reglab/housing_qa huggingface dataset:
CO Code § 10-16-112 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-112. Private Utilization Review - Health-Care Coverage Entity Responsibility - Definitions

  As used in this section, unless the context otherwise requires:   “Private utilization review organization” means an entity, other than a hospital or public reviewer following federal guidelines, that conducts utilization review or reviews and makes determinations on prior authorization requests for health-care services as described in section 10-16-112.5. This definition shall not apply to any independent medical examination provided for in any policy of insurance.    “Utilization review” means an evaluation of the necessity, appropriateness, and efficiency of the use of health-care services, procedures, and facilities, but does not include any independent medical examination provided for in any policy of insurance.       Any private utilization review organization providing services to an insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization regulated pursuant to the provisions of this article is the direct representative of the insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization. Any insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization is responsible for the actions of any private utilization review organization acting within the scope of any contract and on its behalf within the scope of any contract which result in any violation of this title or any rules or regulations promulgated by the commissioner.     History. Source: L. 93: Entire section added, p. 494, § 2, effective April 26. L. 2019: (1)(a) amended,(HB 19-1211), ch. 165, p. 1910, § 3, effective August 2.    Cross references:   For the legislative declaration in HB 19-1211, see section 1 of chapter 165, Session Laws of Colorado 2019.
CO Code § 10-16-113.7 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 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.   History. Source: L. 2005: Entire section added, p. 805, § 4, effective January 1, 2006.
CO Code § 10-16-118 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-118. Prohibition Against Preexisting Condition Exclusions

 A carrier offering an individual or small employer health benefit plan in this state shall not impose any preexisting condition exclusion with respect to coverage under the plan.   History. Source: L. 94: Entire section added, p. 1913, § 9, effective July 1. L. 97: Entire section amended, p. 639, § 7, effective July 1. L. 2002: (1)(a)(I) amended, p. 1284, § 3, effective January 1, 2003; (1)(a)(I) amended, p. 1293, § 5, effective January 1, 2003. L. 2013: Entire section R&RE,(HB 13-1266), ch. 217, p. 972, § 22, effective May 13.    Cross references:   For the legislative declaration contained in the 1997 act amending this section, see section 1 of chapter 154, Session Laws of Colorado 1997.
CO Code § 10-16-119 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-119. Requirements for Excess Loss or Stop-Loss Health Insurance Used in Conjunction With Self-Insured Employer Benefit Plans Under the Federal “Employee Retirement Income Security Act” - Data Collection 2013-18 - Rules

  Any entity issuing excess loss insurance shall file all policy forms with the division and certify compliance with the provisions of this title.    All excess loss insurance shall be issued to cover the employer's liability under the employer's self-insured obligation. Excess loss insurance shall meet the following requirements:   The policy shall only be issued to insure an employer and not the employer's employees;    Payment by the issuer of the insurance shall only be made to the employer and not the employees or providers;    Commencing with policies issued or renewed on and after January 1, 2003, the minimum retention to the employer shall be no less than fifteen thousand dollars per person per plan year with a minimum one hundred twenty percent of expected claims aggregate.         Repealed.         History. Source: L. 94: Entire section added, p. 1913, § 9, effective July 1. L. 2002: (2)(c) amended, p. 1293, § 6, effective January 1, 2003. L. 2013: (3) added,(HB 13-1290), ch. 339, p. 1975, § 1, effective July 1.    Editor's note:   Subsection (3)(d) provided for the repeal of subsection (3), effective September 1, 2019. (See L. 2013, p. 1976 .)
CO Code § 10-16-121.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-121.5. Prohibited Contract Provisions in Contracts Between Carriers and Providers for Dental Services - Definition

  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:   The services are covered services under the person's policy; and    The carrier provides payment for the services under the person's policy in an amount that is reasonable and not nominal or de minimis.       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.    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.    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.     History. Source: L. 2017: Entire section added,(SB 17-190), ch. 147, p. 492, § 2, effective August 9. L. 2019: IP(1) amended,(HB 19-1172), ch. 136, p. 1654, § 45, effective October 1.    Cross references:   For the legislative declaration in SB 17-190, see section 1 of chapter 147, Session Laws of Colorado 2017.
CO Code § 10-16-122.7 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-122.7. Disclosures Between Pharmacists and Patients - Carrier Prohibitions - Short Title - Legislative Declaration - Preemption by Federal Law

  The short title of this section is the “Patient Drug Costs Savings Act”.    The general assembly hereby finds and declares that:   Consumers have the right to know about options to reduce the amount of money they pay at a pharmacy for prescription drugs; and    This section will save consumers money by allowing pharmacists to provide information concerning the cost of prescription drugs.       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:   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;    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    Require a pharmacy to charge or collect a copayment from a covered person that exceeds the total charges submitted by the network pharmacy.       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.    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.     History. Source: L. 2018: Entire section added,(HB 18-1284), ch. 181, p. 1233, § 1, effective August 8. L. 2019: (3)(a) amended,(HB 19-1172), ch. 136, p. 1655, § 48, effective October 1.
CO Code § 10-16-124 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-124. Prescription Information Cards - Legislative Declaration

  It is the intent of the general assembly to lessen patients' waiting times for prescriptions, to decrease administrative burdens for pharmacies, and to improve care to patients by minimizing confusion, eliminating unnecessary paperwork, and streamlining the dispensing of prescription drugs paid for by third party payors.    Each health benefit plan that offers coverage for prescription drugs shall issue to the named insured a card or other device containing uniform prescription drug information. Such card or device shall be in the format approved by the national council for prescription drug programs, shall include all of the required and situational fields and shall conform to the most recent pharmacy identification card or device implementation guide produced by the national council for prescription drug programs.      A new uniform prescription drug information card or device, as required pursuant to subsection (2) of this section, shall be issued by a carrier:   When a person enrolls in a health benefit plan that offers prescription drug coverage; and    When a person's coverage changes and the change affects data contained on the card or device.       Newly issued cards or devices shall be updated with the latest coverage information and shall conform to the national council for prescription drug programs' standards then in effect and to the implementation guide then in use.       No health maintenance organization that supplies benefits to its plan subscribers through an in-house drug or pharmacy outlet and has received a certificate of authority pursuant to part 4 of this article shall be subject to this section.    The provisions of the section shall not apply to the children's basic health plan as described in article 8 of title 25.5, C.R.S.      History. Source: L. 2002: Entire section added, p. 1311, § 1, effective January 1, 2003. L. 2006: (5) amended, p. 1999, § 36, effective July 1.
CO Code § 10-16-124.7 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-124.7. Opioid Analgesics With Abuse-Deterrent Properties - Study - Definitions

  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.    Moneys from the general fund shall not be used for the implementation of this section.    As used in this section:   “Abuse-deterrent opioid analgesic drug product” means a brand or generic opioid analgesic drug product approved by the United States food and drug administration with abuse-deterrence labeling claims that indicate that the drug product is expected to result in a meaningful reduction in abuse.    “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.        History. Source: L. 2015: Entire section added,(HB 15-1214), ch. 175, p. 570, § 1, effective May 11.
CO Code § 10-16-124.8 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-124.8. Colorado Consortium for Prescription Drug Abuse Prevention - Create Process for Recovery - Report

  The governor shall direct the Colorado consortium for prescription drug abuse prevention within the university of Colorado to:   Create a process with the substance abuse recovery community to develop a strategic plan that addresses the full continuum of recovery services, including detoxification services and reintegration into the community with peer support, for individuals who experience substance use disorders;    Develop a definition for recovery residences and issue recommendations regarding whether recovery residences should be licensed; and    Report the recommendations pursuant to this section to the general assembly on or before January 1, 2020.       Money in the general fund may not be used for the implementation of this section.     History. Source: L. 2018: Entire section added,(HB 18-1003), ch. 224, p. 1427, § 2, effective May 21.
CO Code § 10-16-125 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-125. Reimbursement to Nurses

  In counties of the state that are neither part of a metropolitan statistical area nor a primary statistical area, a carrier offering a health benefit plan shall not discriminate between a physician and an advanced practice nurse not practicing under the direction of a physician when establishing reimbursement rates for covered services that could be provided by an advanced practice nurse or a physician.    In order to improve access to primary care and choices of providers, a carrier providing a health benefit plan shall evaluate an application for status as a participating provider from an advanced practice nurse utilizing objective and reasonable criteria and shall take into account the provider-to-covered-person ratio for the covered benefits that appropriately may be provided by the advanced practice nurse. The carrier shall make a determination on an application for participating provider status submitted by an advanced practice nurse, and notify the applicant of its determination, within the same period in which the carrier makes a participating provider determination for physicians. If the application is denied, the carrier shall specify the reason for the denial. If the application is approved, the carrier shall list the advanced practice nurse in the provider directory for the health benefit plan.     History. Source: L. 2002: Entire section added, p. 1295, § 8, effective June 7. L. 2008: Entire section amended, p. 121, § 1, effective January 1, 2009.    Editor's note:   This section was originally enacted as § 10-16-124 in House Bill 02-1003 but has been renumbered on revision for ease of location.
CO Code § 10-16-126 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-126. Fee-for-Service Dental Plans

  Notwithstanding any provision of this title to the contrary, a fee-for-service dental plan for which premiums are not charged is not subject to the provisions of this title and the offering of such a plan shall not be considered transacting the business of insurance pursuant to section 10-3-903. The offeror of a fee-for-service dental plan shall have no liability for payment of claims and the fees paid to the provider of the services shall be paid directly by the consumer.    Any offeror of such fee-for-service dental plan shall advise the consumer that the plan is not an insurance plan and that the consumer shall be solely responsible for full payment to the provider of any fees or charges incurred by the consumer.     History. Source: L. 2003: Entire section added, p. 1740, § 1, effective August 6.
CO Code § 10-16-127 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-127. Coinsurance and Deductibles

 A carrier subject to the provisions of parts 2, 3, and 4 of this article may offer one or more health coverage plans that contain deductibles or coinsurance without any limitation or restriction on the maximum out-of-pocket payable by the insured.   History. Source: L. 2003: Entire section added, p. 1785, § 16, effective January 1, 2004.    Editor's note:   This section was originally numbered as § 10-16-126 but was renumbered on revision for ease of location.
CO Code § 10-16-128 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-128. Annual Report to General Assembly

 Notwithstanding section 24-1-136 (11)(a)(I) , the commissioner shall report to the business affairs and labor committee of the house of representatives and the business, labor, and technology committee of the senate, or any successor committees, no later than October 1, 2004, and every October 1 thereafter. The report shall be an indication of the number, nature, and outcome of complaints against insurers during the preceding twelve months.   History. Source: L. 2003: Entire section added, p. 2494, § 3, effective June 5. L. 2007: Entire section amended, p. 2020, § 12, effective June 1. L. 2017: Entire section amended,(SB 17-044), ch. 4, p. 7, § 4, effective August 9.    Editor's note:   This section was originally numbered as § 10-16-126 but was renumbered on revision for ease of location.
CO Code § 10-16-129 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-129. Health Savings Accounts

 Any carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article may offer a high deductible health plan that would qualify for and may be offered in conjunction with a health savings account pursuant to 26 U.S.C. sec. 223, as amended. A carrier offering a high deductible health plan that may be offered in conjunction with a health savings account may apply the deductible to mandatory health benefits for prostate cancer screening and prosthetic devices pursuant to section 10-16-104 (10) and (14) if those mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount.   History. Source: L. 2004: Entire section added, p. 764, § 2, effective July 1. L. 2009: Entire section amended,(HB 09-1204), ch. 344, p. 1808, § 6, effective January 1, 2010. L. 2013: Entire section amended,(HB 13-1266), ch. 217, p. 973, § 23, effective May 13.    Cross references:   For the legislative declaration contained in the 2009 act amending this section, see section 1 of chapter 344, Session Laws of Colorado 2009.
CO Code § 10-16-130 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-130. Disclosure of Rate Increases to Public Entities - Legislative Declaration - Definitions

  The general assembly hereby finds, determines, and declares that variability in premiums by carriers offering health benefit coverage to a public entity present difficulties for fiscal planning for the public entity. Therefore, it is in the best interest of the state to promote greater accountability to the public and sound fiscal policy by public entities through disclosure by health insurance carriers of information concerning the public entity's rate, loss ratio, and the total number of claims exceeding ten thousand dollars for the public entity.    A carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article to a public entity, with one hundred or more employees enrolled in such coverage, shall disclose to the public entity, at the request of the public entity, once annually and concurrent with the issuance of the employer's rate renewal, the following information as it relates to the amounts of coverage being considered for calculating the renewal:   The total number of employees covered by the carrier for the public entity;    The total dollar amount of claims paid by the carrier on behalf of the public entity;    Total of premiums paid; and    The number of claims that exceed ten thousand dollars for any one covered person under health benefit coverage for the public entity.       As used in this section, unless the context otherwise requires:   “Loss ratio” means the total claims paid for the coverage period divided by the total amount of premiums paid by a public entity.    “Public entity” shall have the same meaning as that provided in section 24-10-103 (5), C.R.S.        History. Source: L. 2005: Entire section added, p. 849, § 1, effective January 1, 2006.
CO Code § 10-16-134 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 1 - General Provisions|§ 10-16-134. Health-Care Transparency - Information Required - Website - Definition

  On or before March 1, 2009, and on or before March 1 each year thereafter, each carrier shall submit to the division a list of the average reimbursement rates, either statewide or by geographic area, as defined by rule of the commissioner pursuant to section 10-16-104.9, for the average inpatient day or the average reimbursement rate for the twenty-five most common inpatient procedures based upon the most commonly reported diagnostic-related groups.      The commissioner shall post the information submitted pursuant to subsection (1) of this section on the division's website.    The division shall ensure that the website and information is easy to navigate, contains consumer-friendly language, and fulfills the intent of this section.       For purposes of this section, “diagnostic-related group” means the classification assigned to an inpatient hospital service claim based on the patient's age and sex, the principal and secondary diagnoses, the procedures performed, and the discharge status.      History. Source: L. 2008: Entire section added, p. 1265, § 4, effective May 27.    Cross references:   In 2008, this section was enacted by the “Health Care Transparency Act”. For the short title and legislative declaration, see sections 1 and 2 of chapter 294, Session Laws of Colorado 2008.