) Be genuine;

(B) Represent the current opinion of the author;

(C) Be applicable to the viatical settlement contract, product, or service advertised, if any; and

(D) Be accurately reproduced with sufficient completeness to avoid misleading or deceiving prospective viators as to the nature or scope of any testimonial, appraisal, analysis, or endorsement.

(II) In using any testimonial, appraisal, or analysis, the viatical settlement licensee makes as its own all the statements contained in them, and the statements are subject to all the provisions of this section.

(III) If the individual making a testimonial, appraisal, analysis, or endorsement has a financial interest in the viatical settlement provider or related entity as a stockholder, director, officer, employee, or otherwise, or receives a benefit, directly or indirectly, other than required union scale wages, that fact must be disclosed prominently in the advertisement.

(IV) An advertisement may not state or imply that a viatical settlement contract, benefit, or service has been approved or endorsed by a group of individuals, society, association, or other organization unless that is the fact and unless any relationship between an organization and the licensee is disclosed. If the entity making the endorsement or testimonial is owned, controlled, or managed by the licensee or receives payment or other consideration from the licensee for making an endorsement or testimonial, that fact must be disclosed in the advertisement.

(V) If an endorsement refers to benefits received under a viatical settlement contract, all pertinent information shall be retained for a period of five years after its use.

(VI) An advertisement may not contain statistical information unless it accurately reflects recent and relevant facts. The source of all statistics used in an advertisement shall be identified.

(VII) An advertisement may not disparage insurers, viatical settlement providers, insurance producers, policies, services, or methods of marketing.

(VIII) The name of the viatical settlement licensee shall be identified clearly in all advertisements about the licensee or its viatical settlement contract, products, or services, and if any specific viatical settlement contract is advertised, the viatical settlement contract must be identified either by form number or some other appropriate description. If an application is part of the advertisement, the name of the viatical settlement provider shall be shown on the application.

(IX) An advertisement may not use a trade name, group designation, name of the parent company of a licensee, name of a particular division of the licensee, service mark, slogan, symbol, or other device or reference without disclosing the name of the licensee if the advertisement has the capacity or tendency to mislead or deceive as to the true identity of the licensee or to create the impression that a company other than the licensee has any responsibility for the financial obligation under a viatical settlement contract.

(X) An advertisement may not use any combination of words, symbols, or physical materials that by their content, phraseology, shape, color, or other characteristics are so similar to a combination of words, symbols, or physical materials used by a government program or agency or otherwise appear to be of such a nature that they tend to mislead prospective viators into believing that the solicitation is in some manner connected with a government program or agency.

(XI) An advertisement may state that a licensee is licensed in the state where the advertisement appears if it does not exaggerate that fact or suggest or imply that a competing licensee may not be so licensed. The advertisement may ask the audience to consult the licensee's website or contact that state's division of insurance to find out if that state requires licensing and, if so, whether the licensee or any other company is licensed.

(XII) An advertisement may not create the impression that the viatical settlement provider or its financial condition or status; the payment of its claims; or the merits, desirability, or advisability of its viatical settlement contracts are recommended or endorsed by any government entity.

(XIII) The name of the actual licensee shall be stated in all of its advertisements. An advertisement may not use a trade name, group designation, name of any affiliate or controlling entity of the licensee, service mark, slogan, symbol, or other device in a manner that has the capacity or tendency to mislead or deceive as to the true identity of the actual licensee or create the false impression that an affiliate or controlling entity has any responsibility for the financial obligation of the licensee.

(XIV) An advertisement may not, directly or indirectly, create the impression that any division or agency of the state or of the United States government endorses, approves, or favors:

(A) A licensee or its business practices or methods of operation;

(B) The merits, desirability, or advisability of a viatical settlement contract;

(C) Any viatical settlement contract; or

(D) Any policy or life insurance company.

(XV) If the advertiser emphasizes the speed with which the viatical settlement contract occurs, the advertising must disclose the average time frame, from completed application to the date of offer and from acceptance of the offer to receipt of the funds by the viator.

(XVI) If the advertising emphasizes the dollar amounts available to viators, the advertising shall disclose the average purchase price as a percent of face value obtained by viators contracting with the licensee during the past six months.
C.R.S. § 10-19-113.5 — CO Code / Title 10 / Article 19 / Section 10-19-113.5
10-19-113.5. Requirement to offer basic and standard long-term care plans - advisory committe
Status: repealed

10-19-113.5. Requirement to offer basic and standard long-term care plans - advisory committee established. (Repealed)
C.R.S. § 10-7-705 — CO Code / Title 10 / Article 7 / Part 7 / Section 10-7-705
10-7-705. Insured's own life
Status: in_force

10-7-705. Insured's own life. An individual has an insurable interest in the individual's own life, and an individual of competent legal capacity who procures or effects a policy on the individual's own life may designate any person as the beneficiary and, unless the individual elects an irrevocable beneficiary designation, change the beneficiary at any time thereafter.
C.R.S. § 10-7-112 — CO Code / Title 10 / Article 7 / Part 1 / Section 10-7-112
10-7-112. Interest payable on benefits or proceeds
Status: in_force

10-7-112. Interest payable on benefits or proceeds. (1) Notwithstanding any other provision of law, each insurer admitted to transact the business of life insurance in this state shall pay interest on the death benefits using an interest rate that is not less than the rate of interest for proceeds left on deposit with the insurer and subject to withdrawal on demand for the period beginning at the date of death through thirty days following the date of receipt by the insurer of a complete request for payout including due proof of death. From that date until the date of settlement of the claim, the annual rate of interest shall be two percentage points above the federal discount rate, which rate shall be the rate of interest a commercial bank pays to the federal reserve bank of Kansas City using a government bond or other eligible paper as security and shall be rounded to the nearest full percent. If the claim is denied and a judgment is rendered against the insurer, the annual rate of interest from the date the action was filed until payment of the claim shall be four percentage points above the federal discount rate, except to the extent such proceeds were deposited with the court in an interpleader action. Any other life insurance policy or contract benefits shall accrue interest at a rate of at least two percentage points above the federal discount rate when any such benefits are not paid more than thirty days after the date of receipt by an insurer of a complete request for payment from an insured. The rates referred to in this subsection (1) shall be determined using a weighted average of the rates in effect during the applicable period based upon the number of days the rate was in effect.

(2) This section shall not require the payment of interest in any case in which the beneficiary elects in writing, delivered to the insurer, to receive the proceeds of the policy by any means other than a lump sum payment thereof.

(3) Nothing in this section shall be construed to allow any insurer admitted to transact the business of life insurance in this state to withhold payment of benefits under a life insurance policy to any beneficiary for a period longer than reasonably necessary to make such payment.

(4) For the purposes of this section, the term "life insurance" shall include:

(a) All individual and group life insurance policies issued in accordance with the provisions of this article;

(b) Life insurance plans issued in connection with part 6 of article 50 of title 24, C.R.S.;

(c) Life insurance policies issued in accordance with the provisions of article 9 of this title;

(d) Life insurance policies or certificates issued in accordance with the provisions of article 10 of this title;

(e) Life insurance benefits payable under accident only type policies; and

(f) Life insurance policies or certificates issued by fraternal benefit societies licensed to do business in this state under article 14 of this title.
C.R.S. § 10-16-206 — CO Code / Title 10 / Article 16 / Part 2 / Section 10-16-206
10-16-206. Third-party ownership of individual sickness and accident insurance policies
Status: in_force

10-16-206. Third-party ownership of individual sickness and accident insurance policies. The word "insured", as used in part 1 of this article and this part 2, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein.
C.R.S. § 10-16-147 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-147
10-16-147. Parity reporting - commissioner - carriers - rules - examination of complaints
Status: in_force

10-16-147. Parity reporting - commissioner - carriers - rules - examination of complaints. (1) (a) By June 1, 2020, and by each June 1 thereafter, the commissioner shall submit a written report to the health and insurance committee and the public health care and human services committee of the house of representatives, or their successor committees, and to the health and human services committee of the senate, or its successor committee, and provide a presentation of the report to those legislative committees before the next regular legislative session that follows submittal of the report, that:

(I) Specifies the methodology the commissioner uses to verify that carriers are complying with section 10-16-104 (5.5) and rules adopted under that section and with the MHPAEA, any regulations adopted pursuant to that act, or guidance related to compliance with and oversight of that act;

(II) Identifies market conduct examinations initiated, conducted, or completed during the preceding twelve months regarding compliance with section 10-16-104 (5.5) and rules adopted under that section and with the MHPAEA and regulations adopted under that act and summarizes the outcomes of those market conduct examinations;

(III) Details any educational or corrective actions the commissioner has taken to ensure carrier compliance with section 10-16-104 (5.5) and rules adopted under that section and with the MHPAEA and regulations adopted under that act.

(b) The commissioner shall ensure that the report is written in plain language and is made available to the public by, at a minimum, posting the report on the division's website.

(c) Notwithstanding section 24-1-136 (11)(a)(I), the reporting requirement specified in this section continues indefinitely.

(2) A carrier that offers a health benefit plan that is subject to section 10-16-104 (5.5) shall submit to the commissioner and make available to the public, by March 1, 2020, and by each March 1 thereafter, a report that contains the following information for the prior calendar year:

(a) Data that demonstrates parity compliance for adverse determinations regarding claims for behavioral, mental health, or substance use disorder services and includes the total number of adverse determinations for such claims;

(b) A description of the process used to develop or select:

(I) The medical necessity criteria used in determining benefits for behavioral, mental health, and substance use disorders; and

(II) The medical necessity criteria used in determining medical and surgical benefits;

(c) Identification of all nonquantitative treatment limitations that are applied to benefits for behavioral, mental health, and substance use disorders and to medical and surgical benefits within each classification of benefits; and

(d) (I) The results of analyses demonstrating that, for medical necessity criteria described in subsection (2)(b) of this section and for each nonquantitative treatment limitation identified in subsection (2)(c) of this section, as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to benefits for behavioral, mental health, and substance use disorders within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each nonquantitative treatment limitation to medical and surgical benefits within the corresponding classification of benefits.

(II) A carrier's report on the results of the analyses specified in this subsection (1)(d) must, at a minimum:

(A) Identify the factors used to determine whether a nonquantitative treatment limitation will apply to a benefit, including factors that were considered but rejected;

(B) Identify and define the specific evidentiary standards used to define the factors and any other evidence relied on in designing each nonquantitative treatment limitation;

(C) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each nonquantitative treatment limitation, as written, and the written processes and strategies used to apply each nonquantitative treatment limitation for benefits for behavioral, mental health, and substance use disorders are comparable to, and are applied no more stringently than, the processes and strategies used to design and apply each nonquantitative treatment limitation, as written, and the written processes and strategies used to apply each nonquantitative treatment limitation for medical and surgical benefits;

(D) Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for benefits for behavioral, mental health, and substance use disorders are comparable to, and are applied no more stringently than, the processes and strategies used to apply each nonquantitative treatment limitation, in operation, for medical and surgical benefits; and

(E) Disclose the specific findings and conclusions reached by the carrier that the results of the analyses indicate that each health benefit plan offered by the carrier complies with section 10-16-104 (5.5) and the MHPAEA.

(3) The commissioner shall adopt rules as necessary to implement the reporting requirements of subsection (2) of this section, including rules to specify the form and manner of carrier reports.

(4) If the commissioner receives a complaint from the office of the ombudsman for behavioral health access to care established pursuant to part 3 of article 80 of title 27 that relates to a possible violation of section 10-16-104 (5.5) or the MHPAEA, the commissioner shall examine the complaint, as requested by the office, and shall report to the office in a timely manner any action taken by the commissioner related to the complaint.
C.R.S. § 10-6-105 — CO Code / Title 10 / Article 6 / Section 10-6-105
10-6-105. Employee benefits - minimum coverages
Status: in_force

10-6-105. Employee benefits - minimum coverages. (1) Any captive insurance company issuing employee benefits coverages, as approved by the commissioner, in its plan of operation shall provide the minimum mandated insurance coverages required of insurance companies in the state.

(2) (a) (Deleted by amendment, L. 91, p. 1224, § 4, effective May 24, 1991.)

(b) (Deleted by amendment, L. 94, p. 542, § 3, effective April 6, 1994.)
C.R.S. § 10-16-151 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-151
10-16-151. Cost sharing in prescription insulin drugs - limits - definition - rules
Status: in_force

10-16-151. Cost sharing in prescription insulin drugs - limits - definition - rules. (1) As used in this section, unless the context otherwise requires, "prescription insulin drug" means a prescription drug, as defined in section 12-280-103 (42), that contains insulin and is used to treat diabetes.

(2) A carrier that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the carrier offers shall cap the total amount that a covered person is required to pay for all covered prescription insulin drugs at an amount not to exceed one hundred dollars for the covered person's entire thirty-day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person's prescription or the number of prescriptions.

(3) Nothing in this section prevents a carrier from reducing a covered person's cost sharing by an amount greater than the amount specified in subsection (2) of this section.

(4) The commissioner may use any of the commissioner's enforcement powers to obtain a carrier's compliance with this section.

(5) The commissioner may promulgate rules as necessary to implement and administer this section and to align with federal requirements.
C.R.S. § 10-7-802 — CO Code / Title 10 / Article 7 / Part 8 / Section 10-7-802
10-7-802. Definitions
Status: in_force

10-7-802. Definitions. As used in this part 8, unless the context otherwise requires:

(1) "Contract" means an annuity contract. The term does not include an annuity used to fund an employment-based retirement plan or program if:

(a) The insurer does not perform the record-keeping services; or

(b) The insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants.

(2) "Death master file" means the United States social security administration death master file or other databases or service that is at least as comprehensive as the United States social security administration death master file for determining that an individual reportedly has died.

(3) "Death master file match" means a search of the death master file that results in a match of the social security number or the name and date of birth of an insured, annuity owner, or retained asset account holder.

(4) "Knowledge of death" means:

(a) Receipt of an original or valid copy of a certified death certificate; or

(b) A death master file match validated by the insurer in accordance with section 10-7-803 (2)(a)(I).

(5) "Policy" means any policy or certificate of life insurance that provides a death benefit. The term does not include:

(a) A policy or certificate of life insurance that provides a death benefit under an employee benefit plan:

(I) Subject to the federal "Employee Retirement Income Security Act of 1974", 29 U.S.C. sec. 1001 et seq., as amended; or

(II) Under any federal employee benefit program;

(b) A policy or certificate of life insurance that is used to fund a pre-need funeral contract or prearrangement;

(c) A policy or certificate of credit life or accidental death insurance; or

(d) A policy issued to a group master policyholder for which the insurer does not provide record-keeping services.

(6) "Record-keeping services" means those services which the insurer has agreed with a group policy or contract customer to be responsible for obtaining, maintaining, and administering in its own or its agents' systems information about each individual insured under an insured's group insurance contract, or a line of coverage thereunder, including at least the following information:

(a) Social security number or name and date of birth;

(b) Beneficiary designation information;

(c) Coverage eligibility;

(d) Benefit amount; and

(e) Premium payment status.

(7) "Retained asset account" means a mechanism whereby the settlement of proceeds payable under a policy or contract is accomplished by the insurer or an entity acting on behalf of the insurer depositing the proceeds into an account with check or draft writing privileges, if those proceeds are retained by the insurer or its agent, pursuant to a supplementary contract not involving annuity benefits other than death benefits.
C.R.S. § 10-3-207.5 — CO Code / Title 10 / Article 3 / Part 2 / Section 10-3-207.5
10-3-207.5. Funding for insurance fraud investigations and prosecutions - creation of fund
Status: repealed

10-3-207.5. Funding for insurance fraud investigations and prosecutions - creation of fund. (Repealed)
C.R.S. § 10-11-114 — CO Code / Title 10 / Article 11 / Part 1 / Section 10-11-114
10-11-114. Legal investments and admitted assets
Status: in_force

10-11-114. Legal investments and admitted assets. (1) Title insurance companies shall comply with the investment requirements for other insurance companies under the laws of this state but, in addition, may invest in a title plant. Such title plant shall be considered an admitted asset as provided by nationally recognized insurance statutory accounting principles. The real estate in which the title plant is housed shall be considered an investment under section 10-3-218. Subject to the limitations of this section and with the approval of the commissioner, a title insurance company may enter into agreements with one or more other title insurance companies authorized to do business in this state whereby such companies shall participate in the ownership, management, and control of a title plant to serve the needs of all such companies, or such companies may hold stock of a corporation owning and operating a title plant for such purposes.

(2) A title insurance company shall include as an admitted asset accounts receivable relating to gross premiums, less agent retention, in the course of collection. Accounts receivable that are more than ninety days past due from the date of notification of the issuance of the policy shall not be included as an admitted asset.
C.R.S. § 10-14-606 — CO Code / Title 10 / Article 14 / Part 6 / Section 10-14-606
10-14-606. Publications
Status: in_force

10-14-606. Publications. Pending, during, or after an examination or investigation of any domestic, foreign, or alien society, the commissioner shall make public no financial statement, report, or finding, nor shall the commissioner permit to become public any financial statement, report, or finding affecting the status, standing, or rights of any such society, until a copy thereof has been served upon such society at its home office or until such society has been afforded a reasonable opportunity to answer any such financial statement, report, or finding and to make such showing in connection therewith as it may desire.
C.R.S. § 10-5-101.2 — CO Code / Title 10 / Article 5 / Section 10-5-101.2
10-5-101.2. Definitions
Status: in_force

10-5-101.2. Definitions. As used in this article 5, unless the context otherwise requires:

(1) "Affiliate" means, with respect to an insured, any entity that controls, is controlled by, or is under common control with the insured.

(2) "Affiliated group" means any group of entities that are all affiliated.

(3) "Broker" means a surplus lines producer duly licensed to export insurance under this article.

(4) "Control" means that an entity has control over another entity if the controlling entity:

(a) Directly or indirectly or acting through one or more other persons owns, controls, or has the power to vote twenty-five percent or more of any class of voting securities of the controlled entity; or

(b) Controls in any manner the election of a majority of the directors or trustees of the controlled entity.

(4.5) "Disability insurance" means insurance that:

(a) Is in excess of policy limits available under a policy issued by an admitted insurer;

(b) Provides income replacement to an insured who becomes an individual with a disability while covered by the disability insurance policy; and

(c) Does not provide coverage for the diagnosis or treatment of an insured's disability.

(5) "Export" means to place with an insurer under this article insurance covering an insured whose home state is Colorado.

(6) "Federal act" means the "Nonadmitted and Reinsurance Reform Act of 2010", 15 U.S.C. sec. 8201 et seq., as amended.

(7) (a) Except as provided in paragraph (b) of this subsection (7),"home state" means, with respect to an insured:

(I) The state in which the insured maintains its principal place of business or, in the case of an individual, the individual's principal residence; or

(II) If one hundred percent of the insured risk is located out of the state referred to in subparagraph (I) of this paragraph (a), the state to which the greatest percentage of the insured's taxable premium for that insurance contract is allocated.

(b) With respect to affiliated groups, if more than one insured from an affiliated group are named insureds on a single surplus lines insurance contract, "home state" means the home state, as determined pursuant to paragraph (a) of this subsection (7), of the member of the affiliated group that has the largest percentage of premium attributed to it under the insurance contract.

(8) "Independently procured insurance" means insurance procured directly by a person from a nonadmitted insurer.

(9) "Multistate risk" means a risk covered by a nonadmitted insurer with insured exposures in more than one state.

(10) "Nonadmitted insurance" means any disability, property, or casualty insurance permitted in a state to be placed directly or through a broker with a nonadmitted insurer eligible to accept such insurance. "Nonadmitted insurance" includes independently procured insurance and surplus lines insurance.

(11) "Nonadmitted insurers" means insurers not having a certificate of authority to transact business in this state.

(12) "Person" has the same meaning as set forth in section 2-4-401, C.R.S.

(13) "Surplus lines insurance":

(a) Means coverage placed with an eligible nonadmitted insurer as provided by section 10-5-108; and

(b) Includes disability insurance.
C.R.S. § 10-3-1605 — CO Code / Title 10 / Article 3 / Part 16 / Section 10-3-1605
10-3-1605. Confidentiality
Status: in_force

10-3-1605. Confidentiality. (1) Documents, materials, and other information, including a CGAD, in the possession or control of the division that are obtained by, created by, or disclosed to the commissioner or any other person under this part 16 are recognized by this state as being proprietary and to contain trade secrets. All such documents, materials, and other information are confidential by law and privileged, not subject to the "Colorado Open Records Act", part 2 of article 72 of title 24; not subject to subpoena; and not subject to discovery or admissible as evidence in any private civil action. However, the commissioner may use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties. The commissioner shall not otherwise make the documents, materials, or other information public without the prior written consent of the insurer or insurance group. Nothing in this section may be construed to require the written consent of an insurer or insurance group before the commissioner may share or receive confidential documents, materials, or other CGAD-related information pursuant to subsection (3) of this section.

(2) Neither the commissioner nor any person who received documents, materials, or other CGAD-related information through examination or otherwise while acting under the authority of the commissioner, or with whom such documents, materials, or other information are shared pursuant to this part 16, may be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (1) of this section.

(3) In order to perform the commissioner's regulatory duties, the commissioner:

(a) May, upon request and subject to subsection (1) of this section, share documents, materials, and other CGAD-related information, including confidential and privileged documents, materials, and information and proprietary and trade secret documents and materials, with other state, federal, and international financial regulatory agencies, including members of any supervisory college, as described in section 10-3-807; the NAIC; and third-party consultants pursuant to section 10-3-1606 so long as the recipient agrees in writing to maintain the confidentiality and privileged status of the CGAD-related documents, materials, or other information and has verified in writing the legal authority to maintain confidentiality;

(b) May receive documents, materials, and other CGAD-related information, including confidential and privileged documents, materials, and information and proprietary and trade secret documents and materials, from regulatory officials of state, federal, and international financial regulatory agencies, including members of any supervisory college as described in section 10-3-807 and the NAIC; and

(c) Shall maintain as confidential or privileged any documents, materials, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information.

(4) The sharing of information and documents by the commissioner pursuant to this part 16 does not constitute a delegation of regulatory authority or rule-making, and the commissioner is solely responsible for the administration, execution, and enforcement of this part 16.

(5) No waiver of any applicable privilege or claim of confidentiality in the documents, proprietary and trade secret materials, or other CGAD-related information occurs as a result of disclosure of the documents, materials, or information to the commissioner under this section or as a result of sharing as authorized in this part 16.
C.R.S. § 10-7-304 — CO Code / Title 10 / Article 7 / Part 3 / Section 10-7-304
10-7-304. Computation of nonforfeiture benefit
Status: in_force

10-7-304. Computation of nonforfeiture benefit. Any paid-up nonforfeiture benefit available under the policy in the event of default in a premium payment due on any policy anniversary shall be such that its present value as of such anniversary shall be at least equal to the cash surrender value then provided for by the policy or, if none is provided for, that cash surrender value which would have been required by this part 3 in the absence of the condition that premiums shall be paid for at least a specified period.
C.R.S. § 10-6-125 — CO Code / Title 10 / Article 6 / Section 10-6-125
10-6-125. Filing of rates
Status: in_force

10-6-125. Filing of rates. (1) A group captive insurance company's rates, rate classification systems, or funding levels shall be sufficient to fund expected operations and expenses. The commissioner may require that a pure captive insurance company file rating or funding data if such pure captive insurance company provides or plans to provide employee benefits.

(2) Rating structures for insurance applied to and paid by employees of a captive insurance company shall not be excessive, inadequate, or unfairly discriminatory.
C.R.S. § 10-23-102 — CO Code / Title 10 / Article 23 / Section 10-23-102
10-23-102. Registration required - qualifications - enforcement
Status: repealed

10-23-102. Registration required - qualifications - enforcement. (1) No person qualifies to be a professional cash-bail agent unless the person registers with the division. However, any bail bonding agent who was licensed by the division as of January 1, 1992, to write bail bonds as a cash-bonding agent may continue to be registered upon compliance with the other requirements of this article.

(2) No firm, partnership, association, or corporation, as such, shall be registered. No person engaged as a law enforcement or judicial officer shall be registered as a cash-bonding agent or professional cash-bail agent.

(3) (a) All registrations expire in accordance with a schedule established by the commissioner, and the registrant shall renew or reinstate the registration in accordance with the rules of the commissioner. If the commissioner schedules a registration to expire for longer or shorter than a year, the commissioner shall proportionally adjust the renewal fee for the registration. The registrant must satisfy all registration and renewal requirements to qualify to register.

(b) The commissioner shall give a registrant a sixty-day grace period to renew the registration without discipline or sanctions. The commissioner may establish renewal fees and delinquency fees for reinstatement by rule. If a person fails to renew a registration when required by the schedule established by the commissioner, the registration expires.

(4) The division shall transmit all fees collected under this article to the state treasurer, who shall credit the fees to the division of insurance cash fund created in section 10-1-103.

(5) The division shall prepare and deliver to each registrant a pocket card showing the name, address, and classification of the registrant. The pocket card must clearly state that the person is authorized to practice as a cash-bonding agent or professional cash-bail agent.

(6) Repealed.
C.R.S. § 10-4-110.3 — CO Code / Title 10 / Article 4 / Part 1 / Section 10-4-110.3
10-4-110.3. Exclusions where claim involves sexual misconduct - void
Status: in_force

10-4-110.3. Exclusions where claim involves sexual misconduct - void. (1) No insurer, in a policy of professional malpractice insurance, shall attempt to nullify or limit its stated liability with regard to claims not relating to sexual misconduct in cases where:

(a) There is an allegation or proof of a claim of sexual misconduct by the insured; and

(b) The policy requires aggregation of all damages under the liability limit for sexual misconduct.

(2) Any policy provision that violates subsection (1) of this section is hereby declared contrary to public policy and is void and unenforceable.

(3) This section shall not apply to nonadmitted insurers approved pursuant to article 5 of this title.
C.R.S. § 10-4-1705 — CO Code / Title 10 / Article 4 / Part 17 / Section 10-4-1705
10-4-1705. Supervision of issuance - training
Status: in_force

10-4-1705. Supervision of issuance - training. (1) A supervising entity shall supervise the administration of the offering and disseminating of self-storage insurance. The supervising entity shall develop a training program for the offering and disseminating of the self-storage insurance and shall require any individual working for or acting on behalf of the self-storage retailer to attend the training.

(2) The training program required pursuant to subsection (1) of this section is mandatory for any individual working for or acting on behalf of a self-storage retailer that is directly engaged in the activity of offering or disseminating self-storage insurance and must include the following:

(a) An education program regarding self-storage insurance that is conducted and overseen by the supervising entity;

(b) Instruction to any individual or business entity working for or acting on behalf of a self-storage retailer about the self-storage insurance offered to occupants and the disclosures required pursuant to this part 17; and

(c) Instruction that any individual or business entity working for or acting on behalf of a self-storage retailer shall not:

(I) Advertise, represent, or otherwise hold himself or herself out as a licensed insurance producer of any kind; or

(II) Evaluate or interpret technical terms, benefits, or conditions of the offered self-storage insurance or evaluate an occupant's existing insurance coverage, if the occupant has any such coverage.

(3) The self-storage retailer may bill and collect premiums for self-storage insurance. These self-storage insurance premiums must be separately itemized if they are not included in the cost of the rental. If the premiums are included in the cost of the rental of the self-storage space, a supervising entity shall ensure that it is clearly and conspicuously disclosed to the occupant that the self-storage insurance is included with the rental fees for the self-storage space. A supervising entity shall establish a separate fiduciary account for the collected coverage premiums but is not required to segregate the individual occupants' premiums in that account. A supervising entity shall remit the coverage premium charges to the insurer within sixty days after receipt. All coverage premiums held by a supervising entity are held in trust by the supervising entity in a fiduciary capacity for the benefit of the insurer.
C.R.S. § 10-4-415 — CO Code / Title 10 / Article 4 / Part 4 / Section 10-4-415
10-4-415. Prohibition against anticompetitive behavior
Status: in_force

10-4-415. Prohibition against anticompetitive behavior. (1) (a) No insurer or rating organization shall monopolize or attempt to monopolize, or combine or conspire with any other person to monopolize, in any territory, the business of insurance of any kind, subdivision, or class thereof.

(b) No insurer or rating organization shall agree with any other insurer or rating organization to charge or adhere to any rate, although insurers and rating organizations may continue to exchange statistical information.

(c) No insurer or rating organization shall make any agreement with any other insurer, rating organization, or other person to restrain trade.

(d) No insurer or rating organization shall make any agreement with any other insurer, rating organization, or other person the effect of which may be substantially to lessen competition in any territory or in any kind, subdivision, or class of insurance.

(e) No insurer may acquire or retain any capital stock or assets of, or have any common management with, any other insurer if the effect of such acquisition, retention, or common management may be substantially to lessen competition in any territory or in any kind, subdivision, or class of insurance.

(f) No insurer or rating organization shall make any agreement with any other insurer or rating organization to refuse to deal with any person in connection with the sale of insurance.

(g) No rating organization or member or subscriber thereof shall interfere with the right of any insurer to make its rates independently of such rating organization or to charge rates different from the rates made by such rating organization.

(h) No member of or subscriber to a rating organization shall refuse to do business with, or prohibit or prevent the payment of commissions to, any licensed agent or broker on the ground that such agent or broker does business with an insurer which makes its rates, or any portion thereof, independently of such rating organization.

(i) Nothing in this part 4 shall be construed as requiring any insurer to become a member of or a subscriber to any rating organization, or as preventing any insurer, while a member of or subscriber to a rating organization, from making its own rates for any kind, subdivision, or class of insurance, for which it does not elect to authorize the rating organization to act on its behalf.

(j) Any insurer which is a member of or subscriber to a rating organization may make its own rates for any kind, subdivision, or class of insurance. No rating organization shall have authority to act on behalf of any insurer which is a member of or subscriber to such rating organization except as authorized in writing by such member or subscriber, which authority may be supplemented, modified, or revoked, in whole or in part, at any time by such member or subscriber at its option.

(k) No rating organization shall have or adopt any rule or exact any agreement, or formulate or engage in any program, the effect of which would be to require any member, subscriber, or other insurer to utilize some or all of its services, or to adhere to its rates, rating plans, rating systems, underwriting rules, or policy forms, or to prevent any insurer from acting independently.

(2) (a) The commissioner, through the attorney general, and any person injured in his business or property by reason of anything forbidden in subsection (1) of this section may maintain an action to enjoin any violation of such subsection (1).

(b) Any person injured in his business or property by reason of anything forbidden in subsection (1) of this section may maintain an action and shall be able to recover punitive damages not to exceed actual monetary loss and expense.
C.R.S. § 10-16-169 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-169
10-16-169. Carriers - prescription drug coverage - transparency
Status: in_force

10-16-169. Carriers - prescription drug coverage - transparency. Beginning July 1, 2025, and on or before each July 1 thereafter, each carrier shall submit to the commissioner, in the same form and manner as submitted to the United States secretary of health and human services, information required by federal pharmacy benefit and drug cost reporting laws.
C.R.S. § 10-16-208 — CO Code / Title 10 / Article 16 / Part 2 / Section 10-16-208
10-16-208. Conforming to statute
Status: in_force

10-16-208. Conforming to statute. (1) No policy provision which is not subject to section 10-16-202 or 10-16-203 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to part 1 of this article and this part 2.

(2) A policy delivered or issued for delivery to any person in this state in violation of part 1 of this article or this part 2 shall be held valid but shall be construed as provided in part 1 of this article and this part 2. When any provision in a policy subject to part 1 of this article and this part 2 is in conflict with any provision of part 1 of this article or this part 2, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of part 1 of this article and this part 2.
C.R.S. § 10-3-557 — CO Code / Title 10 / Article 3 / Part 5 / Section 10-3-557
10-3-557. Interstate priorities
Status: in_force

10-3-557. Interstate priorities. (1) In a liquidation proceeding in this state involving one or more reciprocal states, the order of distribution of the domiciliary state shall control as to all claims of residents of this and reciprocal states. All claims of residents of reciprocal states shall be given equal priority of payment from general assets regardless of where such assets are located.

(2) The owners of special deposit claims against an insurer for which a liquidator is appointed in this or any other state shall be given priority against the special deposits in accordance with the statutes governing the creation and maintenance of the deposits. If there is a deficiency in any deposit, so that the claims secured by it are not fully discharged from it, the claimants may share in the general assets, but the sharing shall be deferred until general creditors, as well as all claimants against other special deposits who have received smaller percentages from their respective special deposits, have been paid percentages of their claims equal to the percentage paid from the special deposit.

(3) The owner of a secured claim against an insurer for which a liquidator has been appointed in this or any other state may surrender the security and file the claim as a general creditor. Alternatively, the claim may be discharged by resort to the security in accordance with section 10-3-540, in which case the deficiency, if any, shall be treated as a claim against the general assets of the insurer on the same basis as claims of unsecured creditors.
C.R.S. § 10-4-605 — CO Code / Title 10 / Article 4 / Part 6 / Section 10-4-605
10-4-605. Proof of notice
Status: in_force

10-4-605. Proof of notice. Proof of mailing notice of cancellation, or of intention not to renew or of reasons for cancellation, to the named insured at the address shown in the policy shall be sufficient proof of notice.
C.R.S. § 10-4-1603 — CO Code / Title 10 / Article 4 / Part 16 / Section 10-4-1603
10-4-1603. Requirements for sale of consumer goods service contracts - definitions
Status: in_force

10-4-1603. Requirements for sale of consumer goods service contracts - definitions. (1) A provider may appoint an administrator or other designee to be responsible for any or all of the administration of service contracts issued by the provider and for compliance with this part 16.

(2) A provider shall not issue, sell, or offer for sale a service contract unless the provider has:

(a) Provided a receipt for, or other written evidence of, the purchase of the service contract to the contract holder; and

(b) Provided a copy of the service contract to the service contract holder before or within a reasonable period of time after the date of purchase.

(3) Upon a consumer's request, a provider shall provide the consumer with a complete sample copy of the service contract terms and conditions or direct the consumer to a website containing a complete sample of the terms and conditions of the service contract.

(4) (a) A provider shall assure faithful performance to its service contract holders by complying with one or more of the following:

(I) Insuring all service contracts under a reimbursement insurance policy issued by a licensed insurer; or

(II) Maintaining, or together with its parent company maintaining, a net worth or stockholders' equity of at least one hundred million dollars.

(b) For the purposes of subparagraph (II) of paragraph (a) of this subsection (4), a provider shall:

(I) Upon the commissioner's request, provide a copy of the provider's or provider's parent company's most recent form 10-K or form 20-F filed with the federal securities and exchange commission; or

(II) If the company does not file with the federal securities and exchange commission, provide, upon the commissioner's request, a copy of the company's audited financial statements showing a net worth of the provider or its parent company of at least one hundred million dollars; or

(III) If the provider's parent company's form 10-K, form 20-F, or financial statements are filed to meet the requirements of this subsection (4), agree to guarantee the obligations of the provider relating to service contracts sold by the provider in this state.

(c) Except for the requirements set forth in this subsection (4), the commissioner shall require no other financial security requirements for service contract providers.

(5) (a) A provider must permit the service contract holder to void the service contract by returning it within twenty days after the date the service contract is mailed to the service contract holder or within ten days after delivery if the service contract is delivered to the service contract holder at the time of sale. The service contract is void when the service contract holder returns the service contract to the provider, and the provider shall refund to the service contract holder, or credit the account of the contract holder, the full purchase price of the service contract.

(b) A service contract may establish a return period greater than twenty days.

(c) The right to void the service contract is not transferable and applies only to the original service contract purchaser.

(d) The right to void the service contract does not apply if a claim has been made prior to the return of the service contract to the provider.

(e) If a refund of a service contract provider fee is not paid or credited within forty-five days after the return of the service contract under this subsection (5), then a ten percent penalty per month shall be added to the refund.

(6) (a) After the time specified in subsection (5) of this section, or if a claim has been made within that time, a service contract holder may cancel the service contract. Upon cancellation, the provider shall refund to the contract holder one hundred percent of the unearned pro rata provider fee, less any claims made.

(b) A provider may charge a reasonable administrative fee, not to exceed ten percent of the gross provider fee paid by the service contract holder.

(7) (a) The provider may cancel a service contract upon mailing, at least five days prior to the date of cancellation, a written notice to the service contract holder at the contract holder's last-known address contained in the provider's records. The notice must state the effective date of the cancellation and the reason for the cancellation.

(b) Prior notice is not required if the reason for cancellation is nonpayment of the provider fee, a material misrepresentation by the service contract holder to the provider, or a substantial breach by the service contract holder relating to the covered product or its use.

(c) If the provider cancels a service contract for a reason other than nonpayment of the provider fee, the provider shall refund to the service contract holder one hundred percent of the unearned pro rata provider fee, less any claims paid.

(8) (a) Provider fees collected on service contracts are not subject to premium taxes.

(b) Premiums for reimbursement insurance policies are subject to applicable taxes.

(9) (a) Providers, related service contract sellers, and administrators are exempt from any licensing requirements of this state set forth in this title.

(b) (I) Each provider of service contracts sold in Colorado shall register with the commissioner. The registration must contain the provider's name, full corporate address, telephone number, and the name of an individual contact person. In addition, the provider shall designate an agent for service of process in Colorado. The provider shall give the commissioner written notice of any change in this information within thirty days after the change.

(II) Upon initial registration, and annually thereafter, each provider that registers pursuant to this paragraph (b) shall pay to the commissioner a fee, set by the commissioner, in an amount sufficient to defray the commissioner's direct and indirect costs of administering this part 16 and subject to periodic adjustment in accordance with section 24-75-402, C.R.S.

(10) With the exception of the requirements set forth in this part 16, the marketing, sale, offering for sale, issuance, making, proposing to make, and administration of service contracts by providers, related service contract sellers, and administrators are exempt from the requirements of this title.
C.R.S. § 10-4-626 — CO Code / Title 10 / Article 4 / Part 6 / Section 10-4-626
10-4-626. Prohibited reasons for nonrenewal or refusal to write policy of automobile insur
Status: in_force

10-4-626. Prohibited reasons for nonrenewal or refusal to write policy of automobile insurance applicable to this part 6. (1) An insurer authorized to transact or transacting business in this state shall not refuse to write or refuse to renew a policy of insurance affording the coverage required by section 10-4-620 solely because of the age, race, creed, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, ancestry, residence, marital status, or lawful occupation, including the military service, of anyone who is or seeks to become insured or solely because another insurer has canceled a policy or refused to write or renew such policy. The commissioner shall administer and enforce this subsection (1).

(2) Nothing in this section shall be construed to prohibit an insurance company authorized to transact or transacting business in this state from issuing policies of insurance affording the coverage required by operation of section 10-4-620 solely to a specialty market authorized by the commissioner.
C.R.S. § 10-1-217 — CO Code / Title 10 / Article 1 / Part 2 / Section 10-1-217
10-1-217. Coordination with other states through NAIC
Status: in_force

10-1-217. Coordination with other states through NAIC. The commissioner shall share information and coordinate the division's examination efforts with other states through the NAIC.
C.R.S. § 10-16-108 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-108
10-16-108. Continuation privileges
Status: in_force

10-16-108. Continuation privileges. (1) Group health benefit plans. (a) Every employer group health benefit plan issued by a carrier must contain a provision specifying that if a covered employee's employment is terminated and the health benefit plan remains in force for active employees of the employer, the covered employee whose employment is terminated may elect to continue the coverage for himself or herself and his or her dependents. The provision must conform to the requirements, where applicable, of paragraphs (b), (c), and (e) of this subsection (1).

(b) An employee is eligible to make the election described in paragraph (a) of this subsection (1) on the employee's own behalf and on behalf of eligible, covered dependents if:

(I) The employee's eligibility to receive insurance coverage has ended for any reason other than discontinuance of the group policy in its entirety or with respect to an insured class;

(II) Any premium or contribution required from or on behalf of the employee has been paid through the employment termination date; and

(III) The employee has been continuously covered under the group health benefit plan, or under any group health benefit plan providing similar benefits that it replaces, for at least six months immediately prior to termination.

(c) The employer is not required to offer continuation of coverage to any person if the person is covered by medicare, Title XVIII of the federal "Social Security Act", or medicaid, Title XIX of the federal "Social Security Act".

(d) Once payment of disability benefits has started, a carrier shall not reduce benefits due under a policy of insurance insuring against disability from sickness or accident based on an increase in federal social security benefits.

(e) (I) Upon the termination of employment of an eligible employee, the death of an eligible employee, or the change in marital or civil union status of an eligible employee, the employee or dependent has the right to continue the coverage for a period of eighteen months after loss of coverage or until the employee or dependent becomes eligible for other group coverage, whichever occurs first. However, should the new coverage exclude a condition covered under the continued plan, coverage under the prior employer's plan may be continued for the excluded condition only for eighteen months or until the new plan covers the condition, whichever occurs first.

(II) The employer shall notify the employee in writing of the employee's right to continue health-care coverage upon termination from employment. A written communication signed by the employee or a notice postmarked within ten days after termination mailed by the employer to the last-known address of the employee satisfies the notice requirements of this subparagraph (II). The notification must inform the employee of:

(A) The employee's right to elect to continue the existing coverage at the applicable rate;

(B) The amount the employee must pay monthly to the employer to retain the coverage, which payment includes the employer's contribution for the employee in addition to the employee's own contribution;

(C) The manner in which, and the office of the employer to which, the employee must submit the payment to the employer;

(D) The date and time by which the employee must submit the payments to the employer to retain coverage; and

(E) The fact that the employee will lose the coverage if the employee does not timely submit the payment to the employer.

(III) The employee shall notify the employer in writing of the employee's election to continue coverage and shall make proper payment to the employer as soon as possible upon notification by the employer of termination. In no case shall the employee submit the notification of election or the proper payment more than thirty days after the date of termination of employment unless the employer has failed to give timely notice in accordance with subparagraph (II) of this paragraph (e). If the employee timely submits the required payment and notice, the employee's health-care coverage is continued as if there had been no interruption of coverage. If the employee fails to timely submit proper payment and notice, the employer is relieved of any responsibility to the employee for the continuation of health-care coverage.

(IV) If the employer fails to notify an eligible employee of the right to elect to continue the coverage, the employee has the option to retain coverage if, within sixty days after the date the employment is terminated, the employee makes the proper payment to the employer to provide continuous coverage.

(V) After timely receipt of the monthly payment from an eligible employee, if the employer fails to make the payment to the carrier, with the result that the employee's coverage is terminated, the employer is liable for the employee's coverage, but to no greater extent than the amount of the premium.

(2) Group policies and group service contracts - reduction in hours of work. Every group policy or group service contract delivered or issued for delivery in this state by an insurer subject to part 2 of this article or by an entity subject to part 3 or 4 of this article that covers full-time employees working forty or more hours per week shall contain a provision that the policyholder may elect to contract with the insurer or other entity to continue the policy or contract under the same conditions and for the same premium for the employees and their dependents even if the policyholder or employer reduces the working hours of the employees to less than thirty hours per week, if the following conditions are met:

(a) The covered employee is employed as a full-time employee of the policyholder or employer and is insured under the group policy or group service contract, or under any group policy or group service contract providing similar benefits that the group policy or group service contract replaces, immediately prior to the reduction in working hours;

(b) The policyholder has imposed the reduction in working hours due to economic conditions or due to the employee's injury, disability, or chronic health conditions; and

(c) The policyholder intends to restore the employee to a full forty-hour work schedule as soon as economic conditions improve or as soon as the employee is able to return to full-time work.
C.R.S. § 10-4-106 — CO Code / Title 10 / Article 4 / Part 1 / Section 10-4-106
10-4-106. Assigned risks
Status: in_force

10-4-106. Assigned risks. (1) The commissioner may, after consultation with the insurers licensed to write mortgage guaranty insurance in this state, establish or approve a reasonable plan, and rules governing the same, for the equitable apportionment among such insurers of applicants for such insurance who are in good faith entitled to but are unable to procure insurance through ordinary methods, and, when such plan has been approved, all such insurers may subscribe thereto and participate therein. Any applicant for such insurance, any person insured under such plan, and any insurer affected may appeal to the commissioner from any ruling or decision of the manager or committee designated to operate such plan.

(2) Insurance provided under this section shall be provided only for the purposes listed in article 49 of title 7, C.R.S., and may be made in cooperation with the corporation established in said article.
C.R.S. § 10-16-122.7 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-122.7
10-16-122.7. Disclosures between pharmacists and patients - carrier and PBM prohibitions - en
Status: in_force

10-16-122.7. Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules. (1) The short title of this section is the "Patient Drug Costs Savings Act".

(2) The general assembly hereby finds and declares that:

(a) Consumers have the right to know about options to reduce the amount of money they pay at a pharmacy for prescription drugs; and

(b) This section will save consumers money by allowing pharmacists to provide information concerning the cost of prescription drugs.

(3) A carrier that has a contract with a pharmacy or pharmacist, or a pharmacy benefit management firm acting on behalf of a carrier, shall not:

(a) Prohibit a pharmacy or pharmacist from providing a covered person information on the amount of the covered person's cost share for the covered person's prescription drug and the clinical efficacy of a more affordable alternative drug that is therapeutically equivalent, as defined in section 12-280-103 (52), to the prescribed drug if one is available;

(b) Penalize a pharmacy or a pharmacist for disclosing the information described in subsection (3)(a) of this section to a covered person or selling a more affordable alternative to a covered person; or

(c) Require a pharmacy to charge or collect a copayment from a covered person that exceeds the total charges submitted by the network pharmacy.

(4) (a) If the commissioner determines that a carrier has not complied with this section, the commissioner shall institute a corrective action plan for the carrier to follow or use any of the commissioner's enforcement powers under this title 10 to obtain the carrier's compliance with this section.

(b) With regard to the requirements of this section applicable to PBMs, the commissioner has the authority to enforce this section and to impose a penalty or other remedy against a pharmacy benefit management firm that fails to comply with this section.

(5) If any provision of this section is inconsistent with, or in conflict with, an applicable federal law, rule, or regulation, the applicable federal law, rule, or regulation applies.

(6) The commissioner may adopt rules to implement and enforce this section.
C.R.S. § 10-16-705.5 — CO Code / Title 10 / Article 16 / Part 7 / Section 10-16-705.5
10-16-705.5. Participating provider networks - definitions - selection standards - informal r
Status: in_force

10-16-705.5. Participating provider networks - definitions - selection standards - informal reconsideration - enforcement - legislative declaration. (1) The general assembly finds and declares that:

(a) Carriers create networks of providers that ensure consumers have access to an adequate number of providers to meet their needs;

(b) In the current marketplace, carriers offer consumers a multitude of plan options, some of which include a limited provider network that may result in a smaller number of participating providers from which to choose;

(c) Limited provider networks allow carriers and providers to work together to improve the quality of care and control the associated costs on behalf of consumers;

(d) Transparency in the market provides consumers, payers, and providers with information necessary to make informed decisions about health-care choices; and

(e) To ensure that consumers have sufficient access to care and appropriate, transparent information to make decisions related to their health care, carriers should:

(I) Disclose the standards used to construct their participating provider networks to the commissioner, providers, and consumers; and

(II) Provide a process for existing participating providers to seek reconsideration of a carrier's decision to change participation in a carrier's network, including tiering of a network.

(2) As used in this section, unless the context otherwise requires:

(a) "High-risk population" means a population presenting a risk of higher-than-average numbers of claims, losses, or health-care utilization rates.

(b) "Tiered network" means a network that identifies and assigns some or all types of providers and facilities into specific groups to which different provider reimbursement, covered person cost sharing, or provider access requirements, or any combination of reimbursement, cost sharing, and access requirements, apply for the same service.

(3) (a) A carrier shall develop standards for the selection of providers in the carrier's participating provider network, including the selection of providers in each health-care specialty. If the carrier offers a tiered network, the carrier shall develop standards for tiering participating providers within the tiered network.

(b) The carrier and the carrier's intermediary shall use the standards developed pursuant to subsection (3)(a) of this section in selecting and tiering providers.

(c) (I) A carrier shall not establish selection and tiering criteria in a manner that would:

(A) Allow a carrier to discriminate against high-risk populations by excluding or tiering providers based on their location in a geographic area that contains high-risk populations; or

(B) Exclude providers because they treat or specialize in treating high-risk populations.

(II) Nothing in this subsection (3)(c) prohibits a carrier from offering specific networks or products that are limited to designated service areas.

(d) A carrier shall make all applicable standards used for selecting and tiering available for review by the commissioner and shall communicate the standards to providers that are participating in one or more of its networks. Additionally, a carrier shall make a description of its standards, in plain language, available to the public.

(4) Upon request, and not more often than quarterly, a carrier shall provide a provider that is participating in one or more of its networks with a complete list of all network plans and products the carrier offers to consumers, with an indication of the provider's participation status within each network plan or product. The carrier shall respond to a provider's request within thirty days after it receives the request.

(5) (a) A carrier shall neither terminate a participating provider nor place a participating provider in a tiered network without first complying with the requirements of this subsection (5).

(b) At least sixty days before terminating or placing a participating provider in a tiered network, the carrier shall send a written notice to the participating provider informing the participating provider of the pending action. The notice must:

(I) Contain an explanation of the reasons for the proposed action in sufficient detail to enable the participating provider to challenge the proposed action, referencing the relevant information the carrier is relying on for the determination;

(II) Inform the participating provider of the opportunity to request the carrier to reconsider the pending action and the period for completing the informal reconsideration process; and

(III) Inform the participating provider of the carrier's ability to rescind the pending action.

(c) A carrier shall establish procedures for a participating provider to request a carrier to reconsider its decision to terminate the participating provider or place the participating provider in a tiered network. The procedures must include:

(I) A reasonable method by which the participating provider may submit a request for the carrier to reconsider a proposed pending action, including the name of the person or division to whom or to which the participating provider is to submit the request; and

(II) An opportunity to submit or have the carrier consider evidence that may correct information relevant to the pending action.

(d) The carrier shall complete the informal reconsideration process within forty-five days after the date the carrier received the request for reconsideration from the participating provider unless the carrier and participating provider agree to an alternative deadline to complete the informal reconsideration process.

(e) A carrier shall not implement the pending action specific to the participating provider that is the subject of a request for reconsideration until the carrier issues a final decision to grant or deny the request to reconsider the pending action.

(6) When a carrier does not select a provider to participate in the carrier's participating provider network, the carrier shall provide a written notification to the provider. The carrier is not required to provide an opportunity for reconsideration to a provider who is not participating in any of the carrier's participating provider networks.

(7) This section does not:

(a) Prohibit a carrier from declining to select a provider who fails to meet other legitimate selection criteria developed by the carrier in compliance with this section;

(b) Prohibit a carrier from creating an exclusive provider network; or

(c) Require a carrier to contract with any provider who is willing to abide by the terms and conditions for participation established by the carrier.

(8) (a) If the commissioner determines that a carrier has not complied with this section, the commissioner shall require a corrective action plan that the carrier must follow. The commissioner may use all enforcement powers under this title 10 to obtain compliance by the carrier.

(b) The commissioner and the commissioner's staff shall not arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network or tiered network or regarding any dispute between a carrier, the carrier's intermediary, or one or more providers arising under or by reason of a provider contract or its termination.
C.R.S. § 10-16-710 — CO Code / Title 10 / Article 16 / Part 7 / Section 10-16-710
10-16-710. Reporting to commissioner - medication-assisted treatment - rules
Status: in_force

10-16-710. Reporting to commissioner - medication-assisted treatment - rules. (1) A carrier shall report to the commissioner:

(a) The number of in-network providers who are federally licensed to prescribe medication-assisted treatment for substance use disorders, including buprenorphine; and

(b) The number of prescriptions filled by enrollees for medication-assisted treatment for substance use disorders; and

(c) The carrier's efforts to ensure sufficient capacity for and access to medication-assisted treatment for substance use disorders.

(2) The commissioner shall promulgate rules concerning the reporting requirements specified in subsection (1) of this section, including the reporting period, the frequency of reporting, and any other provisions necessary to comply with the reporting requirement.
C.R.S. § 10-1-101 — CO Code / Title 10 / Article 1 / Part 1 / Section 10-1-101
10-1-101. Legislative declaration
Status: in_force

10-1-101. Legislative declaration. The general assembly finds and declares that the purpose of this title is to promote the public welfare by regulating insurance to the end that insurance rates shall not be excessive, inadequate, or unfairly discriminatory, to give consumers thereof the greatest choice of policies at the most reasonable cost possible, to permit and encourage open competition between insurers on a sound financial basis, and to avoid regulation of insurance rates except under circumstances specifically authorized under the provisions of this title. Such policy requires that all persons having to do with insurance services to the public be at all times actuated by good faith in everything pertaining thereto, abstain from deceptive or misleading practices, and keep, observe, and practice the principles of law and equity in all matters pertaining to such business.
C.R.S. § 10-13-108 — CO Code / Title 10 / Article 13 / Section 10-13-108
10-13-108. Annual financial report
Status: in_force

10-13-108. Annual financial report. (1) Such attorney shall make a sworn annual report to the commissioner of the business of the preceding year ending December thirty-first, on or before the first day of March succeeding, showing that the financial condition of affairs at the office where such contracts are issued is in accordance with the standard of solvency, and shall furnish such additional information and reports as may be required to show the total premiums or deposits collected, the total losses paid, the total amounts returned to subscribers, and the amounts retained for expenses and subject to taxation. Such attorney shall not be required to furnish the names and addresses of any subscribers, except for purposes of verifying by the commissioner the reports furnished under section 10-13-105. These names and addresses are not to be filed or to become any part of the public records. The report shall be on a form prescribed by the commissioner.

(2) The business affairs and assets of any reciprocal or interinsurance exchange or attorney's office shall be subject to examination by the commissioner.
C.R.S. § 10-7-620 — CO Code / Title 10 / Article 7 / Part 6 / Section 10-7-620
10-7-620. Severability
Status: in_force

10-7-620. Severability. If any provision of this part 6 is for any reason held to be unconstitutional or invalid, such holding shall not affect the constitutionality or validity of the remaining provisions of this part 6, and to this end the provisions of this part 6 are expressly declared to be severable.
C.R.S. § 10-1-102 — CO Code / Title 10 / Article 1 / Part 1 / Section 10-1-102
10-1-102. Definitions
Status: in_force

10-1-102. Definitions. As used in this title 10, unless the context otherwise requires:

(1) "Actuary" means a person designated by the commissioner as a qualified actuary based on requirements set forth in rules promulgated by the commissioner.

(2) "Admitted assets" includes the investments that are admitted assets of a domestic company under parts 1 and 2 of article 3 and part 4 of article 7 of this title and, in addition thereto, includes:

(a) Those assets defined as admitted by nationally recognized insurance statutory accounting principles; and

(b) Other assets deemed by the commissioner to be available for the payment of losses and claims, at values to be determined by the commissioner.

(3) "Admitted company" or "authorized company" designates companies duly qualified and licensed to transact business in this state, under the provisions of this title. "Nonadmitted companies" or "unauthorized companies" designates companies not licensed to transact business in this state, under the provisions of this title (except article 15) and article 14 of title 24, C.R.S.

(3.5) "Bail insurance company" means an insurer engaged in the business of writing bail bonds through bonding agents and subject to regulation by the division.

(3.7) "Bail recovery" means actions taken by a person other than a peace officer to apprehend an individual or take an individual into custody because of the individual's failure to comply with bail conditions.

(4) "Charitable gift annuity" means an annuity that:

(a) Meets the definition and standards contained in section 501 (m)(5) of the federal "Internal Revenue Code of 1986", as amended;

(b) Contains on its face the following statement: "This annuity is not issued by an insurance company nor regulated by the Colorado division of insurance and is not protected by any state guaranty fund or protective association."

(c) Is issued or guaranteed by an organization that at all times during the three years preceding the date of the issuance of such annuity:

(I) Was qualified to receive contributions described in section 170 (c) of the federal "Internal Revenue Code of 1986", as amended; and

(II) If required as a condition of such qualification by provisions of the federal "Internal Revenue Code of 1986", as amended, was in receipt of notification from the federal internal revenue service that such organization was so qualified.

(5) "Commissioner" or "insurance commissioner" means the commissioner of insurance.

(6) (a) "Company", "corporation", "insurance company", or "insurance corporation" includes all corporations, associations, partnerships, or individuals engaged as insurers in the business of insurance, including the attorney-in-fact authorized by and acting for the subscribers of a reciprocal insurer or interinsurance exchange, or suretyship except fraternal or benevolent orders and societies.

(b) "Company", "corporation", "insurance company", or "insurance corporation" does not include health maintenance organizations unless the specific provision of law by its terms applies to health maintenance organizations.

(c) For the purposes of a "company", "corporation", or "insurance company", a reciprocal insurer shall be considered a single economic entity.

(6.5) "Disqualified insurance company" means a company licensed as a captive insurance company under the laws of this state or the laws of another jurisdiction with gross receipts for the taxable year that consist fifty percent or less of premiums from arrangements that constitute insurance for federal income tax purposes.

(7) "Division" means the division of insurance.

(8) "Domestic" designates those companies incorporated or formed in this state.

(9) "Foreign", when used without limitation, includes all those companies formed by authority of any other state or government.

(10) "Institution" means any entity including, but not limited to, a corporation, a joint-stock company, a limited liability company, an association, a bank, a trust, a partnership, a joint venture, a special district, a government, or a quasi-governmental agency.

(11) "Insurable interest in property" means every interest in property or any relation thereto, or liability in respect thereof, of such a nature that a contemplated peril might directly damnify the insured.

(12) "Insurance" means a contract whereby one, for consideration, undertakes to indemnify another or to pay a specified or ascertainable amount or benefit upon determinable risk contingencies, and includes annuities.

(13) "Insurer" means every person engaged as principal, indemnitor, surety, or contractor in the business of making contracts of insurance.

(14) "Motor vehicle rental agreement" means an agreement for the rental of a motor vehicle for transportation purposes, for a period of no more than ninety days, in return for a fee that is calculated on a daily, weekly, or monthly basis.

(15) "Motor vehicle rental company" means an entity that is in the business of renting, pursuant to motor vehicle rental agreements, motor vehicles that do not come within the definition of a commercial motor vehicle as set forth in section 42-2-402 (4), C.R.S.

(16) "Nonadmitted assets" includes, but is not limited to, those assets defined as nonadmitted by nationally recognized insurance statutory accounting principles. Nonadmitted assets shall not be taken into account in determining the financial condition of a company.

(17) (a) "Qualified United States financial institution" means an institution that is:

(I) Organized or, in the case of a United States office of a foreign banking organization, licensed under the laws of the United States or any state thereof; and

(II) Regulated, supervised, and examined by United States federal or state authorities having regulatory authority over banks, trust companies, or savings and loan associations.

(b) If any qualified United States financial institution issues letters of credit, such institution shall have been determined by either the commissioner or the securities valuation office of the national association of insurance commissioners to meet such standards of financial condition and standing as are considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner.

(c) If any qualified United States financial institution operates a trust, such institution shall be eligible to operate as a fiduciary of a trust and shall have been granted authority to operate with fiduciary powers.

(18) "Real estate" and "real property" include fee simple and leasehold estates therein.

(19) "Transact" as applied to insurance means and includes any of the following:

(a) Solicitation and inducement;

(b) Negotiations preliminary to effectuation of a contract of insurance;

(c) Execution of a contract of insurance;

(d) Transaction of matters subsequent to effectuation of a contract of insurance and arising out of the contract obligations.
C.R.S. § 10-2-104 — CO Code / Title 10 / Article 2 / Part 1 / Section 10-2-104
10-2-104. Authority of commissioner - rules
Status: in_force

10-2-104. Authority of commissioner - rules. Pursuant to the provisions of article 4 of title 24, C.R.S., the commissioner may promulgate reasonable rules for the implementation and administration of the provisions of this article. The commissioner may contract with any party for the purpose of performing any ministerial duty required of the commissioner under this article. All reasonable charges and expenses of such contractors shall be paid directly to the contractors by licensees.
C.R.S. § 10-3-1716 — CO Code / Title 10 / Article 3 / Part 17 / Section 10-3-1716
10-3-1716. Merger or consolidation effective with division
Status: in_force

10-3-1716. Merger or consolidation effective with division. (1) To facilitate the merger or consolidation of any resulting insurer with and into another company simultaneously with the effectiveness of a division authorized by this part 17, a dividing insurer, including its officers, directors, and shareholders, may:

(a) Adopt and execute a plan of merger or consolidation on behalf of a resulting insurer;

(b) Execute and deliver documents, plans, certificates, and resolutions; and

(c) Make any filings, in each case, on behalf of the resulting insurer.

(2) If so provided in a plan of merger or consolidation described in this section, the merger or consolidation is effective simultaneously with the effectiveness of a division authorized by this part 17.

(3) On request of the dividing insurer, the commissioner may waive the other requirements of this section with respect to any merger or consolidation involving only domestic stock insurers and may issue the commissioner's final approval of the merger or consolidation as part of the commissioner's approval of a plan of division under this part 17.
C.R.S. § 10-1-133 — CO Code / Title 10 / Article 1 / Part 1 / Section 10-1-133
10-1-133. Consumer insurance council - creation - advisory body - appointment of members -
Status: repealed

10-1-133. Consumer insurance council - creation - advisory body - appointment of members - meetings - repeal. (1) There is hereby created in the division the consumer insurance council, also referred to in this section as the "council". The council is an advisory body to the commissioner concerning insurance matters of interest to the public. Nothing in this section divests the commissioner of the commissioner's authority to regulate the business of insurance.

(2) (a) The council consists of at least six and not more than fifteen members appointed by the commissioner, all of whom must represent consumer organizations or be consumers who are not engaged, directly or indirectly, in the insurance industry or any other industry, business, or profession that might present a conflict of interest, as determined by the commissioner, and one of whom must be a consumer whose first language is not English. To the greatest extent possible, the council must reflect the geographic and demographic diversity of the state. Insurance producers, insurance industry representatives, actively practicing health-care providers, and any other individuals who may have a conflict of interest, as determined by the commissioner, are not eligible for membership on the council.

(b) The commissioner shall appoint members of the council in a timely manner. Members shall serve two-year terms with a maximum of three consecutive terms.

(c) Three or more unexcused absences of a member of the council constitute grounds for the removal of the member. The chair of the council, in consultation with the commissioner, shall determine whether a member with three or more unexcused absences may continue service on the council. If a member is removed, the commissioner shall appoint a new member to serve the remaining portion of the two-year term.

(d) Members of the council shall serve without compensation but are entitled to reimbursement for actual and necessary expenses incurred in traveling to and from council meetings, including any required dependent care and dependent or attendant travel, food, and lodging expenses.

(3) (a) The council shall elect a chair from its membership. The chair shall serve a one-year term and may be elected to another one-year term.

(b) The council shall elect a vice-chair from its membership. The vice-chair shall serve in the absence of the chair. The vice-chair shall serve a one-year term and may be elected to another one-year term.

(4) (a) The council shall meet quarterly and may request up to four additional meetings per year. All meetings of the council are open to the public. General meetings of the council shall be held at the office of the division. The council may meet in other locations of the state as agreed upon by the council. Members of the council may participate in meetings via telephonic communications.

(b) A council member may request a special meeting. Requests for special meetings must be made to the chair of the council.

(c) All members of the council may request topics of discussion for the council.

(d) The council must act by consensus.

(e) The council may submit recommendations to the commissioner, including legislative recommendations. If the council submits a recommendation to the commissioner, the commissioner shall provide a response to the council, in a timely manner, regarding the recommendation and how the commissioner will address the recommendation.

(5) This section is repealed, effective September 1, 2029. Before the repeal, the council is scheduled for review in accordance with section 2-3-1203.
C.R.S. § 10-13-110 — CO Code / Title 10 / Article 13 / Section 10-13-110
10-13-110. Noncompliance a misdemeanor
Status: in_force

10-13-110. Noncompliance a misdemeanor. Any attorney, agent, or representative who, except for the purpose of applying for a certificate of authority, exchanges any contracts of indemnity of the kind and character specified in section 10-13-101 or directly or indirectly solicits or negotiates any application for the same without first complying with the provisions of this title is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than one hundred dollars nor more than one thousand dollars.
C.R.S. § 10-20-105 — CO Code / Title 10 / Article 20 / Section 10-20-105
10-20-105. Construction
Status: in_force

10-20-105. Construction. This article shall be construed to effect the purpose set forth in section 10-20-102, which shall constitute an aid and guide to interpretation.
C.R.S. § 10-16-124.7 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-124.7
10-16-124.7. Opioid analgesics with abuse-deterrent properties - study - definitions
Status: in_force

10-16-124.7. Opioid analgesics with abuse-deterrent properties - study - definitions. (1) The governor shall direct the Colorado consortium for prescription drug abuse prevention to study the barriers to the use of abuse-deterrent opioid analgesic drug products as a way to reduce abuse and diversion of opioid drug products. On or before January 15, 2017, the consortium shall report its findings to the public health care and human services committee and the health, insurance, and environment committee of the house of representatives and the health and human services committee of the senate, or their successor committees.

(2) Moneys from the general fund shall not be used for the implementation of this section.

(3) As used in this section:

(a) "Abuse-deterrent opioid analgesic drug product" means a brand or generic opioid analgesic drug product approved by the FDA with abuse-deterrence labeling claims that indicate that the drug product is expected to result in a meaningful reduction in abuse.

(b) "Opioid analgesic drug product" means a drug product in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release or long-acting form, that may be combined with other drug substances to form a single drug product or dosage form.
C.R.S. § 10-3-113 — CO Code / Title 10 / Article 3 / Part 1 / Section 10-3-113
10-3-113. Increase of capital
Status: in_force

10-3-113. Increase of capital. (1) Any such corporation organized and duly licensed by the commissioner to conduct an insurance business may sell additional stock or increase its capital for the purpose, in the manner, and to the extent prescribed by law, but the expense incurred in connection with such sale shall not exceed twenty percent of the amount realized from the sale of its capital stock, whether in cash or notes, and said expense shall be paid from surplus funds of the corporation.

(2) The provisions of this title (except article 15) and article 14 of title 24, C.R.S., also apply in the formation and authorization of domestic insurance companies formed upon the mutual plan, and to associations formed upon the assessment plan, that are organized with a guaranty fund in lieu of capital as provided in said references.
C.R.S. § 10-7-311 — CO Code / Title 10 / Article 7 / Part 3 / Section 10-7-311
10-7-311. Minimum aggregate reserves
Status: in_force

10-7-311. Minimum aggregate reserves. (1) In no event shall a company's aggregate reserves for all life insurance policies, excluding disability and accidental death benefits, issued on or after July 1, 1992, be less than the aggregate reserves calculated in accordance with the methods set forth in sections 10-7-310, 10-7-310.5, 10-7-313, and 10-7-313.1 and the mortality table or tables and rate or rates of interest used in calculating nonforfeiture benefits for such policies.

(2) In no event shall the aggregate reserves for all policies, contracts, and benefits be less than the aggregate reserves determined by the appointed actuary to be necessary to render the opinion required by section 10-7-114.
C.R.S. § 10-7-706 — CO Code / Title 10 / Article 7 / Part 7 / Section 10-7-706
10-7-706. Reliance on statements
Status: in_force

10-7-706. Reliance on statements. An insurer is entitled to rely upon all reasonable statements, declarations, and representations made by an applicant for life insurance relative to the existence of an insurable interest. No insurer incurs legal liability, except as set forth in the policy, by virtue of untrue statements, declarations, or representations relied upon in good faith by the insurer.
C.R.S. § 10-16-103.3 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-103.3
10-16-103.3. Commission on mandated health insurance benefits - cash fund - purpose - creatio
Status: repealed

10-16-103.3. Commission on mandated health insurance benefits - cash fund - purpose - creation - duties - repeal. (Repealed)
C.R.S. § 10-3-1303 — CO Code / Title 10 / Article 3 / Part 13 / Section 10-3-1303
10-3-1303. Definitions
Status: in_force

10-3-1303. Definitions. As used in this part 13, unless the context otherwise requires:

(1) "Insurer" means every person engaged as principal, indemnitor, surety, or contractor in the business of making contracts of insurance, and any person authorized to represent an insurer with respect to a claim.

(2) "Nonoriginal equipment replacement crash part" means a replacement crash part which is not supplied by the manufacturer of the motor vehicle on which the part is used.

(3) "Replacement crash part" means a replacement for any of the nonmechanical sheet metal or plastic parts which generally constitute the exterior of a motor vehicle, including inner and outer panels.
C.R.S. § 10-3-1608 — CO Code / Title 10 / Article 3 / Part 16 / Section 10-3-1608
10-3-1608. Rules
Status: in_force

10-3-1608. Rules. The commissioner shall, upon notice and opportunity for all interested persons to be heard, issue rules and orders to carry out this part 16.
C.R.S. § 10-1-212 — CO Code / Title 10 / Article 1 / Part 2 / Section 10-1-212
10-1-212. Targeted, on-site market conduct examinations - rules
Status: repealed

10-1-212. Targeted, on-site market conduct examinations - rules. (Repealed)
C.R.S. § 10-19-115 — CO Code / Title 10 / Article 19 / Section 10-19-115
10-19-115. Severability
Status: in_force

10-19-115. Severability. If any provision of this article or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the article and the application of such provision to other persons or circumstances shall not be affected thereby.
C.R.S. § 10-16-121.5 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-121.5
10-16-121.5. Prohibited contract provisions in contracts between carriers and providers for d
Status: in_force

10-16-121.5. Prohibited contract provisions in contracts between carriers and providers for dental services - definition. (1) A contract between a carrier and a dentist licensed to practice under article 220 of title 12 must not require, directly or indirectly, that a dentist who is a participating provider provide services to a covered person at a fee set by, or subject to the approval of, the carrier unless:

(a) The services are covered services under the person's policy; and

(b) The carrier provides payment for the services under the person's policy in an amount that is reasonable and not nominal or de minimis.

(2) The dentist may charge the covered person for noncovered items or services in any amount determined by the dentist and agreed to by the patient that is equal to, or less than, the usual and customary amount that the dentist charges individuals who do not have coverage for such items and services.

(3) If the commissioner determines that a carrier has not complied with this section, the commissioner shall institute a corrective action plan that the carrier shall follow or may use any of the commissioner's enforcement powers to obtain the carrier's compliance with this section.

(4) For purposes of this section, "covered services" means dental care services for which reimbursement is available under a covered person's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other contractual limitations.
C.R.S. § 10-3-1509 — CO Code / Title 10 / Article 3 / Part 15 / Section 10-3-1509
10-3-1509. Sanctions
Status: in_force

10-3-1509. Sanctions. Any insurer failing, without just cause, to timely file the ORSA summary report as required in this part 15 shall, after notice and hearing, pay a penalty of two hundred dollars for each day's delay. The maximum penalty under this section is twenty-five thousand dollars. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
C.R.S. § 10-3.5-111 — CO Code / Title 10 / Article 3.5 / Section 10-3.5-111
10-3.5-111. Repeal of article
Status: repealed

10-3.5-111. Repeal of article. This article 3.5 is repealed, effective July 1, 2025.
C.R.S. § 10-16-421.5 — CO Code / Title 10 / Article 16 / Part 4 / Section 10-16-421.5
10-16-421.5. Acquisition of control of or merger of a health maintenance organization
Status: in_force

10-16-421.5. Acquisition of control of or merger of a health maintenance organization. No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person would, directly or indirectly, (or by conversion or by exercise of any right to acquire) be in control of the health maintenance organization, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request, or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the health maintenance organization information required by sections 10-3-801, 10-3-802, 10-3-803 (2) to (11), and 10-3-803.5 and the offer, request, invitation, agreement, or acquisition has been approved by the commissioner.
C.R.S. § 10-1-207 — CO Code / Title 10 / Article 1 / Part 2 / Section 10-1-207
10-1-207. Immunity from liability - prohibited activity
Status: in_force

10-1-207. Immunity from liability - prohibited activity. (1) No cause of action shall arise, nor shall any liability be imposed, against the commissioner, the commissioner's authorized representatives, or any examiner appointed by the commissioner for any statements made or conduct performed in good faith while carrying out the provisions of this part 2.

(2) No cause of action shall arise, nor shall any liability be imposed, against any person for the act of communicating or delivering information or data to the commissioner or the commissioner's authorized representative or examiner pursuant to an examination made under this part 2, if such act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive.

(3) This section does not abrogate or modify in any way any common-law or statutory privilege or immunity heretofore enjoyed by any person identified in subsection (1) of this section.

(4) A person identified in subsection (1) of this section shall be entitled to an award of attorney fees and costs if such person is the prevailing party in a civil action for libel, slander, or any other relevant tort arising out of activities in carrying out the provisions of this part 2 and the party bringing the action was not substantially justified in doing so. For purposes of this section, a proceeding is "substantially justified" if it had a reasonable basis in law or fact at the time that it was initiated.

(5) An insurer shall not take any retaliatory personnel action against an employee because the employee provides information to or testifies before the commissioner conducting an examination into the practices of the company.

(6) (a) An employee who has been the subject of a retaliatory personnel action in violation of subsection (5) of this section may institute a civil action in a court of competent jurisdiction for relief within one year after the date of the alleged retaliatory action.

(b) A court of competent jurisdiction may order relief as follows:

(I) Reinstatement of the employee to the same position held before the retaliatory personnel action or an equivalent position;

(II) Reinstatement of full benefits and seniority rights; and

(III) Compensation for lost wages and benefits.

(c) Upon a determination that an insurer has taken a retaliatory personnel action, the court may award costs of the action together with reasonable attorney fees.
C.R.S. § 10-7-315 — CO Code / Title 10 / Article 7 / Part 3 / Section 10-7-315
10-7-315. Operative date
Status: in_force

10-7-315. Operative date. At any time after April 11, 1961, and before January 1, 1966, any company may file with the commissioner a written notice of its election to comply with the provisions of this part 3 after a specified date before January 1, 1966. After the filing of such notice, then upon such specified date (which shall be the operative date of this part 3 for such company) this part 3 shall become operative with respect to policies thereafter issued by such company. If a company makes no such election, the operative date of this part 3 for such company shall be January 1, 1966.
C.R.S. § 10-15-103.5 — CO Code / Title 10 / Article 15 / Section 10-15-103.5
10-15-103.5. Scope of article - exemptions
Status: in_force

10-15-103.5. Scope of article - exemptions. (1) This article does not apply to a person providing a developed final resting place within a designated cemetery approved for the interment, entombment, or inurnment of human remains.

(2) (a) A person providing an undeveloped final resting place is exempt from this article if the cemetery where the undeveloped final resting place is located contains unsold developed final resting places representing at least twenty-five percent of the outstanding paid-in-full contracts for undeveloped final resting places.

(b) If the specific and identifiable final resting place is not developed for use at the time of need and full payment has been made, then the contract must provide the purchaser with an immediate alternate and comparable final resting place at the same cemetery or with a full refund of moneys paid to qualify for the exemption under this subsection (2).
C.R.S. § 10-3-559 — CO Code / Title 10 / Article 3 / Part 5 / Section 10-3-559
10-3-559. Severability
Status: in_force

10-3-559. Severability. If any provision of this part 5 or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of this part 5 and the application of such provision to other persons or circumstances shall not be affected thereby.
C.R.S. § 10-4-634 — CO Code / Title 10 / Article 4 / Part 6 / Section 10-4-634
10-4-634. Assignment of payment for covered benefits
Status: in_force

10-4-634. Assignment of payment for covered benefits. (1) A policy of motor vehicle insurance coverage pursuant to this part 6 shall allow, but not require, an insured under the policy to assign, in writing, payments due under medical payments coverage of the policy to a licensed hospital or other licensed health-care provider; an occupational therapist, as defined in section 12-270-104 (9); an occupational therapy assistant, as defined in section 12-270-104 (11); or a massage therapist, as defined in section 12-235-104 (5), for services provided to the insured that are covered under the policy.

(2) When a licensed hospital or other licensed health-care provider, occupational therapist, or massage therapist receives an assignment from an insured, it is the responsibility of the provider to bill the insurer and notify the insurer that the licensed health-care provider holds an assignment on file. The insurer shall honor this assignment the same as if a copy of the assignment had been received by the insurer. Only upon request of the insurer shall the health-care provider be required to provide a copy of the assignment. The provider shall also provide a copy of such bill to the insured, stating on such copy that it is for informational purposes only and that the insurer has been billed for covered benefits. The provider shall also furnish to the insurer a current taxpayer identification number as part of the initial bill and each subsequent billing. Subsequent billings to an insurer need not include a copy of the assignment unless required by the insurer so long as it is clearly noted on each such subsequent billing that the benefits have been assigned. The insurer shall honor such assignment and make payment of covered benefits directly to such licensed hospital or other licensed health-care provider, occupational therapist, or massage therapist. If the insurer fails to honor such assignment but instead makes payment to the insured, and if the insured fails to timely pay an amount equivalent to such payment to the licensed hospital or other licensed health-care provider, then the insurer shall be liable for such payment directly to the licensed hospital or other licensed health-care provider, occupational therapist, or massage therapist. It shall be the responsibility of the licensed hospital or other licensed health-care provider, occupational therapist, or massage therapist to notify the insurer if timely payment has not been received.
C.R.S. § 10-2-803 — CO Code / Title 10 / Article 2 / Part 8 / Section 10-2-803
10-2-803. Notice of penalty, suspension, termination, revocation, or denial
Status: in_force

10-2-803. Notice of penalty, suspension, termination, revocation, or denial. (1) The commissioner shall promptly notify any insurance producer licensee regarding any penalty assessed, suspension, revocation, termination, or denial of the licensee's license by the commissioner.

(2) Upon assessment of a penalty, suspension, revocation, or termination of the license of a resident licensee, the commissioner shall notify the central office of the national association of insurance commissioners or its affiliate or subsidiary.
C.R.S. § 10-14-703 — CO Code / Title 10 / Article 14 / Part 7 / Section 10-14-703
10-14-703. Review
Status: in_force

10-14-703. Review. All final decisions and findings of the commissioner made under the provisions of this article shall be subject to judicial review by the court of appeals pursuant to section 24-4-106 (11), C.R.S.
C.R.S. § 10-3-231 — CO Code / Title 10 / Article 3 / Part 2 / Section 10-3-231
10-3-231. Valuation of investments
Status: in_force

10-3-231. Valuation of investments. (1) (a) Subject to the provisions of paragraphs (b), (c), and (d) of this subsection (1), all obligations having a fixed term and rate may, if not in default as to principal or interest, be valued as follows: If purchased at par, at the par value; if purchased above or below par, on the basis of the purchase price adjusted so as to bring the value to par at maturity and so as to yield in the meantime the effective rate of interest at which the purchase was made.

(b) The purchase price shall in no case be taken at a higher figure than the actual market value at the time of purchase, plus brokerage charges paid in the acquisition of such obligations.

(c) No such obligation shall be carried at above the call price for the entire issue during any period within which the obligation may be so called, and premiums paid at purchase shall be amortized by the scientific method to the first call date at which the entire issue may be redeemed.

(d) Obligations subject to amortization under the published findings of the national association of insurance commissioners shall be carried at their amortized values. Obligations which do not qualify for amortization shall be reported at their market value or a book value based on an amortized computation, whichever is lower.

(2) (a) Common stocks shall be valued at their market value, as determined by customary method, or, at the option of the company, they may be carried at cost if cost is less than market value. If no publicly traded market quotation is available, the value of the stocks shall be based on the pro rata share of the issuing company's net worth as shown by its audited financial statement or, in the case of an insurance company, the pro rata share of its statutory net worth.

(b) Preferred stocks shall be valued in accordance with procedures promulgated annually by the valuations committee of the national association of insurance commissioners.

(3) Other property purchased by a company may be valued at not more than its cost plus the cost of capitalized additions and permanent improvements, less depreciation. Depreciation shall be computed under the straight line method or, at the option of the company, under any other method resulting in larger accumulated depreciation at any given time. Depreciation of any buildings shall be based upon an estimated useful life of not more than fifty years.

(4) Property acquired in satisfaction of a debt shall be valued at its fair market value or the amount of the debt, including capitalized taxes and expenses, whichever amount is less.

(5) Property originally acquired in satisfaction of a debt and subsequently transferred to qualification under section 10-3-220 or 10-3-230 shall be valued as provided in subsection (3) of this section, and its cost shall be deemed to be its value at time of transfer determined under subsection (4) of this section.

(6) To the extent investments are valued by the securities valuation office of the national association of insurance commissioners, all investments owned by domestic insurance companies shall be valued in accordance with the most recently published valuations of the securities valuation office. Other investments not valued by the securities valuation office shall be valued as otherwise is provided in this section, or, if not otherwise provided in this section, in accordance with procedures promulgated by the national association of insurance commissioners.
C.R.S. § 10-4-404 — CO Code / Title 10 / Article 4 / Part 4 / Section 10-4-404
10-4-404. Rate administration
Status: in_force

10-4-404. Rate administration. (1) The commissioner shall promulgate rules and regulations which shall require each insurer to record and report its loss and expense experience and such other data, including reserves, as may be necessary to determine whether rates comply with the standards set forth in section 10-4-403. Every insurer or rating organization shall provide such information and in such form as the commissioner may require. No insurer shall be required to record or report its loss or expense experience on a classification basis that is inconsistent with the rating system used by it. The commissioner may designate one or more rating organizations or advisory organizations to assist him in gathering and in compiling such experience and data. No insurer shall be required to record or report its experience to a rating organization unless it is a member of such organization.

(2) (a) The commissioner may require that the annual report and any such supplemental report which contains information of a company's loss and loss adjustment reserves be accompanied by an opinion signed and sworn to by a qualified and independent actuary verifying that, within the nine months prior to the submission of the report, the actuary has conducted a review and analysis of the insurance company's loss and loss adjustment reserves and the reserves are computed in accordance with accepted loss reserving standards and are fairly stated in accordance with sound loss reserving principles.

(b) For purposes of the requirements of this section, a qualified actuary shall be an associate or fellow of the casualty actuarial society and shall be independent of the company whose reserves the actuary has reviewed and analyzed and which is submitting the sworn actuarial certificate.

(3) Any insurer who fails to comply with the terms of this section shall pay a civil penalty of ten thousand dollars and a fine of two hundred dollars for every day thereafter until the insurer complies with this section.

(4) It is the duty of the commissioner to maintain for at least six years by carrier all reports submitted by insurers pursuant to rules and regulations promulgated by the commissioner under this section. The commissioner shall consider these reports in determining the appropriateness of premium rates for various types of insurance in this state.

(5) In order to make the administration of rate regulatory laws uniform, the commissioner and every insurer and rating organization may exchange information and loss experience data.

(6) The commissioner shall promulgate regulations to effect rate reductions or credits for insureds who implement plans pursuant to article 14.5 of title 8, C.R.S.

(7) This section shall not apply to insurers providing coverage for exempt commercial policyholders, as defined pursuant to section 10-4-1402 and rules adopted by the commissioner pursuant to that section.
C.R.S. § 10-15-111.5 — CO Code / Title 10 / Article 15 / Section 10-15-111.5
10-15-111.5. Change of ownership - rules
Status: in_force

10-15-111.5. Change of ownership - rules. (1) (a) A sale of an existing preneed contract that changes who provides funeral goods and services is void unless approved by the commissioner under this section. To transfer ownership, the contract seller must report a pending sale of the preneed contract to the commissioner in writing at least fourteen days before the sale closing. The notice must include:

(I) The name and address of the contract seller;

(II) The name and address of the organization proposing to acquire ownership of the preneed contract, referred to in this section as the "transferee";

(III) The name and address of the owners, operators, corporate officers, partners, or members of the transferee;

(IV) The name and address of the financial institution where preneed funds are held;

(V) The name under which preneed funds are held;

(VI) A description of each preneed contract, arrangement, or agreement included in the sale;

(VII) An accounting of the trust fund and all transferred and outstanding preneed contracts, including the number of pending contracts, the full contract value, the current value for each contract, a record of all disbursements from preneed trust accounts within the last twenty-four months, and the information required in the annual report;

(VIII) Any documents or amendments thereto concerning the trust or insurance funds, or any other preplanning or prefunding agreements;

(IX) A copy of the notice proposed to be sent to the contract buyers after the transfer; and

(X) Any other information that is reasonably required by the commissioner by rule.

(b) The commissioner may, by rule or order, waive or reduce any or all of the requirements in subparagraphs (I) to (X) of paragraph (a) of this subsection (1) as unnecessary or inappropriate in the public interest or for the protection of the contract buyers.

(2) (a) The commissioner shall approve the contract seller's application for change of ownership by written authorization if:

(I) The accounting is complete, accurate, and shows the trust fund is whole and intact;

(II) All required information and documents are filed with the commissioner; and

(III) The transferee holds a valid contract seller's license, or is qualified under section 10-15-103 for a contract seller's license, and is able to perform all transferred preneed contracts in accordance with this article.

(b) The commissioner shall approve or disapprove of the sale of an existing preneed contract in writing within sixty days after receiving the report required by paragraph (a) of subsection (1) of this section. If the commissioner fails to disapprove of the sale in writing within sixty days, the sale is deemed approved.

(3) (a) The contract seller, or person with an interest in the contract, remains liable for all funds and transactions until the effective date of the transfer.

(b) Any discrepancies, malfeasance, or fraud prior to the sale of the preneed contract is the responsibility of the seller, for which the seller is liable.

(4) Within thirty days after approval by the commissioner, the transferee of a preneed contract shall send a notice to the last-known address of each contract buyer informing the buyer of the change in ownership and the assumption of the obligation to perform the preneed contract.
C.R.S. § 10-2-415.5 — CO Code / Title 10 / Article 2 / Part 4 / Section 10-2-415.5
10-2-415.5. Appointment of insurance producer - continuation - renewal - exceptions
Status: in_force

10-2-415.5. Appointment of insurance producer - continuation - renewal - exceptions. (1) No insurance producer shall claim to be a representative or authorized or appointed agent of, or use any other term implying a contractual relationship with, a particular bail insurance company or accept applications on behalf of the bail insurance company unless the insurance producer becomes through a written contract a producer appointee, appointed by that bail insurance company in accordance with this section, to act in the capacity of an agent of the bail insurance company.

(2) (a) A bail insurance company shall notify the commissioner of each insurance producer appointment. Each bail insurance company shall file with the commissioner, monthly or at such other less frequent intervals as the commissioner may prescribe, a current list of insurance producers that it has appointed to solicit business on its behalf. The list shall contain all relevant appointment information as prescribed by the commissioner, including the effective date of appointment.

(b) Subject to renewal, each insurance producer appointment shall remain in effect until:

(I) The insurance producer's license is allowed to expire, discontinued, or canceled by the insurance producer or revoked by the commissioner; or

(II) Notice of termination of the appointment is filed with the commissioner by the insurer.

(c) (I) A bail insurance company shall not appoint an insurance producer to act as its agent to write bail bonds unless the agent is licensed as an insurance producer authorized to write bail bonds and has completed the prelicensure education required by this paragraph (c) and submitted to the bail insurance company evidence of satisfactory completion of the education. The education must be approved by the division and consist of at least:

(A) Eight clock hours regarding bail bonding, two of which concern the criminal court system, two of which concern bail bond industry ethics, and four of which concern the bail bond laws; and

(B) Sixteen clock hours of training in bail recovery practices that complies with standards established by the peace officers standards and training board under section 24-31-303 (1)(h), C.R.S.

(II) This paragraph (c) does not apply to a person who has successfully completed the required prelicensure training pursuant to section 12-7-102.5, C.R.S., as it existed prior to July 1, 2012.

(III) A bail insurance company failing to comply with this paragraph (c) is subject to discipline under section 10-1-110 or the assessment of a penalty.

(3) Each active insurance producer appointment shall be subject to renewal on October 1 of the renewal year. The division shall provide a list of active insurance producer appointees to the bail insurance company along with a renewal invoice stating the fee required for the renewal of each active insurance producer appointment.

(4) Any appointment that is not renewed on or before October 1 shall be deemed to have expired or been discontinued, effective on that date; except that the commissioner may renew an insurer's appointment upon receipt of the renewal invoice together with the renewal fees due and any applicable late fee.
C.R.S. § 10-16-707 — CO Code / Title 10 / Article 16 / Part 7 / Section 10-16-707
10-16-707. Enforcement
Status: in_force

10-16-707. Enforcement. (1) If it is determined that a carrier has not contracted with enough participating providers to assure that covered persons have accessible health-care services in a geographic area, that a carrier's access plan does not assure reasonable access to covered benefits, that a carrier has entered into a contract that does not comply with this part 7, or that a carrier has not complied with a provision of this part 7, the commissioner may institute a corrective action that shall be followed by the carrier or may use any of the commissioner's other enforcement powers to obtain the carrier's compliance with this part 7.

(2) The commissioner shall not act to arbitrate, mediate, or settle disputes between a managed care plan and a provider concerning a provider's inclusion or termination from the network.

(3) Failure of a provider to comply with the requirements of section 10-16-705 (16) shall preclude a carrier from contracting with a provider.
C.R.S. § 10-4-640 — CO Code / Title 10 / Article 4 / Part 6 / Section 10-4-640
10-4-640. Operator's policy of insurance
Status: in_force

10-4-640. Operator's policy of insurance. (1) Except as otherwise provided in subsection (8) of this section, any natural person may satisfy the requirements of section 10-4-619 by obtaining, in lieu of an owner's policy of insurance, an operator's policy of liability insurance that meets the requirements of this section and of this part 6.

(2) An operator's policy of liability insurance shall provide coverage and shall state in a conspicuous type face and font on the face of the policy, that:

(a) The insurer is only liable under the policy for liability or damages incurred by the insured while the named insured is the operator of a motor vehicle or while a motor vehicle owned by the insured is not being operated by any other person;

(b) The policy does not provide coverage for any vicarious liability imposed on the owner of the motor vehicle as a result of the operation by another person of a motor vehicle owned by the insured;

(c) The coverage provided by the policy may not meet the requirements of the mandatory motor vehicle insurance or financial responsibility laws of another state.

(3) No operator's policy of liability insurance issued pursuant to this section may be delivered or issued for delivery in this state unless the insured has signed a statement, in the same medium as the application was taken, that appears on the contract and states that the insured has read and understood the policy and its limitations.

(4) An owner of a motor vehicle that is registered or required to be registered in this state and who holds an operator's policy of liability insurance shall not permit another person to operate such motor vehicle if the owner knows or should have known that the person does not have insurance to cover such other person's operation of such motor vehicle. If a motor vehicle insured under an operator's policy of liability insurance is driven by a person who does not have in effect a complying policy as required by section 10-4-619 and such person is involved in an accident, the owner of such motor vehicle and such driver shall be liable for any liability or damages arising out of such person's use of the motor vehicle.

(5) An operator's policy of liability insurance shall not provide coverage for damages incurred while a person other than the named insured is operating a motor vehicle.

(6) An operator's policy of liability insurance may provide coverage that applies in other jurisdictions if the coverage available pursuant to this section does not meet the mandatory motor vehicle insurance or financial responsibility requirements of other jurisdictions.

(7) An operator's policy of liability insurance shall provide coverage for liability incurred by the insured while a motor vehicle owned by the insured is not being operated by any other person.

(8) This section shall not apply to a lessor, dealer, manufacturer, rebuilder, or distributor of a motor vehicle; an owner of a fleet; a common, contract, or private motor carrier; or any other individual who owns a motor vehicle for use in the individual's business.

(9) If an insurer writing policies of insurance pursuant to this part 6 offers an operator's policy of insurance, such policy shall meet the requirements of this section.
C.R.S. § 10-2-407 — CO Code / Title 10 / Article 2 / Part 4 / Section 10-2-407
10-2-407. License - definitions of lines of insurance - authority
Status: repealed

10-2-407. License - definitions of lines of insurance - authority. (1) Unless a person is denied licensure pursuant to section 10-2-801, the division shall issue to a person who has met the requirements of sections 10-2-401 and 10-2-404 an insurance producer license. An insurance producer may receive qualification for a single license to include one or more of the following lines of authority:

(a) "Life", which means insurance coverage on human lives that:

(I) Shall include benefits of endowment and annuities; and

(II) May include benefits for:

(A) The event of death or dismemberment by accident; and

(B) Disability income;

(b) "Accident and health", which means insurance coverage for sickness, bodily injury, or accidental death and that may include benefits for disability income;

(c) "Variable life and variable annuity products", which means insurance coverage provided under variable life insurance contracts and variable annuities;

(d) "Property", which means insurance coverage for the direct or consequential loss or damage to property of every kind;

(e) "Casualty", which means insurance coverage against legal liability, including that for death, injury, or disability or damage to real or personal property;

(f) Repealed.

(g) Limited lines credit insurance;

(h) Crop hail;

(i) Title;

(j) Surplus lines;

(k) Travel insurance, as defined in section 10-2-414.5;

(l) Health maintenance organizations ("HMO"); except that no person shall be issued a new license for this individual line of authority on or after January 1, 2002, pursuant to section 10-2-402;

(m) Nonprofits; except that no person shall be issued a new license for this individual line of authority on or after January 1, 2002, pursuant to section 10-2-402;

(n) "Personal lines", which means property and casualty insurance sold to individuals and families for primarily noncommercial purposes; or

(o) Any other line of insurance permitted under state law or regulation.

(2) (Deleted by amendment, L. 2001, p. 1199, § 14, effective January 1, 2002.)

(3) An insurance producer license for surplus lines may be issued to resident persons pursuant to article 5 of this title.
C.R.S. § 10-16-1014 — CO Code / Title 10 / Article 16 / Part 10 / Section 10-16-1014
10-16-1014. Technical assistance to authorized cooperatives from division of insurance
Status: repealed

10-16-1014. Technical assistance to authorized cooperatives from division of insurance. (1) Subject to available appropriations, the commissioner may provide technical assistance to any cooperative that:

(a) to (c) Repealed.

(d) Establishes rules that specify that employer members shall take no action to limit their employees' choice of plans offered through the cooperative or to encourage or discourage employees from making particular choices of plans offered through the cooperative;

(e) Repealed.

(f) Develops and implements a marketing plan to publicize the cooperative to potential members and develops and implements methods for informing the public about the cooperative and its services;

(g) Develops specific plans to expand health-care coverage and to expand access to health care in this state; and

(h) Gives each covered member the opportunity to choose among carriers that contract with the cooperative.

(2) The technical assistance the commissioner may provide pursuant to subsection (1) of this section may include:

(a) Providing technical assistance in the formation of a cooperative pursuant to this part 10 so long as the cooperative is not formed or administered by the commissioner as an entity or instrumentality of the state;

(b) Educating communities, businesses, and nonprofit organizations about cooperatives; and

(c) Advertising or otherwise publicizing successful cooperatives that have been formed in the state.
C.R.S. § 10-16-122.5 — CO Code / Title 10 / Article 16 / Part 1 / Section 10-16-122.5
10-16-122.5. Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits -
Status: in_force

10-16-122.5. Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rules. (1) A pharmacy benefit manager, a carrier, or an entity acting on behalf of a pharmacy benefit manager or a carrier that audits a pharmacy shall:

(a) Give the pharmacy at least seven days' written notice prior to commencing an audit;

(b) Conduct the audit by or in consultation with a licensed pharmacist to the extent the audit requires the application of clinical or professional judgment;

(c) Not use extrapolation or other statistical expansion techniques in calculating the amount of a recoupment or penalty resulting from an audit of a pharmacy;

(d) Allow the pharmacy to produce additional claims documentation using any commercially reasonable method, including facsimile, mail, or electronic claims submission, if an audit results in the dispute or denial of a claim;

(e) Establish a written appeals process that includes procedures to allow a pharmacy to appeal to the pharmacy benefit manager or the carrier the preliminary reports resulting from the audit and any resulting recoupment or penalty; and

(f) Not subject a pharmacy to the recoupment of funds when an audit results in the identification of a clerical error in a required document or record unless the error results in actual financial harm to the pharmacy benefit manager, a health benefit plan providing prescription drug benefits that are managed by the pharmacy benefit manager, or a consumer.

(2) A pharmacy may use verifiable statements or records, including medication administration records of a nursing home, assisted living facility, hospital, physician, or other authorized practitioner, to validate the pharmacy record and delivery.

(3) Any legal prescription may be used to validate claims in connection with prescriptions, refills, or changes in prescriptions, including medication administration records, faxes, electronic prescriptions, or documented telephone calls from the prescriber or the prescriber's agent.

(4) The time period covered by an audit may not exceed twenty-four months from the date that the prescription was submitted to or adjudicated by the entity, unless a longer period is required by state or federal law.

(5) The time periods specified are waived for audits of pharmacy records when fraud or other intentional or willful misrepresentation is indicated through review of claims data, statements, physical review, or other investigative methods. The pharmacy benefit manager, carrier, or entity acting on behalf of the pharmacy benefit manager or carrier shall deliver to the pharmacy at the time of the audit a written or verbal explanation of the information that led to the conclusion that there is an indication of fraud or other intentional or willful misrepresentation. The explanation is not required if law enforcement has intervened due to the indication of fraud.

(5.5) Except under circumstances specified in subsection (5) of this section, on or after July 6, 2021, a pharmacy benefit manager, a carrier, or an entity acting on behalf of a PBM or a carrier shall not conduct an on-site audit of a pharmacy for which the PBM, carrier, or entity acting on behalf of a PBM or a carrier has conducted an on-site audit within the immediately preceding twelve months.

(5.7) With regard to the requirements of this section applicable to pharmacy benefit managers, the commissioner has the authority to enforce this section and to impose a penalty or other remedy against a pharmacy benefit manager that fails to comply with this section.

(5.9) The commissioner may adopt rules to implement and enforce this section.

(6) As used in this section, "pharmacy" includes any entity authorized under article 280 of title 12 to dispense prescription drugs.