reglab/statecodes huggingface dataset:
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-145.5 - Step therapy - prior authorization - prohibited - stage four advanced metastatic cancer - opioid prescription - definitions

[
Editor's note: For the applicability of this section on or after January 1, 2024, see the editor's note following this section.
]
(1)
Notwithstanding section
10-16-145
, a carrier that provides coverage under a health benefit plan for the treatment of stage four advanced metastatic cancer shall not limit or exclude coverage under the health benefit plan for a drug that is approved by the FDA and that is on the carrier's prescription drug formulary by mandating that a covered person with stage four advanced metastatic cancer undergo step therapy if the use of the approved drug is consistent with:
(a)
The FDA-approved indication or the National Comprehensive Cancer Network drugs and biologics compendium indication for the treatment of stage four advanced metastatic cancer; or
(b)
Peer-reviewed medical literature.
(2)
Notwithstanding section
10-16-145
, a carrier that provides prescription drug benefits shall:
(a)
Provide coverage for at least one atypical opioid that has been approved by the FDA for the treatment of acute or chronic pain at the lowest tier of the carrier's drug formulary and not require step therapy or prior authorization, as defined in section
10-16-112.5 (7)(d)
, for that atypical opioid; and
(b)
Not require step therapy for the prescription and use of any additional atypical opioid medications that have been approved by the FDA for the treatment of acute or chronic pain.
(3)
As used in this section:
(a)
"A typical opioid" means an opioid agonist with a documented safer side-effect profile and less risk of addiction than older opium-based medications.
(b)
"Stage four advanced metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body.
(c)
"Step therapy" has the same meaning as specified in section
10-16-145 (1)(g)
.
Added by 2022 Ch. 184, § 5, eff. 8/10/2022, app. to health benefit plans issued or renewed on or after 1/1/2023 ..
Added by 2022 Ch. 184, § 4, eff. 8/10/2022, app. to health benefit plans issued or renewed on or after 1/1/2023 ..
Amended by 2021 Ch. 364, § 3, eff. 1/1/2023.
Added by 2018 Ch. 109, § 2, eff. 1/1/2019.
L. 2018: Entire section added, (HB 18-1148), ch. 799, p. 799, § 2, effective 1/1/2019.
2022 Ch. 184, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2022 Ch. 184, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-146 - Periodic updates to provider directory

Each carrier shall, at least every thirty days, update its provider directory as posted on the carrier's website in accordance with the information contained on the websites maintained by the applicable health-care prescriber board, as that term is defined in section
12-30-104
, to remove a provider whose license has been revoked or suspended by the applicable health-care prescriber board.
Amended by 2019 Ch. 136,§ 53, eff. 10/1/2019.
Added by 2017 Ch. 377,§ 1, eff. 6/6/2017.
L. 2017: Entire section added, (HB 17-1165), ch. 377, p. 1944, § 1, effective June 6.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-148 - Medication-assisted treatment - limitations on carriers - rules

(1)
Notwithstanding any provision of law to the contrary, beginning January 1, 2020, a carrier that provides prescription drug benefits for the treatment of substance use disorders shall, for prescription medications that are on the carrier's formulary:
(a)
Not impose prior authorization requirements on any prescription medication approved by the FDA for the treatment of substance use disorders;
(b)
Not impose any step therapy requirements as a prerequisite for coverage for a prescription medication approved by the FDA for the treatment of substance use disorders;
(c)
Place at least one covered prescription medication approved by the FDA for the treatment of substance use disorders on the lowest tier of the drug formulary developed and maintained by the carrier; and
(d)
Not exclude coverage for any prescription medication approved by the FDA for the treatment of substance use disorders and any associated counseling or wraparound services solely on the grounds that the medications and services were court ordered.
(1.5)
The commissioner, in consultation with the department of public health and environment, may promulgate rules or seek a revision to the prescription drug benefits required under the essential health benefits package concerning prescription medications that must be included on a carrier's formulary for medication-assisted treatment of substance use disorders.
(2)
Repealed.
Amended by 2022 Ch. 126,§5, eff. 8/10/2022.
Amended by 2020 Ch. 286,§8, eff. 7/13/2020.
Added by 2019 Ch. 195,§10, eff. 5/16/2019.
L. 2019: Entire section added, (HB 19-1269), ch. 2131, p. 2131, § 10, effective May 16. L. 2020: (1.5) added, (SB 20-007), ch. 1391, p. 1391, § 8, effective July 13.
Section 17 of chapter 195 (HB 19-1269), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 16, 2019.
2022 Ch. 126, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-149 - [Repealed]

Added by 2019 Ch. 195, § 10, eff. 5/16/2019.
L. 2019: Entire section added, (HB 19-1269), ch. 2131, p. 2131, § 10, effective May 16.
Section 17 of chapter 195 (HB 19-1269), Session Laws of Colorado 2019, provides that the act adding this section applies to conduct occurring on or after May 16, 2019.
For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 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.
Amended by 2021 Ch. 437,§ 2, eff. 9/7/2021.
Added by 2019 Ch. 248,§ 2, eff. 8/2/2019 and applicable to health coverage plans issued or renewed on or after 1/1/2020, or the date of the official declaration of the vote by the governor, whichever is later.
L. 2019: Entire section added, (HB 19-1216), ch. 2419, p. 2419, § 2, effective August 2.
Section 5 of chapter 248 (HB 19-1216), Session Laws of Colorado 2019, provides that the act adding this section applies to health coverage plans issued or renewed on or after January 1, 2020, or the date of the official declaration of the vote by the governor, whichever is later.
For the legislative declaration in HB 19-1216, see section 1 of chapter 248, Session Laws of Colorado 2019. For the legislative declaration in HB 21-1307, see section 1 of chapter 437, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-152 - HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repeal

(1)
A carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a pharmacist may, pursuant to section
12-280-125.7
, prescribe or dispense an HIV prevention drug.
(2)
Before July 1, 2027, a carrier shall not require a covered person to undergo step therapy or to receive prior authorization before a provider may, acting within the provider's scope of practice, prescribe or dispense any drug approved by the FDA and used for the treatment or prevention of HIV that is included on the carrier's prescription drug formulary as of March 1, 2023.
(3)
(a)
The division shall contract with one or more entities to conduct a study that includes qualitative patient and provider experience information and an actuarial review to consider the predicted cost and health impacts of removing the requirement for a covered person to undergo step therapy or to receive prior authorization before a provider may, acting within the provider's scope of practice, prescribe or dispense a drug for the treatment of HIV. In conducting the study, the entity contracted to perform the study must consult with community organizations led by people living with HIV. The division shall provide the completed study to the general assembly no later than October 1, 2026.
(b)
This subsection (3) is repealed, effective July 1, 2027.
Amended by 2023 Ch. 69,§ 3, eff. 4/14/2023.
Added by 2020 Ch. 281, § 3, eff. 7/13/2020.
L. 2020: Entire section added, (HB 20-1061), ch. 1375, p. 1375, § 3, effective July 13.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-153 - Coverage for opioid antagonists provided by a hospital - definition

(1)
As used in this section, unless the context otherwise requires, "opioid antagonist" has the same meaning as set forth in section
12-30-110 (7)(d)
.
(2)
A carrier that provides coverage for opioid antagonists pursuant to the terms of a health coverage plan the carrier offers shall reimburse a hospital for the hospital's cost of an opioid antagonist if the hospital gives a covered person an opioid antagonist upon discharge from the hospital.
Amended by 2024 Ch. 458,§ 8, eff. 6/6/2024.
Added by 2020 Ch. 287, § 1, eff. 9/14/2020.
L. 2020: Entire section added, (HB 20-1065), ch. 1419, p. 1419, § 1, effective September 14.
This section was numbered as § 10-16-154 in HB 20-1065 but was renumbered on revision for ease of location.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-154 - Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcement

(1)
A carrier that has a contract with a physical therapist, an occupational therapist, a chiropractor, or an acupuncturist shall not:
(a)
Prohibit the physical therapist, occupational therapist, chiropractor, or acupuncturist from providing a covered person information on the amount of the covered person's financial responsibility for the physical therapy, occupational therapy, chiropractic services, or acupuncture services provided to the covered person;
(b)
Penalize the physical therapist, occupational therapist, chiropractor, or acupuncturist for disclosing the information described in subsection (1)(a) of this section to a covered person or providing a more affordable alternative to a covered person; or
(c)
Require the physical therapist, occupational therapist, chiropractor, or acupuncturist to charge an amount to a covered person or collect a copayment from a covered person that exceeds the total charges submitted to the carrier by the physical therapist, occupational therapist, chiropractor, or acupuncturist.
(2)
If the commissioner determines that a carrier has not complied with this section, the commissioner shall require the carrier to develop and provide to the division for approval a corrective action plan or use any of the commissioner's enforcement powers under this title 10 to ensure the carrier's compliance with this section.
Added by 2021 Ch. 364,§ 4, eff. 7/1/2021.
For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-155.5 - Actuarial review of doula services - report - definition

(1)
The division shall contract with an independent entity to conduct an actuarial review of the potential health-care costs and benefits of including coverage for doula services for pregnant and postpartum persons covered by health benefit plans.
(2)
The division shall present the results from the actuarial review conducted pursuant to subsection (1) of this section to the general assembly as part of the division's "SMART Act" presentation required by section
2-7-203
during state fiscal year 2024-25.
(3)
As used in this section, unless the context otherwise requires, "doula" means a trained birth companion who provides personal, nonmedical support to pregnant and postpartum people and their families prior to childbirth, during labor and delivery, and during the postpartum period.
Added by 2023 Ch. 279,§ 3, eff. 5/30/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-158 - Treatment of sexually transmitted infection - cost sharing - rules - definition

(1)
For health benefit plans issued or renewed on or after January 1, 2025, if the treatment of a sexually transmitted infection, as defined in section
25-4-402 (10)
, is a covered service, the health benefit plan must provide the coverage without deductibles, copayments, coinsurance, annual or lifetime maximum benefit limits, or other cost sharing for or limits on the coverage for the treatment of a sexually transmitted infection.
(2)
The provisions of this section do not apply to a high deductible health benefit plan pursuant to
26 U.S.C. sec. 223
, as amended, issued or renewed in this state until an eligible insured's deductible has been met, unless allowed pursuant to federal law.
(3)
The commissioner may promulgate rules to implement this section.
(4)
As used in this section, "treatment" means medically necessary care for the management of the existing sexually transmitted infection.
Added by 2023 Ch. 69,§ 4, eff. 4/14/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-159 - Coverage for sterilization services - cost sharing

(1)
For health benefit plans issued or renewed on or after January 1, 2025, if sterilization services are a covered service, the health benefit plan must provide the coverage regardless of the covered person's sex or gender and without deductibles, copayments, coinsurance, annual or lifetime maximum benefit limits, or other cost sharing for or limits on the coverage for sterilization services.
(2)
The provisions of this section do not apply to a high deductible health benefit plan pursuant to
26 U.S.C. sec. 223
, as amended, issued or renewed in this state until an eligible insured's deductible has been met, unless allowed pursuant to federal law.
Added by 2023 Ch. 69,§ 4, eff. 4/14/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-160 - Cost sharing - prescription epinephrine - limits - rules - definition

(1)
As used in this section, unless the context otherwise requires, "epinephrine auto-injector" has the same meaning as set forth in section
12-280-142 (1)(c)
.
(2)
For health coverage plans issued or renewed on or after January 1, 2024, if a carrier provides coverage for prescription epinephrine auto-injectors, the carrier shall cap the total amount that a covered person is required to pay for all covered prescription epinephrine auto-injectors at an amount not to exceed sixty dollars for a two-pack of epinephrine auto-injectors, regardless of the amount or type of epinephrine needed to fill the covered person's prescription.
(3)
Nothing in this section prevents a carrier from reducing a covered person's cost sharing to an amount that is lower than the amount specified in subsection (2) of this section.
(4)
The coverage required by this section may be offered through a high deductible plan that includes a health savings account pursuant to
26 U.S.C. sec. 223
of the federal "Internal Revenue Code of 1986"; except that a carrier may apply deductible amounts for the required coverage if the coverage is not considered by the United States department of the treasury to be preventive or to have an acceptable deductible amount.
(5)
The commissioner may use any of the commissioner's enforcement powers to obtain a carrier's compliance with this section.
(6)
The commissioner may promulgate rules as necessary to implement and administer this section and to align with federal requirements.
Added by 2023 Ch. 447,§ 2, eff. 8/7/2023.
2023 Ch. 447, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-162 - Prohibition on discrimination for coverage based solely on natural medicine consumption - definitions

(1)
A carrier that offers, issues, or renews a health benefit plan shall not, solely on the basis of a person's consumption of natural medicine or natural medicine product:
(a)
Decline or limit coverage of a person; or
(b)
Penalize a covered person or reduce or limit coverage for a person.
(2)
A carrier that offers, issues, or renews a health benefit plan that provides coverage for anatomical gifts, organ transplants, or related treatments or services shall not, solely on the basis of a covered person's consumption of natural medicine or natural medicine product:
(a)
Deny coverage to a covered person for an organ transplant or related treatment or services;
(b)
Decline or limit coverage of a covered person solely for the purpose of avoiding the requirements of this section; or
(c)
Penalize a covered person or reduce or limit coverage for a covered person for health-care services related to organ transplantation, as determined in consultation with the attending physician and the covered person or the covered person's representative.
(3)
This section does not require a health benefit plan to provide coverage for the donation of an anatomical gift, an organ transplant, or related treatment or services.
(4)
As used in this section, unless the context otherwise requires:
(a)
"Anatomical gift" means the donation of part of a human body for the purpose of transplantation to another person.
(b)
(I)
"Natural medicine" means the following substances:
(A)
Dimethyltryptamine;
(B)
Mescaline;
(C)
Ibogaine;
(D)
Psilocybin; or
(E)
Psilocin.
(II)
"Natural medicine" does not mean a synthetic or synthetic analog of the substances listed in this subsection (4)(b), including a derivative of a naturally occurring compound of natural medicine that is produced using chemical synthesis, chemical modification, or chemical conversion.
(c)
"Natural medicine product" means a product infused with natural medicine that is intended for consumption.
Amended by 2024 Ch. 452,§ 1, eff. 6/6/2024.
Added by 2023 Ch. 249,§ 32, eff. 7/1/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-164 - Hospital facility fee report - data collection

The commissioner is authorized to collect from a carrier offering a health benefit plan information specified in section
25.5-4-216
, if available, for purposes of facilitating the development of the report relating to facility fees.
Added by 2023 Ch. 277,§ 2, eff. 5/30/2023.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-166 - Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rules

(1)
(a)
Every health benefit plan subject to part 2, 3, or 4 of this article 16, except those described in section
10-16-102 (32)(b)
, shall not utilize the body mass index, ideal body weight, or any other standard requiring an achieved weight when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder, including but not limited to bulimia nervosa, atypical anorexia nervosa, binge-eating disorder, avoidant restrictive food intake disorder, and other specified feeding and eating disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(b)
Subsection (1)(a) of this section does not apply when determining medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype, or binge-eating/purging subtype; however, body mass index, ideal body weight, or any other standard requiring an achieved body weight must not be the determining factor when assessing medical necessity or the appropriate level of care for an individual diagnosed with anorexia nervosa, restricting subtype, or binge-eating/purging subtype.
(2)
The following factors, at a minimum, must be considered when determining medical necessity or the appropriate level of care for an individual diagnosed with an eating disorder:
(a)
The individual's eating behaviors;
(b)
The individual's need for supervised meals and support interventions;
(c)
Laboratory results, including but not limited to, the individual's heart rate, renal or cardiovascular activity, and blood pressure;
(d)
The recovery environment; and
(e)
Co-occurring disorders the individual may have.
(3)
The commissioner may promulgate rules as necessary to implement and enforce this section.
Added by 2023 Ch. 275,§ 1, eff. 1/1/2024.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-167 - [Effective 8/7/2024] Medical aid-in-dying - carrier prohibitions

(1)
A carrier shall not:
(a)
Deny or alter benefits otherwise available to a covered individual with a terminal disease based on the availability of medical aid-in-dying pursuant to article 48 of title 25.
(b)
Attempt to coerce an individual with a terminal disease to make a request for medical aid-in-dying medication.
Added by 2024 Ch. 406,§ 20, eff. 8/7/2024.
2024 Ch. 406, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-169 - Carriers - prescription drug coverage - transparency - violation

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.
Added by 2024 Ch. 411,§ 1, eff. 6/5/2024.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-201.5 - [Repealed]

Repealed by 2013 Ch. 217, § 28, eff. 5/13/2013.
L. 96: Entire section added, p. 458, § 1, effective July 1. L. 97: Entire section amended, p. 640, § 8, effective May 1. L. 98: (8) added, p. 691, § 1, effective May 18. L. 99: IP(1), (1)(d), and (2) amended, p. 199, § 5, effective 1/1/2000. L. 2001: IP(6), (6)(a), and (6)(b) amended and (6)(d) added, p. 812, § 4, effective 1/1/2002. L. 2002: (1)(d) amended, p. 1295, § 9, effective June 7. L. 2004: (2) amended, p. 1319, § 1, effective May 28; (1)(f) amended, p. 990, § 11, effective August 4. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, § 28, effective May 13.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-204 - Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance

If any provision of part 1 of this article or this part 2 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
L. 92: Entire article R&RE, p. 1669, § 1, effective July 1.
This section is similar to former § 10-8-106 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-205 - Order of certain policy provisions in individual policies of sickness and accident insurance

The provisions which are the subject of sections
10-16-202
and
10-16-203
, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections, or, at the option of the insurer, any such provision may appear as a unit in any part of the policy with other provisions to which it may be logically related, but the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.
L. 92: Entire article R&RE, p. 1669, § 1, effective July 1.
This section is similar to former § 10-8-107 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 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.
L. 92: Entire article R&RE, p. 1670, § 1, effective July 1.
This section is similar to former § 10-8-108 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-207 - Requirements of other jurisdictions

(1)
Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of part 1 of this article and this part 2 and which is prescribed or required by the law of the state under which the insurer is organized.
(2)
Any policy of a domestic insurer, when issued for delivery in any other state or country, may contain any provision permitted or required by the laws of such other state or country.
L. 92: Entire article R&RE, p. 1670, § 1, effective July 1.
This section is similar to former § 10-8-109 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 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.
L. 92: Entire article R&RE, p. 1670, § 1, effective July 1.
This section is similar to former § 10-8-110 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-209 - Application for policy

(1)
The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof. If any such policy delivered or issued for delivery to any person in this state is reinstated or renewed, and the insured or the beneficiary or assignee of such policy makes written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer, within fifteen days after the receipt of such request at its home office or any branch office of the insurer, shall deliver or mail to the person making such request a copy of such application. If such copy is not so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal.
(2)
No alteration of any written application for any such policy shall be made by any person other than the applicant without the applicant's written consent; except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
(3)
The falsity of any statement in the application for any policy covered by part 1 of this article or this part 2 may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
L. 92: Entire article R&RE, p. 1670, § 1, effective July 1.
This section is similar to former § 10-8-111 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-210 - Notice - waiver

The acknowledgment by any insurer of the receipt of notice given under any policy covered by part 1 of this article or this part 2, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim under such policy shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
L. 92: Entire article R&RE, p. 1671, § 1, effective July 1.
This section is similar to former § 10-8-112 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-211 - Age limit

If any such policy contains a provision establishing, as an age limit or otherwise, a date after which coverage provided by the policy will not be effective, and if such date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which the premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased prior to the acceptance of such premium, the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
L. 92: Entire article R&RE, p. 1671, § 1, effective July 1.
This section is similar to former § 10-8-113 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-212 - Exemption from attachment and execution

So much of any benefits under all policies of sickness and accident insurance as does not exceed two hundred dollars for each month during any period of disability covered by such policy shall not be liable to attachment, trustee process, or other process, or to be seized, taken, appropriated, or applied by any legal or equitable process or by operation of law, either before or after payment of such benefits, to pay any debt or liabilities of the person insured under such policy. This exemption shall not apply where an action is brought to recover for necessaries contracted for during such period and the writ or complaint contains a statement to that effect. When a policy provides for a lump sum payment because of a dismemberment or other loss insured, such payment shall be exempt from execution by the insured's creditors.
L. 92: Entire article R&RE, p. 1672, § 1, effective July 1.
This section is similar to former § 10-8-114 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-213 - Industrial sickness and accident insurance

(1)
The term "industrial sickness and accident insurance", as used in this part 2, means sickness and accident insurance under individual policies for which the premium is payable weekly and includes any such policy which covers sickness only or accident only.
(2)
Any insurer authorized to write sickness and accident insurance in this state has the power to issue industrial sickness and accident policies.
(3)
No policy of industrial sickness and accident insurance may be delivered or issued for delivery in this state unless it has printed on such policy the words "industrial policy".
(4)
(a)
Each such policy shall be subject to the provisions of this part 2; except that no such policy shall be required to contain any of the policy provisions set forth in section
10-16-202
or
10-16-203
and except that no such policy shall contain any provision relative to notice of proof of loss, or the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the commissioner is less favorable to the insured than would be permitted by said policy provisions. Such policy may contain a provision that, upon proper written request, a named beneficiary shall be designated in or by endorsement on the policy to receive the proceeds thereof on the death of the insured, and there shall be reserved to the insured the power to change the beneficiary at any time by written notice to the insurer at its home office, accompanied by the policy for endorsement of the change on said policy by the insurer. The insurer shall have the right to refuse to designate a beneficiary if evidence satisfactory to the company of such beneficiary's insurable interest in the life of the insured is not furnished on request.
(b)
Any such policy may provide in substance that any payment under said policy may be made to the insured or the insured's estate or to any relative by blood or connection by marriage of the insured, or, to the extent of such portion of any payment under the policy as reasonably appears to the insurer to be due to such person or to any other person equitably entitled thereto by reason of having incurred expense occasioned by the maintenance or illness or burial of the insured. If the policy is in force at the death of the insured, the proceeds from said policy shall be payable to the named beneficiary if living, but, upon the expiration of fifteen days after the death of the insured, unless proof of claim in the manner and form required by the policy, accompanied by the policy for surrender, has theretofore been made by such beneficiary, the insurer may pay to any other person permitted by the policy.
L. 92: Entire article R&RE, p. 1672, § 1, effective July 1.
This section is similar to former § 10-8-115 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-216 - Examinations

(1)
The commissioner may, at any reasonable time, make or cause to be made an examination of every admitted health insurer transacting any insurance to which the provisions of part 1 of this article and this part 2 are applicable to ascertain whether each insurer and every rate used by it for every such class of insurance complies with the requirements and standards of this title applicable thereto. Such examination need not be a part of a periodic general examination participated in by representatives of more than one state.
(2)
The officers, managers, agents, and employees of any such insurer may be examined at any time under oath and shall exhibit all books, records, accounts, documents, or agreements governing its method of operation, together with all data, statistics, and information of every kind and character collected or considered by such insurer in the conduct of the operations to which such examination relates.
(3)
The commissioner may conduct such examination on the basis of concern for an insurer's solvency or the complaint of a person claiming to be aggrieved or to ascertain compliance by insurers with the requirements of part 1 of this article and this part 2.
(4)
Filed reports on examinations conducted pursuant to this section shall be available for public inspection at the division of insurance.
L. 92: Entire article R&RE, p. 1679, § 1, effective July 1; entire section amended, p. 1592, § 115, effective July 1.
This section is similar to former § 10-8-118 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-217 - Application of part 1 of this article and part 2

(1)
Nothing in part 1 of this article or this part 2 shall apply to or affect any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage in said policy; or life insurance, endowment, or annuity contracts, or contracts supplemental to said policy which contain only such provisions relating to sickness and accident insurance as provide additional benefits in case of death by accident, and as operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract.
(2)
With the exception of section
10-16-201(3)
, the provisions of sections
10-16-201
to
10-16-205
shall not apply to those forms of sickness and accident policies enumerated in sections
10-16-214
and
10-16-215
; except that no such policy shall contain any provision relative to notice or proof of loss, or the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the commissioner is less favorable to the insured than would be permitted by the policy provisions set forth in section
10-16-202
or
10-16-203
.
L. 92: Entire article R&RE, p. 1680, § 1, effective July 1.
This section is similar to former § 10-8-119 as it existed prior to 1992.
For provisions pertaining to workers' compensation, see articles 40 to 47 of title 8.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-218 - Judicial review

Any final action of the commissioner pursuant to part 1 of this article and this part 2 shall be subject to judicial review by the court of appeals pursuant to section
24-4-106(11)
, C.R.S.
L. 92: Entire article R&RE, p. 1680, § 1, effective July 1; entire section amended, p. 1596, § 118, effective July 1.
This section is similar to former § 10-8-120 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-219 - Benefits for care in tax-supported institutions - behavioral health disorders - mental health disorders - intellectual and developmental disabilities

(1)
On and after July 1, 1977, an individual or group policy of sickness, health, or accident insurance or small group sickness and accident insurance delivered or issued for delivery to any person in this state that provides coverage for behavioral or mental health disorders or intellectual and developmental disabilities must not exclude or be construed to diminish benefits for the payment of the direct costs, related directly to the treatment of such behavioral or mental health disorders or intellectual and developmental disabilities, provided by a state institution, including community clinics and centers providing services for persons with behavioral or mental health disorders or intellectual and developmental disabilities if the charges for treatment of such behavioral or mental health disorders or intellectual and developmental disabilities are customarily charged to nonindigent patients by the state institution.
(2)
Any policy issued on or after July 1, 1977, on a form approved prior to said date, containing any provisions in conflict with the provisions of this section shall be in effect only if there is attached to such policy at the time of issue a rider or endorsement amending such policy to conform to the provisions of this section.
Amended by 2017 Ch. 263,§ 38, eff. 5/25/2017.
L. 92: Entire article R&RE, p. 1680, § 1, effective July 1. L. 2017: (1) amended, (SB 17-242), ch. 263, p. 1266, § 38, effective May 25.
This section is similar to former § 10-8-123 as it existed prior to 1992.
For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-220 - Minimum standards for sickness and accident plans

The commissioner may promulgate regulations prescribing minimum standards applicable to the valuation of sickness and accident plans or products, and in conformance with standards as adopted by the national association of insurance commissioners.
L. 92: Entire section added, p. 1498, § 28, effective July 1.
This section was enacted by section 28 of chapter 203, Session Laws of Colorado 1992, as § 10-8-127 but was renumbered on revision and harmonized with this article since part 1 of article 8 was repealed and the substantive provisions thereof were moved to this article.