reglab/housing_qa huggingface dataset:
CO Code § 10-16-406 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-406. Evidence of Coverage - Rules

  Every enrollee residing in this state is entitled to evidence of coverage under a health-care plan. If the enrollee obtains coverage under a health-care plan through an insurance policy or a contract issued by a nonprofit hospital, medical-surgical, and health service corporation, whether by option or otherwise, the insurer or the nonprofit hospital, medical-surgical, and health service corporation shall issue the evidence of coverage. Otherwise, the health maintenance organization shall issue the evidence of coverage.      The commissioner may establish, by rule, the required elements of an evidence of coverage, which must:   Not contain any provisions or statements that are unjust, unfair, inequitable, misleading, or deceptive; encourage misrepresentation; or are untrue, misleading, or deceptive as defined in section 10-16-413 (1); and    Contain a clear and complete statement, if a contract, or a reasonably complete summary, if a certificate, of:   The health-care services and the insurance or other benefits, if any, to which the enrollee is entitled under the health-care plan, including the ability to obtain a second opinion for proposed treatment by the health-care provider, if the health benefit plan provides such coverage;    Any limitations on the services, kind of services, benefits, or kind of benefits to be provided, including any deductible or copayment feature;    Where and in what manner information is available as to how services may be obtained;    The total amount of payment for health-care services and the indemnity or service benefits, if any, that the enrollee is obligated to pay with respect to individual contracts, or an indication whether the plan is contributory or noncontributory with respect to group certificates;    A clear and understandable description of the health maintenance organization's method for resolving enrollee complaints.          The carrier may evidence a subsequent change in coverage in a separate document issued to the enrollee.    A copy of the form of the evidence of coverage to be used in this state, and any amendment to the form, is subject to the filing and approval requirements of section 10-16-107.2.         History. Source: L. 92: Entire article R&RE, p. 1700, § 1, effective July 1. L. 2013: Entire section amended with relocations,(HB 13-1266), ch. 217, p. 980, § 33, effective May 13.    Editor's note:      This section is similar to former § 10-17-108 as it existed prior to 1992. (1) (a) This section is similar to former § 10-17-108 as it existed prior to 1992.    Subsection (2) is similar to § 10-16-107 (3)(b), (3)(c), and (3)(d) as they existed prior to 2013.
CO Code § 10-16-408 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-408. Open Enrollment

  After a health maintenance organization has been in operation twenty-four months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. A health maintenance organization may apply to the commissioner for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high or unmarketable charges for enrollee coverage for health-care services. The commissioner shall approve or deny such application within thirty days of the receipt thereof from the health maintenance organization.    Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in subsection (1) of this section to all members of the group or groups covered by such contracts.    Except as provided in subsection (2) of this section, the enrollment policies of health maintenance organizations may not be such as to prevent or hinder the enrollment by, or in any other manner discriminate against, persons eligible for medical benefits under Titles XVIII and XIX of the federal “Social Security Act” as authorized under Public Law 89-97; such policies shall be grounds for suspension or revocation of the organization's certificate of authority issued pursuant to this article.     History. Source: L. 92: Entire article R&RE, p. 1701, § 1, effective July 1.    Editor's note:   This section is similar to former § 10-17-111 as it existed prior to 1992.
CO Code § 10-16-409 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-409. Complaint System

     Every health maintenance organization shall establish and maintain a complaint system that has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health-care services.    Each health maintenance organization shall maintain written records relating to its complaint system in a form prescribed by the commissioner, for examination by the commissioner, which form must include:   A description of the procedures of such complaint system;    The total number of complaints handled through such complaint system and a compilation of causes underlying the complaints filed;    The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization and any of the providers used by it which involve services covered by the health maintenance organization.          The health maintenance organization shall maintain records of written complaints filed with it concerning other than health-care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. Such complaints involving other persons shall be referred to such persons with a copy to the commissioner.    The commissioner may examine the complaint system required by subsection (1) of this section, subject to the limitations concerning medical records of individuals set forth in section 10-16-416 (3).     History. Source: L. 92: Entire article R&RE, p. 1701, § 1, effective July 1. L. 2017: (1)(a), IP(1)(b), and (3) amended,(SB 17-249), ch. 283, p. 1545, § 8, effective June 1.    Editor's note:   This section is similar to former § 10-17-112 as it existed prior to 1992.   ANNOTATION   No conflict exists between the Health Care Availability Act and the Colorado Health Maintenance Organization Act. An agreement to arbitrate professional negligence claims obtained on behalf of persons or entities that unquestionably are health care providers must comply with the provisions of the Health Care Availability Act. Evans v. Colo. Permanente Medical Group, P.C., 902 P.2d 867 (Colo. App. 1995), aff'd, 926 P.2d 1218 (Colo. 1996).   If dispute resolution procedures include arbitration of professional negligence claims against health care providers who provide medical services, the patient must be notified of this fact in a manner consistent with the Health Care Availability Act requirements; this section does not conflict with requirements of that act. Evans v. Colo. Permanente Medical Group, P.C., 902 P.2d 867 (Colo. App. 1995), aff'd, 926 P.2d 1218 (Colo. 1996).
CO Code § 10-16-410 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-410. Investments

 With the exception of investments made in accordance with section 10-16-403 (1)(a) and (2), the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the commissioner may permit.   History. Source: L. 92: Entire article R&RE, p. 1702, § 1, effective July 1.    Editor's note:   This section is similar to former § 10-17-113 as it existed prior to 1992.
CO Code § 10-16-413 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-413. Prohibited Practices

  No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of part 1 of this article and this part 4:   A statement or item of information is deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health-care plan.    A statement or item of information is deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person not possessing special knowledge regarding health-care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health-care plan, if such benefit or advantage or absence of limitation, exclusion, or disadvantage does not in fact exist.    An evidence of coverage is deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health-care plans and evidences of coverage therefor, to expect benefits, services, charges, or other advantages which the evidence of coverage does not provide or which the health-care plan issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.       Part 11 of article 3 of this title shall apply to health maintenance organizations, health-care plans, and evidences of coverage except to the extent that the commissioner determines that the nature of health maintenance organizations, health-care plans, and evidences of coverage render such article clearly inapplicable.    An enrollee may not be canceled or nonrenewed on the basis of the status of such enrollee's health.    No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words “insurance”, “casualty”, “surety”, “mutual”, or any other words descriptive of the insurance, casualty, or surety business and shall be distinguishable on the records of the secretary of state from the name or description of any insurance or surety corporation doing business in this state.     History. Source: L. 92: Entire article R&RE, p. 1705, § 1, effective July 1. L. 2000: (4) amended, p. 988, § 104, effective July 1.    Editor's note:   This section is similar to former § 10-17-115 as it existed prior to 1992.
CO Code § 10-16-414 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-414. Regulation of Agents

 The commissioner may, after notice and hearing, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents. An agent means a person directly or indirectly associated with a health-care plan who engages in solicitation or enrollment.   History. Source: L. 92: Entire article R&RE, p. 1706, § 1, effective July 1.    Editor's note:   This section is similar to former § 10-17-116 as it existed prior to 1992.
CO Code § 10-16-415 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-415. Powers of Insurers and Nonprofit Hospital, Medical-Surgical, and Health Service Corporations

  An insurance company licensed in this state, or a nonprofit hospital, medical-surgical, and health service corporation authorized to do business in this state, may either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of part 1 of this article and this part 4. Notwithstanding any other law which may be inconsistent, any two or more such insurance companies, nonprofit hospital, medical-surgical, and health service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. An insurance company shall not be considered in violation of the laws regulating insurance by the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.    Notwithstanding any other provision of law, an insurer or a nonprofit hospital, medical-surgical, and health service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts, the insurer or nonprofit hospital, medical-surgical, and health service corporation may make benefit payments to health maintenance organizations for health-care services rendered by providers pursuant to contracts with health maintenance organizations.     History. Source: L. 92: Entire article R&RE, p. 1706, § 1, effective July 1.    Editor's note:   This section is similar to former § 10-17-117 as it existed prior to 1992.
CO Code § 10-16-418 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-418. Rehabilitation, Liquidation, or Conservation of Health Maintenance Organization

  Any rehabilitation, liquidation, or conservation of a health maintenance organization is deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies, except as otherwise provided in this section.    A provider which has not expressly agreed to hold enrollees harmless if the provider is not paid by the health maintenance organization may elect to take the priority of a person stated in section 10-3-541 (1)(b); except that, if such election is made, the claim by such provider shall only be paid upon condition that the provider shall not assert such claim against any enrollee of the health maintenance organization.     History. Source: L. 92: Entire article R&RE, p. 1709, § 1, effective July 1. L. 94: (2) amended, p. 1630, § 28, effective May 31.    Editor's note:   This section is similar to former § 10-17-120 as it existed prior to 1992.   Cross references:   For provisions pertaining to the rehabilitation and liquidation of insurers, see part 5 of article 3 of this title 10.
CO Code § 10-16-419 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-419. Administrative Procedures

  When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least twenty days but, in the case of a denial, not more than sixty days thereafter for a hearing on the matter.    After a hearing held pursuant to subsection (1) of this section or upon the failure of the health maintenance organization to appear at the hearing, the commissioner shall take action as is deemed advisable on written findings, which shall be mailed to the health maintenance organization.    The provisions of article 4 of title 24, C.R.S., shall apply to proceedings under this section to the extent they are not in conflict with subsections (1) and (2) of this section, and any final action of the commissioner pursuant to this section shall be subject to judicial review by the court of appeals.     History. Source: L. 92: Entire article R&RE, p. 1710, § 1, effective July 1; (3) amended, p. 1600, § 125, effective July 1. L. 2017: (1) and (2) amended,(SB 17-249), ch. 283, p. 1547, § 11, effective June 1.    Editor's note:   This section is similar to former § 10-17-122 as it existed prior to 1992.   Cross references:   For judicial review by the court of appeals, see § 24-4-106 .
CO Code § 10-16-421 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-421. Statutory Construction and Relationship to Other Laws

  Except for sections 10-1-102, 10-1-116, 10-1-117, 10-1-118, 10-3-128, and 10-3-208, part 2 of article 1 of this title, and parts 4 to 8 of article 3 of this title, and as otherwise provided in this article, the provisions of the insurance law and provisions of nonprofit hospital, medical-surgical, and health service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this part 4.    Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed as violating any provision of law relating to solicitation or advertising by health professionals; but such health professionals shall be individually subject to the laws, rules and regulations, and ethical provisions governing their individual profession.    Any health maintenance organization authorized under part 1 of this article and this part 4 shall not be deemed to be practicing medicine and shall be exempt from the provisions of laws relating to the practice of medicine.     History. Source: L. 92: Entire article R&RE, p. 1712, § 1, effective July 1; (1) amended, p. 1600, § 127, effective July 1. L. 94: (1) amended, p. 1630, § 30, effective May 31. L. 97: (1) amended, p. 93, § 4, effective March 24. L. 99: (1) amended, p. 84, § 4, effective July 1. L. 2001: (1) amended, p. 287, § 13, effective March 30; (1) amended, p. 1050, § 34, effective July 1. L. 2003: (1) amended, p. 618, § 19, effective July 1. L. 2004: (1) amended, p. 991, § 13, effective August 4. L. 2013: (1) amended,(HB 13-1115), ch. 338, p. 1972, § 12, effective March 31, 2015. L. 2014: (1) amended,(HB 14-1315), ch. 295, p. 1218, §§ 9, 10, effective January 1, 2015. L. 2016: (1) amended,(SB 16-189), ch. 210, p. 757, § 17, effective June 6.    Editor's note:    This section is similar to former § 10-17-125 as it existed prior to 1992.    Amendments to subsection (1) by House Bill 01-1064 and House Bill 01-1319 were harmonized.     ANNOTATION   Breach of contract or tort claim may not be brought against a health maintenance organization for negligently providing or failing to provide medical services and plaintiffs' attempt to distinguish “health care services” from “medical services” was not factually presented to the trial court in a timely manner. Evans v. Colo. Permanente Medical Group, P.C., 902 P.2d 867 (Colo. App. 1995), aff'd in part and rev'd in part on other grounds, 926 P.2d 1218 (Colo. 1996).   “Provisions of the insurance law” construed. In subsection (1), “provisions of the insurance law”, when read in the context of this article (on health maintenance organizations), refers to the provisions of title 10 concerning general statutory regulations of the insurance industry. Rederscheid v. Comprecare, Inc., 667 P.2d 766 (Colo. App. 1983).
CO Code § 10-16-421.5 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 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.   History. Source: L. 92: Entire section added, p. 1600, § 128, effective July 1. L. 2014: Entire section amended,(SB 14-152), ch. 312, p. 1354, § 3, effective July 1.
CO Code § 10-16-422 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-422. Filings and Reports as Public Documents

 All applications, filings, and reports required under part 1 of this article and this part 4 shall be treated as public documents.   History. Source: L. 92: Entire article R&RE, p. 1712, § 1, effective July 1.    Editor's note:   This section is similar to former § 10-17-126 as it existed prior to 1992.
CO Code § 10-16-423 (2021)
2021 Colorado Code|Title 10 - Insurance|Article 16 - Health Care Coverage|Part 4 - Health Maintenance Organizations|§ 10-16-423. Confidentiality of Health Information

 Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of part 1 of this article or this part 4; or upon the express consent of the enrollee or applicant; or pursuant to statute or court order for the production of evidence or the discovery thereof; or in the event of claim or litigation between such person and the health maintenance organization wherein such data or information is pertinent; or as otherwise required or permitted by state or federal law. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure that the provider, who furnished such information to the health maintenance organization, is entitled to claim.   History. Source: L. 92: Entire article R&RE, p. 1712, § 1, effective July 1. L. 2003: Entire section amended, p. 1785, § 18, effective July 1.    Editor's note:   The provisions of this section were 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.   ANNOTATION   A patient's medical record may be examined by the patient's health maintenance organization (HMO) to the extent it is relevant to the claims against the HMO when the patient sues the HMO for the medical care it provided to the patient. A review of the patient's complete medical record is relevant to the HMO's ability to prepare a defense. Ortega v. Colo. Permanente Med. Group, P.C., 265 P.3d 444 (Colo. 2011).