reglab/housing_qa huggingface dataset:
CO Code § 10-16-104.3 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-104.3. Health Coverage for Persons Under Twenty-Six Years of Age - Coverage for Students Who Take Medical Leave of Absence

     A carrier that offers a health benefit plan in the state and that makes dependent coverage for children available under the health benefit plan shall make the coverage available for a child who is under twenty-six years of age. The carrier shall not deny or restrict coverage for a child who is under twenty-six years of age based on a factor such as:   Residency with the policyholder or any other person;    The presence or absence of financial dependence on the policyholder or any other person;    Marital or civil union status;    Student status;    Employment status; or    A combination of any of the factors listed in paragraphs (a) to (d) of this subsection (1).       A carrier shall not deny dependent coverage of a child based on the child's eligibility for other coverage.    Except as otherwise provided in state law, a carrier offering dependent coverage of children in a health benefit plan shall not vary the terms of coverage in the policy or contract based on age, except for premium rates for children who are twenty-one years of age or older.    Nothing in this subsection (1) requires a carrier to make coverage available for the child of a child receiving dependent coverage unless the grandparent becomes the permanent legal guardian or adoptive parent of that grandchild.       Repealed.      All individual and group sickness and accident insurance policies providing coverage within the state by an entity subject to the provisions of part 2 of this article and all group health service contracts issued by an entity subject to the provisions of part 3 or 4 of this article that provide dependent coverage to a child who is enrolled in a postsecondary educational institution shall not terminate coverage due to a medically necessary leave of absence before the date that is the earlier of:   One year after the first day of the medically necessary leave of absence; or    The date the coverage would otherwise terminate under the terms of the plan or health insurance coverage.       For purposes of this subsection (3), “medically necessary leave of absence” means a leave of absence from a postsecondary educational institution or a change in enrollment of the dependent at the institution that:   Begins while the dependent is suffering from a serious illness;    Is medically necessary; and    Causes the dependent to lose student status for the purpose of dependent coverage.            History. Source: L. 2005: Entire section added, p. 1503, § 1, effective January 1, 2006. L. 2009: (3) added,(HB 09-1338), ch. 353, p. 1844, § 5, effective July 1. L. 2013: (1) R&RE and (2) repealed,(HB 13-1266), ch. 217, p. 925, § 4, effective May 13.
CO Code § 10-16-104.6 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-104.6. Off-Label Use of Cancer Drugs

  A health benefit plan that provides coverage for prescription drugs shall not limit or exclude coverage for any drug approved by the United States food and drug administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States food and drug administration for the treatment of the specific type of cancer for which the drug is prescribed if:   The drug is recognized for treatment of that cancer in the authoritative reference compendia as identified by the secretary of the United States department of health and human services; and    The treatment is for a covered condition.        History. Source: L. 2010: Entire section added,(HB 10-1355), ch. 229, p. 989, § 1, effective August 11.
CO Code § 10-16-104.7 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-104.7. Substance Use Disorders - Court-Ordered Treatment Coverage

  An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for treatment of a substance use disorder must provide coverage for such treatment regardless of whether the treatment is voluntary or court-ordered as a result of contact with the criminal justice or legal system. The health benefit plan is only required to provide coverage for benefits that are medically necessary and otherwise covered under the plan. Such coverage is subject to copayment, deductible, and policy maximums and limitations. Health benefit plans issued by an entity subject to the provisions of part 4 of this article 16 may provide that the benefits required pursuant to this section are covered benefits only if the services are deemed medically necessary and are rendered by a provider who is designated by and affiliated with the health maintenance organization.    Nothing in this section mandates or is meant to construe that any health benefit plan must provide coverage for treatment of a substance use disorder.     History. Source: L. 2002: Entire section added, p. 750, § 1, effective January 1, 2003. L. 2017: Entire section amended,(SB 17-242), ch. 263, p. 1264, § 36, effective May 25.    Cross references:   For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
CO Code § 10-16-104.9 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-104.9. Geographic Areas for Small Employers

  The commissioner shall promulgate a rule concerning geographic case characteristics, which may include metropolitan statistical areas for small employers. In promulgating such rule, the commissioner shall take testimony from all interested parties, including, but not limited to, consumer advocates and consumers, insurers, health-care providers, the state demographer, and producers. The rule shall include, without limitation, the following features:   If the rule establishes separate geographic areas, in rate filings to the commissioner, a carrier shall be required to show that rates reflect a relativity to rates for other areas in the state and that rates and relativities are not excessive, inadequate, or unfairly discriminatory in such geographic areas;    The rule shall contain a determination of the appropriate population base for statistical reliability in determining geographic areas or metropolitan statistical areas;      The rule shall provide justifications of why any separate geographic areas, which may include metropolitan statistical areas, serve the public interest in regard to ensuring that premium rates for different geographic areas of the state are not excessive, inadequate, or unfairly discriminatory; (c) (I) The rule shall provide justifications of why any separate geographic areas, which may include metropolitan statistical areas, serve the public interest in regard to ensuring that premium rates for different geographic areas of the state are not excessive, inadequate, or unfairly discriminatory;    If the commissioner determines that metropolitan statistical areas are no longer the best method for addressing geographic case characteristics, the commissioner shall provide detailed justifications concerning the separate geographic areas, in connection with which the commissioner shall make public the impact the geographic case characteristics may have on insurance premiums for the separate geographic areas; and       In adopting such rule, the commissioner may consider the cost of health care in a geographic area, experience of health care of any separate geographic area, and information including actuarial opinions or certifications and set loss ratios for loss ratio guarantees submitted by small employer carriers pursuant to section 10-16-107 (1). The cost of health care and experience and the population that may be served may be a consideration when determining whether separate geographic case characteristics are necessary, but shall not be the sole factors of separate geographic case characteristics, nor shall it compromise the public interest of insureds and potential insureds of this state.         History. Source: L. 2002: Entire section added, p. 1294, § 7, effective June 7. L. 2003: (1)(c)(I) amended, p. 1988, § 21, effective May 22.    Editor's note:   This section was originally enacted as § 10-16-104.7 in House Bill 02-1003 but has been renumbered on revision for ease of location.
CO Code § 10-16-105.3 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-105.3. Health Benefit Plans - Not Prohibited

  A carrier shall not be prohibited from offering to a small employer additional options of health benefit plans that:   Provide for different benefits for insureds and dependents of such insureds covered by the same policy; and    Encourage appropriate health-care condition management based on clinical guidelines by providing case management benefits to covered persons.        History. Source: L. 2003: Entire section added, p. 1778, § 12, effective January 1, 2004.
CO Code § 10-16-105.6 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-105.6. Rate Usage

  A carrier offering an individual or group health benefit plan shall not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or, for group plans, a contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health-status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.    The prohibition in subsection (1) of this section does not:   Restrict the amount that a carrier may charge an employer for coverage under a group health benefit plan; or    Prevent a carrier from establishing premium discounts or rebates or modifying otherwise applicable copayments, coinsurance, or deductibles in return for adherence to programs of health promotion and disease prevention if otherwise allowed by state or federal law.       Repealed.    A small employer carrier may impose a premium surcharge of up to thirty-five percent above the modified community rate on a small employer group whose small group insurance has been discontinued because of nonpayment of premiums or fraud. The small employer carrier may impose the premium surcharge when the small business group reapplies for coverage in the small group market. A small employer carrier may require the increased premium to apply to the small business group for up to twelve months.     History. Source: L. 2013: Entire section added with relocations,(HB 13-1266), ch. 217, p. 934, § 9, effective May 13. L. 2016: (2)(b) amended,(SB 16-189), ch. 210, p. 756, § 14, effective June 6. L. 2017: (3) repealed,(SB 17-249), ch. 283, p. 1549, § 19, effective June 1.    Editor's note:   Subsections (1) and (2) are similar to former § 10-16-107 (6) ; subsections (3)(a), (3)(b), and (3)(c) are similar to former § 10-16-105 (13)(a) ; subsection (3)(d) is similar to former § 10-16-105 (13)(d) ; and subsection (4) is similar to former § 10-16-105 (14)(a) , as those sections existed prior to 2013.
CO Code § 10-16-106.3 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-106.3. Uniform Claims - Billing Codes - Electronic Claim Forms

  On or before July 1, 2002, all carriers shall accept the claim form adopted by the American dental association for use by all dental providers and carriers in the state, and the centers for medicare and medicaid services' claim forms CMS-1500 and CMS-1450, otherwise known as form UB-04, as amended, as the uniform health-care claim forms for use by all other health-care providers and carriers in the state. All carriers shall accept such claim forms from health-care providers in electronic form. A carrier shall not prohibit submission of health-care claims in hard copy form, nor shall a carrier be prohibited from requiring that a claim be submitted in hard copy form. A carrier shall not require submission of a claim on a form other than those set forth in this section, except as provided in subsection (3) of this section.    On or before July 1, 2002, the commissioner shall adopt a uniform list of required elements to be used on the uniform claim forms accepted by carriers pursuant to this section. Such elements shall be used by health-care providers in order for a claim to be considered a clean claim.    Concurrent with the effective date for implementation of the federal “Health Insurance Portability and Accountability Act of 1996”, as amended, and the federal regulations implemented pursuant to such act, as amended, for claims filed electronically, carriers shall require the submission of electronic claims with the elements in the format required by such act and such regulations and shall not require the submission of forms and elements pursuant to subsections (1) and (2) of this section.     History. Source: L. 2002: Entire section added, p. 312, § 1, effective April 19. L. 2007: (1) amended, p. 921, § 1, effective May 17.
CO Code § 10-16-107.1 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-107.1. False or Misleading Information - Penalties

  A person or organization shall not knowingly withhold information that will affect the rates or premiums chargeable under this part 1 or knowingly give false or misleading information to the commissioner or any statistical agent, advisory organization, or carrier. A person or organization who violates this section shall be subject to the penalties in subsection (2) of this section.    Upon a finding that any person or organization has knowingly violated subsection (1) of this section, the commissioner may impose a penalty of not more than ten thousand dollars for each violation but, if the violation is found to be willful, a penalty of not more than twenty-five thousand dollars for each violation. The penalties may be in addition to any other penalty provided by law.     History. Source: L. 2008: Entire section added, p. 2255, § 7, effective July 1.    Cross references:   In 2008, this section was enacted by the “Fair Accountable Insurance Rates Act”. For the short title and legislative declaration, see sections 1 and 2 of chapter 439, Session Laws of Colorado 2008.
CO Code § 10-16-107.2 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-107.2. Filing of Health Policies - Rules

  All carriers authorized by the commissioner to conduct business in Colorado shall submit an annual report to the commissioner listing any policy form, endorsement, or rider for any sickness, accident, nonprofit hospital and health service corporation, health maintenance organization, or other health insurance policy, contract, certificate, or other evidence of coverage issued or delivered to any policyholder, certificate holder, enrollee, subscriber, or member in Colorado. Each carrier shall submit the annual report by December 31 of each year and shall include in the report a certification by an officer of the carrier that, to the best of the carrier's good-faith knowledge and belief, each policy form, endorsement, or rider in use complies with Colorado law. The commissioner shall determine the necessary elements of the certification.    All carriers authorized by the commissioner to conduct business in Colorado shall also submit to the commissioner a list of any new policy form, application, endorsement, or rider at least thirty-one days before using the policy form, application, endorsement, or rider for any health coverage. The carrier shall include in the listing a certification by an officer of the carrier that each new policy form, application, endorsement, or rider proposed to be used complies, to the best of the carrier's good-faith knowledge and belief, with Colorado law. The commissioner shall determine the necessary elements of the certification. A carrier shall not deliver or issue a new policy form, application, endorsement, or rider until the carrier files the listing and certification required by this subsection (2).    The commissioner shall promulgate rules, as needed, setting forth the standards for policy forms, endorsements, and riders marketed in Colorado.    The commissioner may examine and investigate carriers authorized to conduct business in Colorado to determine whether policy forms, endorsements, and riders comply with the certification of the carrier and statutory mandates.     History. Source: L. 92: Entire section added, p. 1745, § 5, effective June 2. L. 2005: (2) amended, p. 741, § 1, effective January 1, 2006. L. 2006: (2)(b)(I) amended, p. 1077, § 5, effective January 1, 2007. L. 2010: (2)(c) added,(HB 10-1242), ch. 222, p. 966, § 1, effective August 11. L. 2013: Entire section amended,(HB 13-1266), ch. 217, p. 950, § 13, effective May 13.    Editor's note:    Although the effective date for the repeal and reenactment of this article was July 1, 1992, this section was added, effective June 2, 1992.    The former subsection (2)(b) was relocated to § 10-16-107.5 in 2013.     Cross references:   For the legislative declaration contained in the 2006 act amending subsection (2)(b)(I), see section 1 of chapter 236, Session Laws of Colorado 2006.
CO Code § 10-16-107.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-107.5. Uniform Application Form - Use by All Carriers - Rules

  The commissioner, by rule, shall develop a uniform application form for health benefit plans and shall require all carriers providing health benefit plans that are authorized by the commissioner to conduct business in Colorado to exclusively use the uniform application form for the conduct of business in this state. By a date specified by the commissioner, all carriers that provide health benefit plans shall use the uniform application form for their health benefit plans.    The commissioner may permit carriers to use a modified electronic version of the uniform application form.     History. Source: L. 2013: Entire section added with relocations,(HB 13-1266), ch. 217, p. 951, § 14, effective May 13.    Editor's note:   This section is similar to former § 10-16-107.2 (2)(b) as it existed prior to 2013.
CO Code § 10-16-107.7 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-107.7. Nondiscrimination Against Providers

  A carrier offering an individual or group health benefit plan in this state shall not discriminate with respect to participation under the plan or coverage against any provider who is acting within the scope of his or her license or certification under applicable state law.    This section does not:   Require a carrier to contract with any provider willing to abide by the terms and conditions for participation established by the plan or carrier; or    Prevent a carrier from establishing varying reimbursement rates based on quality or performance measures.        History. Source: L. 2013: Entire section added,(HB 13-1266), ch. 217, p. 952, § 15, effective May 13.
CO Code § 10-16-109 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-109. Rules

 Pursuant to article 4 of title 24, C.R.S., the commissioner may promulgate reasonable rules consistent with this article that are necessary or proper for implementing and administering this article, including rules necessary to align state law with the requirements imposed by federal law regarding health-care coverage in this state.   History. Source: L. 92: Entire article R&RE, p. 1655, § 1, effective July 1. L. 2013: Entire section amended,(HB 13-1266), ch. 217, p. 956, § 18, effective May 13.    Editor's note:   The provisions of this section are similar to provisions of several former sections as they existed prior to 1992. For a detailed comparison, see the comparative tables located in the back of the index.
CO Code § 10-16-110 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-110. Fees Paid by Health Coverage Entities

     There shall be paid to the division of insurance by every corporation subject to the provisions of this part 1 and part 3 of this article such fees as are prescribed pursuant to sections 10-3-207 and 24-31-104.5, C.R.S.    Every nonprofit hospital and health service corporation representative subject to this part 1 and part 3 of this article shall pay to the commissioner the following fees:   For each enrollment representative's initial license, ten dollars;    For each enrollment representative's renewal license, six dollars.       To defray the cost of administering this article, every corporation subject to the provisions of this part 1 and part 3 of this article shall pay annually to the commissioner on March 1 an amount equivalent to five cents per person exceeding ten thousand in number enrolled in the health service plans of such corporation.         Every health maintenance organization subject to this part 1 and part 4 of this article shall pay to the commissioner the fees as prescribed pursuant to sections 10-3-207 and 24-31-104.5, C.R.S.    Every health maintenance organization representative subject to this part 1 and part 4 of this article shall pay to the commissioner the following fees:   For each enrollment representative's initial license, ten dollars;    For each enrollment representative's renewal license, six dollars.          Coincident with the filing of the annual report prescribed by section 10-16-111, each prepaid dental care plan organization subject to this part 1 and part 5 of this article shall pay to the state treasurer through the commissioner fees for transacting a prepaid dental care plan. The fees shall be as prescribed pursuant to sections 10-3-207 and 24-31-104.5, C.R.S.    Notwithstanding the amount specified for any fee in this section, the commissioner by rule or as otherwise provided by law may reduce the amount of one or more of the fees if necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of one or more of the fees is credited. After the uncommitted reserves of the fund are sufficiently reduced, the commissioner by rule or as otherwise provided by law may increase the amount of one or more of the fees as provided in section 24-75-402 (4), C.R.S.      History. Source: L. 92: Entire article R&RE, p. 1655, § 1, effective July 1. L. 98: (4) added, p. 1328, § 33, effective June 1. L. 2010: (1)(a), (2)(a), and (3) amended,(HB 10-1385), ch. 204, p. 884, § 8, effective May 5. L. 2012: (1)(a), (2)(a), and (3) amended,(SB 12-110), ch. 158, p. 562, § 10, effective July 1.    Editor's note:   The provisions of this section are similar to provisions of several former sections as they existed prior to 1992. For a detailed comparison, see the comparative tables located in the back of the index.