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 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-222 - Termination of policies

A carrier shall not retroactively terminate a policy issued pursuant to this part 2 except for fraud or intentional misrepresentation. For any termination other than for fraud or intentional misrepresentation, the carrier shall provide notice thirty days in advance of the cancellation of the policy.
Added by 2013 Ch. 217,§ 31, eff. 5/13/2013.
L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 980, § 31, 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-301 - Legislative declaration

(1)
It is the policy of the general assembly, and the intent and purpose of this article, to promote the availability of hospital care, medical-surgical care, and other health services on a voluntary nonprofit prepaid basis, and to thereby promote the health and welfare of the people of the state of Colorado.
(2)
It is further the policy of the general assembly to conform the laws of the state of Colorado to section 1012 of the federal "Tax Reform Act of 1986", as amended, to ensure uniform federal and Colorado income taxation treatment of nonprofit hospitals, medical-surgical, and health service corporations. The general assembly recognizes that health-care coverage may be offered to the citizens of this state by various entities with distinct organizational and functional forms. The placement of this part 3 in this article should in no way be construed so as to alter the distinct organizational and functional character of nonprofit hospital, medical-surgical, and health service corporations or to alter the legal distinctions between such corporations and other health-care coverage entities.
L. 92: Entire article R&RE, p. 1681, § 1, effective July 1.
This section is similar to former § 10-16-102 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-302 - Incorporation and organization - exemptions

(1)
Any nonprofit corporation organized under the laws of Colorado for the purpose of establishing, maintaining, and operating a nonprofit plan whereby prepaid hospital care, medical-surgical care, and other health services are made available to persons who become subscribers to the plan under a contract with the corporation, or for the purpose of providing long-term care insurance to persons pursuant to a contract with the corporation is subject to and governed by part 1 of this article 16 and this part 3 and, except as provided in this article 16 and elsewhere in this title 10, is not subject to the laws of this state relating to insurance or insurance companies. The provisions of section
10-3-128
; articles
1
and
2
of this title 10; and parts 4, 5, 7, 8, 11, 12, and 16 of article
3
of this title 10, to the extent applicable, govern corporations organized pursuant to this part 3.
(2)
The provisions of this part 3 shall not apply to any employer's health plan or services established and maintained solely for its employees and their immediate families, nor to any labor organization's health plan or services established and maintained solely for its members and their immediate families, which plans or services are self-insured, nor to any such health plan or services established, maintained, and insured jointly by any employer and any labor organization.
Amended by 2019 Ch. 188, § 4, eff. 8/2/2019.
Amended by 2016 Ch. 210, § 16, eff. 6/6/2016.
Amended by 2013 Ch. 338, § 11, eff. 3/31/2015.
L. 92: Entire article R&RE, p. 1681, § 1, effective July 1; (1) amended, p. 1597, § 118, effective July 1. L. 94: (1) amended, p. 596, § 2, effective April 7; (1) amended, p. 1648, § 90, effective May 31. L. 2001: (1) amended, p. 1050, § 33, effective July 1. L. 2013: (1) amended, (HB 13-1115), ch. 1972, p. 1972, § 11, effective 3/31/2015. L. 2016: (1) amended, (SB 16-189), ch. 757, p. 757, § 16, effective June 6. L. 2019: (1) amended, (HB 19-1291), ch. 2094, p. 2094, § 4, effective August 2.
(1) This section is similar to former § 10-16-103 as it existed prior to 1992.
(2) Amendments to subsection (1) by Senate Bill 94-206 and House Bill 94-1275 were harmonized.
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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-303 - Filing of articles of incorporation

(1)
Whenever any number of persons associate to form a corporation for any of the purposes named in section
10-16-302
, they shall submit articles of incorporation which shall be issued in triplicate to the commissioner and the attorney general for examination. After being approved by such officers, the articles shall be filed and recorded in the office of the secretary of state who shall issue a certificate of incorporation. A copy of such articles, certified by the secretary of state, shall be filed with the commissioner.
(2)
When not less than the amount required by section
10-16-310
is deposited with the commissioner, as provided for in this part 3, the commissioner shall cause an examination to be made either by the commissioner or some disinterested person, especially appointed by the commissioner for the purpose, who shall certify that the provisions of part 1 of this article and this part 3 have been complied with by said corporation, as far as applicable thereto. Such certificate shall be filed in the office of the commissioner, who shall thereupon deliver to such corporation a certified copy thereof, which, together with a copy of the articles of incorporation, shall be filed in the office of the clerk and recorder of the county wherein the principal office of the company is to be located, before the authority to commence business is granted.
(3)
Whenever any such corporation thereafter desires to amend its articles of incorporation, it shall file its certificate of amendment with the commissioner before filing the same with the secretary of state, and if the commissioner, with the advice of the attorney general, finds the same to have been legally adopted and to be in due legal form and not in conflict with the provisions of law governing such corporations, then, and not otherwise, such certificate of amendment shall be filed with the secretary of state.
(4)
Any corporation organized under the laws of this state relating to corporations not for profit prior to July 1, 1967, for the purposes named in section
10-16-302
, shall within one year after July 1, 1967, comply with all of the provisions of this section and shall thereupon become subject to and be governed by said provisions.
L. 92: Entire article R&RE, p. 1682, § 1, effective July 1.
This section is similar to former § 10-16-104 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-304 - Contents of articles

(1)
In addition to the contents required or permitted by the general corporation laws of this state relating to corporations not for profit, the articles of incorporation of any corporation shall comply with the following:
(a)
The name of the corporation shall not include the words "insurance", "casualty", "surety", "mutual", or any other words descriptive of the insurance, casualty, or surety business. The corporate name of any corporation formed under this article shall not be the same as and shall be distinguishable on the records of the secretary of state from the name of any other corporation authorized to do business in this state; and
(b)
The statement of purposes shall be in conformity with the provisions of part 1 of this article and this part 3.
(2)
Any such corporation organized prior to July 1, 1967, whose existing articles of incorporation shall not be in substantial conformity with part 1 of this article and this part 3 shall forthwith cause to be adopted and filed, as required in part 1 of this article and in this part 3 such amendments thereto as shall be necessary to effect substantial compliance with part 1 of this article and this part 3.
L. 92: Entire article R&RE, p. 1683, § 1, effective July 1. L. 2000: (1)(a) amended, p. 988, § 103, effective July 1.
This section is similar to former § 10-16-105 as it existed prior to 1992.
For corporation laws relating to corporations not for profit, see article 40 of title 7.
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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-305 - Directors

(1)
The property and lawful business of every such corporation subject to the provisions of part 1 of this article and this part 3 shall be held and managed by a board of trustees or directors with such powers and authority as shall be necessary or incidental to the complete execution of the purposes of each such corporation as limited by its articles or the bylaws. No such board shall be composed of less than ten nor more than twenty-four members. Every such corporation with annual gross subscription income exceeding one million dollars shall have a majority of its board consisting of persons who are not:
(a)
Members of the medical or nursing profession; or
(b)
Employed by a hospital or clinic or employed by a corporation subject to part 1 of this article and to this part 3; or
(c)
Otherwise directly or indirectly connected with hospitals or licensed health-care institutions or purveyors of health services in this state.
(2)
It is the duty of all members of a board of trustees or directors to represent the interests of the subscribers or members of health service plans of such corporation.
(3)
Any such corporation subject to the provisions of part 1 of this article and this part 3 shall keep correct and complete books and records of account and shall keep minutes of the proceedings of its board of trustees or directors and committees having authority of the board of trustees, and shall keep at its registered office or principal office in this state a record of the names and addresses of its subscribers or members of the health service plans of such corporation. All books and records, excluding privileged medical records and personal records of subscribers or members, of such corporation may be inspected by any subscriber, or his agent or attorney at the registered or principal office of the corporation, for any proper purpose at any reasonable time.
L. 92: Entire article R&RE, p. 1683, § 1, effective July 1.
This section is similar to former § 10-16-106 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-306 - Contracts - benefits for long-term care insurance

Corporations subject to the provisions of part 1 of this article and this part 3 may enter into contracts for the rendering of long-term care insurance, as defined in section
10-19-103(5)
, on behalf of any of their subscribers. Such contracts shall comply with article
19
of this title.
L. 92: Entire article R&RE, p. 1684, § 1, effective July 1.
This section is similar to former § 10-16-107 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-307 - Authority to do business

No corporation subject to the provisions of part 1 of this article and this part 3 shall transact any business in this state unless it first procures from the commissioner a certificate of authority stating that the requirements of the laws of this state have been complied with and authorizing it to do business. The certificate of authority shall expire on June 30 each year and shall be renewed annually if the corporation has continued to comply with the provisions of part 1 of this article and this part 3.
L. 92: Entire article R&RE, p. 1684, § 1, effective July 1; entire section amended, p. 1597, § 119, effective July 1.
This section is similar to former § 10-16-110 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-308 - Automatic extension of certificate

When the annual statement of a corporation subject to the provisions of part 1 of this article and this part 3 has been filed and all fees due from the corporation have been tendered, the corporation's certificate of authority to do business in this state shall automatically be extended until such time as the commissioner refuses to relicense such corporation, and when the fee involved in the renewal of an enrollment representative's license has been tendered by the corporation, or the individual representative, the license shall automatically be extended until such time as the commissioner refuses to renew such license.
L. 92: Entire article R&RE, p. 1685, § 1, effective July 1.
This section is similar to former § 10-16-111 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-309 - Requirements for certificate of authority

(1)
The commissioner shall not issue or renew a certificate of authority to any corporation operating or proposing to operate a nonprofit hospital, medical-surgical, and other health services plan, unless:
(a)
The subscription or membership certificates which the corporation offers to its subscribers or members, together with a schedule of the dues and fees to be paid by subscribers or members, have been filed with the commissioner in accordance with the provisions of section
10-16-107
;
(b)
The schedule of the dues and fees to be paid by subscribers or members is such as will enable such corporation to meet the expenses of the hospital, medical-surgical, and other health services which are made available to its subscribers or members without impairing the guarantee fund required by section
10-16-310
.
L. 92: Entire article R&RE, p. 1685, § 1, effective July 1.
This section is similar to former § 10-16-112 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-310 - Surplus - guarantee fund deposit - regulations

(1)
No corporation subject to the provisions of part 1 of this article and this part 3 shall be permitted to do any business in this state unless, in addition to the other requirements of law, it has and maintains surplus in an amount not less than five percent of the corporation's subscription income collected in the preceding year, not exceeding two million dollars, plus two and one-half percent of such income exceeding two million dollars but not exceeding ten million dollars, plus one percent of such income exceeding ten million dollars; but, in no event shall such surplus be less than one hundred thousand dollars. All corporations subject to the provisions of part 1 of this article and this part 3 shall place on deposit with the commissioner a guarantee fund of cash or approved securities in an amount determined by such formula, but not less than one hundred thousand dollars nor more than one million five hundred thousand dollars. Any amount of said surplus required by this subsection (1) and subsection (3) of this section in excess of one million five hundred thousand dollars shall be maintained by the corporation at all times, but shall not be required to be placed on deposit with the commissioner.
(2)
The cash or securities representing the guarantee fund required by this section shall be deposited with the commissioner under joint control in the same manner as prescribed in sections
10-3-206
,
10-3-210
, and
10-3-211
.
(3)
The regulations authorized in this subsection (3) are to be promulgated to avoid situations where the transactions of a corporation subject to the provisions of part 1 of this article and this part 3 would create undue financial risks to its subscribers or the people of this state. The commissioner may by regulation establish standards consistent with the risk-based capital models applicable to hospital, medical, and dental service or indemnity corporations developed or adopted by the national association of insurance commissioners which require any such corporation to maintain a greater minimum level of surplus than the specified dollar minimums established by subsection (1) of this section. Such minimum level of surplus shall reflect the type, volume, and nature of the business being transacted. Such regulations may additionally require the submission of an opinion by a qualified actuary which states whether or not the surplus level of the entity is sufficient.
L. 92: Entire article R&RE, p. 1685, § 1, effective July 1; (2) amended, p. 1597, § 120, effective July 1. L. 94: (1) amended and (3) added, p. 596, § 3, effective April 7. L. 96: (2) amended, p. 97, § 2, effective July 1.
This section is similar to former § 10-16-113 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-311 - Group benefits for depositors of banks - benefits for subscribers in public institutions

(1)
Nonprofit hospitals and health service corporations may contract with any bank located and doing business in any community in this state, the population of which does not exceed ten thousand inhabitants, as shown by the last preceding federal census, to provide group hospital and medical benefits for the depositors of such bank if the premiums are paid by the bank as holder of the master contract from authorized deductions from individual member depositors' accounts in such bank in accordance with applicable laws governing such deductions.
(2)
(a)
No certificate issued, renewed, or reinstated by a corporation subject to the provisions of part 1 of this article and this part 3 shall contain any provision which limits or excludes payments under hospital or medical benefits coverage to or on behalf of the subscriber because the subscriber or any covered dependent is eligible for or receiving medical assistance benefits under articles
4
,
5
, and
6
of title
25.5
, C.R.S.
(b)
The requirements of paragraph (a) of this subsection (2) shall apply to all such certificates issued, renewed, or reinstated on or after August 1, 1984.
L. 92: Entire article R&RE, p. 1686, § 1, effective July 1. L. 2006: (2)(a) amended, p. 1999, § 38, effective July 1.
The provisions of this section are similar to several former provisions of §
10-16-114
as they 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-312 - Contracts with other organizations

Any corporation subject to the provisions of part 1 of this article and this part 3 may contract with any agency, instrumentality, or political subdivision of the United States of America, or of the state of Colorado for the making available of hospital, medical-surgical, and other health-care services, and in aid or furtherance of such contract may accept, receive, and administer in trust, funds directly or indirectly made available by such agency, instrumentality, or political subdivision. Any such corporation may also subcontract with any organization which has contracted with any agency, instrumentality, or political subdivision of the United States of America or of the state of Colorado for the furnishing of hospital, medical-surgical, or other health services by which subcontract such corporation undertakes to furnish the services specified by the basic contract. Any corporation subject to the provisions of part 1 of this article and this part 3 may also enter into agreements or contracts with other similar organizations or corporations licensed to do business in this state or any other state for the transfer of subscribers or members, for the reciprocal or joint provision of benefits to the subscribers or members of such corporation and such organizations, or such other joint undertakings as the corporation's board of directors or trustees may approve.
L. 92: Entire article R&RE, p. 1687, § 1, effective July 1.
This section is similar to former § 10-16-116 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-313 - [Repealed]

L. 92: Entire article R&RE, p. 1687, § 1, effective July 1; (2) amended, p. 1598, § 121, effective July 1. L. 94: Entire section repealed, p. 597, § 4, effective April 7.
Prior to its repeal in 1994, the provisions of this section were similar to provisions of several former sections as they 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-314 - Payment for examinations of corporations

A corporation periodically examined by the commissioner shall pay to the commissioner the cost of such examination, as determined by the commissioner.
L. 92: Entire article R&RE, p. 1688, § 1, effective July 1. L. 94: Entire section amended, p. 598, § 5, effective April 7.
This section is similar to former § 10-16-120 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-316 - Complaints

Any individual subscriber of a corporation subject to the provisions of part 1 of this article and this part 3 who is aggrieved by any act or omission of such corporation or its officers, directors, agents, or representatives, may file a statement in writing of such grievance in the office of the commissioner and the commissioner may make such investigation of such grievance as the commissioner deems appropriate. No such investigation by the commissioner shall act as a bar to any suit in a court of competent jurisdiction instituted by any such member or subscriber, or any defense thereto by the corporation involved.
L. 92: Entire article R&RE, p. 1691, § 1, effective July 1.
This section is similar to former § 10-16-122 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-317 - Exemption of direct payment methods

Nothing contained in part 1 of this article or this part 3 shall be construed to affect or apply to hospitals, or other licensed health-care institutions, nor to any individuals, partnerships, associations, or corporations which are the direct purveyors of health services; nor shall anything contained in part 1 of this article or this part 3 be construed to in any way limit the rights of such hospitals, or other licensed health-care institutions or purveyors of health services, to establish methods of payment directly with the purchasers of their services; except such methods of payment by all corporations subject to part 1 of this article and this part 3 shall be on a prospective reimbursement basis as required by section
10-16-318
; but the commissioner may require from any such institution or purveyor of services such information as will enable the commissioner to determine whether any such arrangements for payment for services are subject to the provisions of part 1 of this article and this part 3.
L. 92: Entire article R&RE, p. 1691, § 1, effective July 1.
This section is similar to former § 10-16-124 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-319 - Effective date

Sections 10-16-317 and 10-16-318 shall take effect January 1, 1974, and shall be implemented with the beginning of each hospital's fiscal year.
L. 92: Entire article R&RE, p. 1693, § 1, effective July 1.
This section is similar to former § 10-16-133 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-320 - Investment of funds

The investable funds of a corporation subject to the provisions of part 1 of this article and this part 3 may only be invested in those types of investments which are permitted by law for the investment of the assets of life insurance companies and in such other types of investments as the commissioner may permit; notwithstanding any condition, restriction, or exclusion set forth in sections
10-3-218
and
10-3-220
, any asset used for a home office building or for rental to others held on May 13, 1981, by a company subject to the provisions of this article shall remain an admitted asset under part 2 of article
3
of this title so long as such company's home office is located in such asset. The provisions of section
10-3-233
shall not apply to such corporation.
L. 92: Entire article R&RE, p. 1693, § 1, effective July 1.
This section is similar to former § 10-16-139 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-321 - Medicare supplement benefit standards

The provisions of article
18
of this title shall apply to corporations organized pursuant to the provisions of this part 3. On and after July 1, 1983, no corporation subject to the provisions of part 1 of this article and this part 3 shall deliver or issue for delivery in this state any subscription certificate or membership certificate intended as a medicare supplement policy, as defined in section
10-18-101
, or any endorsement, rider, or application which becomes a part thereof, until a copy of the form and of the premium rates or dues pertaining thereto have been filed with the commissioner, nor shall any such certificate endorsement, rider, or application be used until the expiration of thirty days after the filing thereof, unless the commissioner sooner gives written approval thereto and of the premium rates or dues pertaining thereto. Within thirty days of such filing the commissioner shall notify the corporation which has filed any such form in writing if the documents do not comply with the requirements of law or if the rates do not meet the loss ratio standards set forth in section
10-18-105
, and shall specify the reasons for such opinion. In all other cases, the commissioner shall give approval. Final orders and decisions of the commissioner relating to medicare supplement policies and rates filed under this section are subject to judicial review as provided in section
24-4-106
, C.R.S. All medicare supplement policies, subscription certificates, and benefit forms and the premium rates or dues pertaining thereto which were approved by the commissioner prior to July 1, 1983, shall remain approved under the provisions of this article.
L. 92: Entire article R&RE, p. 1693, § 1, effective July 1. L. 94: Entire section amended, p. 1649, § 91, effective May 31.
This section is similar to former § 10-16-140 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-322 - Filing of health policies

Nonprofit hospital and health service corporations shall be subject to the requirements regarding the filing of health policies pursuant to section
10-16-107.2
.
L. 92: Entire section added, p. 1747, § 7, effective June 2.
Although the effective date of the repeal and reenactment of this article was July 1, 1992, this section was added, effective June 2, 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-323 - [Repealed]

L. 94: Entire section added, p. 598, § 6, effective April 7. L. 96: Entire section repealed, p. 1866, § 2, 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 3 - NONPROFIT HOSPITAL, MEDICAL-SURGICAL, AND HEALTH SERVICE CORPORATIONS (§§ 10-16-301 — 10-16-325) › Section 10-16-325 - Termination of health policies

A corporation shall not retroactively terminate a policy issued pursuant to this part 3 except for fraud or intentional misrepresentation. For any termination other than for fraud or intentional misrepresentation, the corporation shall provide notice thirty days in advance of the cancellation of the policy.
Added by 2013 Ch. 217,§ 32, eff. 5/13/2013.
L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 980, § 32, 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-404 - Governing body

(1)
The governing body of any health maintenance organization may include providers, other individuals, or both.
(2)
Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.
L. 92: Entire article R&RE, p. 1700, § 1, effective July 1.
This section is similar to former § 10-17-106 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-405 - Fiduciary responsibilities

Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the enrollees.
L. 92: Entire article R&RE, p. 1700, § 1, effective July 1.
This section is similar to former § 10-17-107 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-406 - Evidence of coverage - rules

(1)
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.
(2)
(a)
The commissioner may establish, by rule, the required elements of an evidence of coverage, which must:
(I)
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
(II)
Contain a clear and complete statement, if a contract, or a reasonably complete summary, if a certificate, of:
(A)
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;
(B)
Any limitations on the services, kind of services, benefits, or kind of benefits to be provided, including any deductible or copayment feature;
(C)
Where and in what manner information is available as to how services may be obtained;
(D)
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;
(E)
A clear and understandable description of the health maintenance organization's method for resolving enrollee complaints.
(b)
The carrier may evidence a subsequent change in coverage in a separate document issued to the enrollee.
(c)
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
.
Amended with relocated provisions by 2013 Ch. 217,§ 33, eff. 5/13/2013.
(1) (a) This section is similar to former § 10-17-108 as it existed prior to 1992.
(b) Subsection (2) is similar to §
10-16-107(3)(b), (3)(c), and (3)(d)
as they existed prior to 2013.
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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-408 - Open enrollment

(1)
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.
(2)
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.
(3)
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.
L. 92: Entire article R&RE, p. 1701, § 1, effective July 1.
This section is similar to former § 10-17-111 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-409 - Complaint system

(1)
(a)
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.
(b)
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:
(I)
A description of the procedures of such complaint system;
(II)
The total number of complaints handled through such complaint system and a compilation of causes underlying the complaints filed;
(III)
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.
(2)
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.
(3)
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)
.
Amended by 2017 Ch. 283,§ 8, eff. 6/1/2017.
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.
This section is similar to former § 10-17-112 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 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.
L. 92: Entire article R&RE, p. 1702, § 1, effective July 1.
This section is similar to former § 10-17-113 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-413 - Prohibited practices

(1)
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)
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.
(b)
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.
(c)
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.
(2)
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.
(3)
An enrollee may not be canceled or nonrenewed on the basis of the status of such enrollee's health.
(4)
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.
L. 92: Entire article R&RE, p. 1705, § 1, effective July 1. L. 2000: (4) amended, p. 988, § 104, effective July 1.
This section is similar to former § 10-17-115 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 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.
L. 92: Entire article R&RE, p. 1706, § 1, effective July 1.
This section is similar to former § 10-17-116 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-415 - Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations

(1)
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.
(2)
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.
L. 92: Entire article R&RE, p. 1706, § 1, effective July 1.
This section is similar to former § 10-17-117 as it existed prior to 1992.