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 10-16-110 - Fees paid by health coverage entities

(1)
(a)
There shall be paid to the division of insurance by every corporation subject to the provisions of this part 1 and part 3 of this article such fees as are prescribed pursuant to sections
10-3-207
and
24-31-104.5
, C.R.S.
(b)
Every nonprofit hospital and health service corporation representative subject to this part 1 and part 3 of this article shall pay to the commissioner the following fees:
(I)
For each enrollment representative's initial license, ten dollars;
(II)
For each enrollment representative's renewal license, six dollars.
(c)
To defray the cost of administering this article, every corporation subject to the provisions of this part 1 and part 3 of this article shall pay annually to the commissioner on March 1 an amount equivalent to five cents per person exceeding ten thousand in number enrolled in the health service plans of such corporation.
(2)
(a)
Every health maintenance organization subject to this part 1 and part 4 of this article shall pay to the commissioner the fees as prescribed pursuant to sections
10-3-207
and
24-31-104.5
, C.R.S.
(b)
Every health maintenance organization representative subject to this part 1 and part 4 of this article shall pay to the commissioner the following fees:
(I)
For each enrollment representative's initial license, ten dollars;
(II)
For each enrollment representative's renewal license, six dollars.
(3)
Coincident with the filing of the annual report prescribed by section
10-16-111
, each prepaid dental care plan organization subject to this part 1 and part 5 of this article shall pay to the state treasurer through the commissioner fees for transacting a prepaid dental care plan. The fees shall be as prescribed pursuant to sections
10-3-207
and
24-31-104.5
, C.R.S.
(4)
Notwithstanding the amount specified for any fee in this section, the commissioner by rule or as otherwise provided by law may reduce the amount of one or more of the fees if necessary pursuant to section
24-75-402(3)
, C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of one or more of the fees is credited. After the uncommitted reserves of the fund are sufficiently reduced, the commissioner by rule or as otherwise provided by law may increase the amount of one or more of the fees as provided in section
24-75-402(4)
, C.R.S.
L. 92: Entire article R&RE, p. 1655, § 1, effective July 1. L. 98: (4) added, p. 1328, § 33, effective June 1. L. 2010: (1)(a), (2)(a), and (3) amended, (HB 10-1385), ch. 204, p. 884, §8, effective May 5. L. 2012: (1)(a), (2)(a), and (3) amended, (SB 12-110), ch. 158, p. 562, § 10, effective July 1.
The provisions of this section are 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-112 - Private utilization review - health-care coverage entity responsibility - definitions

(1)
As used in this section, unless the context otherwise requires:
(a)
"Private utilization review organization" means an entity, other than a hospital or public reviewer following federal guidelines, that conducts utilization review or reviews and makes determinations on prior authorization requests for health-care services as described in section
10-16-112.5
. This definition shall not apply to any independent medical examination provided for in any policy of insurance.
(b)
"Utilization review" means an evaluation of the necessity, appropriateness, and efficiency of the use of health-care services, procedures, and facilities, but does not include any independent medical examination provided for in any policy of insurance.
(2)
Any private utilization review organization providing services to an insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization regulated pursuant to the provisions of this article is the direct representative of the insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization. Any insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization is responsible for the actions of any private utilization review organization acting within the scope of any contract and on its behalf within the scope of any contract which result in any violation of this title or any rules or regulations promulgated by the commissioner.
Amended by 2019 Ch. 165,§ 3, eff. 8/2/2019 and applicable to prior authorization requests for health care services submitted on or after 1/1/2020.
L. 93: Entire section added, p. 494, § 2, effective April 26.
Section 4 of chapter 165 (HB 19-1211), Session Laws of Colorado 2019, provides that the act changing this section applies to prior authorization requests for health care services submitted on or after August 2, 2019.
For the legislative declaration in HB 19-1211, see section 1 of chapter 165, 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 10-16-113.7 - Reporting the denial of benefits to division

Each carrier shall report the number and outcome of second-level internal appeals pursuant to section
10-16-113
to the division by February 1 of each year. On at least an annual basis, the division shall compile the information reported by each carrier along with the number and outcome of third-level external appeals of each health coverage plan and make such information available on the division website and for public inspection. The commissioner may specify the format in which the information shall be submitted by a carrier.
L. 2005: Entire section added, p. 805, § 4, effective 1/1/2006.
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 10-16-114 - [Repealed]

Repealed by 2013 Ch. 217, § 27, eff. 5/13/2013. See now section
10-16-116(1)
.
L. 94: Entire section added, p. 742, § 1, effective 1/1/1995. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, § 27, effective May 13.
This section was relocated to §
10-16-116(1)
in 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-115 - [Repealed]

Repealed by 2013 Ch. 217, § 27, eff. 5/13/2013. See now section
10-16-116(6)
.
L. 94: Entire section added, p. 742, § 1, effective 1/1/1995. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, § 27, effective May 13.
This section was relocated to §
10-16-116(6)
in 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-116.5 - [Repealed]

Added by 2018 Ch. 194, § 2, eff. 8/8/2018.
L. 2018: Entire section added, (SB 18-132), ch. 194, p. 1283, § 2, effective August 8.
As of publication date, the revisor of statutes has not received the notice referred to in subsection (6).
For the legislative declaration in SB 18-132, see section 1 of chapter 194, Session Laws of Colorado 2018.
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 10-16-117 - [Repealed]

Repealed by 2013 Ch. 217, § 27, eff. 5/13/2013. See now section
10-16-116
.
L. 94: Entire section added, p. 742, § 1, effective 1/1/1995. L. 2004: Entire section amended, p. 990, § 9, effective August 4. L. 2013: Entire section repealed, (HB 13-1266), ch. 217, p. 978, § 27, effective May 13.
This section was relocated to § 10-116 (4) and (5) in 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-118 - Prohibition against preexisting condition exclusions

A carrier offering an individual or small employer health benefit plan in this state shall not impose any preexisting condition exclusion with respect to coverage under the plan.
Repealed and reenacted with amendments by 2013 Ch. 217,§ 22, eff. 5/13/2013.
For the legislative declaration contained in the 1997 act amending this section, see section 1 of chapter 154, Session Laws of Colorado 1997.
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 10-16-119 - Requirements for excess loss or stop-loss health insurance used in conjunction with self-insured employer benefit plans under the federal "Employee Retirement Income Security Act" - data collection 2013-18 - rules

(1)
Any entity issuing excess loss insurance shall file all policy forms with the division and certify compliance with the provisions of this title.
(2)
All excess loss insurance shall be issued to cover the employer's liability under the employer's self-insured obligation. Excess loss insurance shall meet the following requirements:
(a)
The policy shall only be issued to insure an employer and not the employer's employees;
(b)
Payment by the issuer of the insurance shall only be made to the employer and not the employees or providers;
(c)
Commencing with policies issued or renewed on and after January 1, 2003, the minimum retention to the employer shall be no less than fifteen thousand dollars per person per plan year with a minimum one hundred twenty percent of expected claims aggregate.
(3)
Repealed.
Amended by 2013 Ch. 339, § 1, eff. 7/1/2013.
L. 94: Entire section added, p. 1913, § 9, effective July 1. L. 2002: (2)(c) amended, p. 1293, § 6, effective 1/1/2003. L. 2013: (3) added, (HB 13-1290), ch. 339, p. 1975, § 1, effective July 1.
Subsection (3)(d) provided for the repeal of subsection (3), effective September 1, 2019. (See L. 2013, p. 1976.)
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 10-16-120 - [Repealed]

L. 94: Entire section added, p. 1913, § 9, effective July 1. L. 96: (1) amended, p. 1230, § 52, effective August 7. L. 97: (1) amended, p. 1478, § 25, effective June 3. L. 2001: (2) amended, p. 1167, § 2, effective July 1. L. 2006: Entire section repealed, p. 1077, § 4, effective July 1.
For the legislative declaration contained in the 2006 act repealing this section, see section 1 of chapter 236, Session Laws of Colorado 2006.
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 10-16-121.5 - Prohibited contract provisions in contracts between carriers and providers for dental services - definition

(1)
A contract between a carrier and a dentist licensed to practice under article
220
of title
12
must not require, directly or indirectly, that a dentist who is a participating provider provide services to a covered person at a fee set by, or subject to the approval of, the carrier unless:
(a)
The services are covered services under the person's policy; and
(b)
The carrier provides payment for the services under the person's policy in an amount that is reasonable and not nominal or de minimis.
(2)
The dentist may charge the covered person for noncovered items or services in any amount determined by the dentist and agreed to by the patient that is equal to, or less than, the usual and customary amount that the dentist charges individuals who do not have coverage for such items and services.
(3)
If the commissioner determines that a carrier has not complied with this section, the commissioner shall institute a corrective action plan that the carrier shall follow or may use any of the commissioner's enforcement powers to obtain the carrier's compliance with this section.
(4)
For purposes of this section, "covered services" means dental care services for which reimbursement is available under a covered person's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other contractual limitations.
Amended by 2019 Ch. 136,§ 45, eff. 10/1/2019.
Added by 2017 Ch. 147,§ 2, eff. 8/9/2017.
L. 2017: Entire section added, (SB 17-190), ch. 147, p. 492, § 2, effective August 9.
For the legislative declaration in SB 17-190, see section 1 of chapter 147, 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-122.7 - Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rules

(1)
The short title of this section is the "Patient Drug Costs Savings Act".
(2)
The general assembly hereby finds and declares that:
(a)
Consumers have the right to know about options to reduce the amount of money they pay at a pharmacy for prescription drugs; and
(b)
This section will save consumers money by allowing pharmacists to provide information concerning the cost of prescription drugs.
(3)
A carrier that has a contract with a pharmacy or pharmacist, or a pharmacy benefit management firm acting on behalf of a carrier, shall not:
(a)
Prohibit a pharmacy or pharmacist from providing a covered person information on the amount of the covered person's cost share for the covered person's prescription drug and the clinical efficacy of a more affordable alternative drug that is therapeutically equivalent, as defined in section
12-280-103 (52)
, to the prescribed drug if one is available;
(b)
Penalize a pharmacy or a pharmacist for disclosing the information described in subsection (3)(a) of this section to a covered person or selling a more affordable alternative to a covered person; or
(c)
Require a pharmacy to charge or collect a copayment from a covered person that exceeds the total charges submitted by the network pharmacy.
(4)
(a)
If the commissioner determines that a carrier has not complied with this section, the commissioner shall institute a corrective action plan for the carrier to follow or use any of the commissioner's enforcement powers under this title 10 to obtain the carrier's compliance with this section.
(b)
With regard to the requirements of this section applicable to PBMs, the commissioner has the authority to enforce this section and to impose a penalty or other remedy against a pharmacy benefit management firm that fails to comply with this section.
(5)
If any provision of this section is inconsistent with, or in conflict with, an applicable federal law, rule, or regulation, the applicable federal law, rule, or regulation applies.
(6)
The commissioner may adopt rules to implement and enforce this section.
Amended by 2023 Ch. 160,§ 5, eff. 8/7/2023.
Amended by 2019 Ch. 136, § 48, eff. 10/1/2019.
Added by 2018 Ch. 181, § 1, eff. 8/8/2018.
L. 2018: Entire section added, (HB 18-1284), ch. 181, p. 1233, § 1, effective August 8.
2023 Ch. 160, 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 10-16-124 - Prescription information cards - legislative declaration

(1)
It is the intent of the general assembly to lessen patients' waiting times for prescriptions, to decrease administrative burdens for pharmacies, and to improve care to patients by minimizing confusion, eliminating unnecessary paperwork, and streamlining the dispensing of prescription drugs paid for by third party payors.
(2)
Each health benefit plan that offers coverage for prescription drugs shall issue to the named insured a card or other device containing uniform prescription drug information. Such card or device shall be in the format approved by the national council for prescription drug programs, shall include all of the required and situational fields and shall conform to the most recent pharmacy identification card or device implementation guide produced by the national council for prescription drug programs.
(3)
(a)
A new uniform prescription drug information card or device, as required pursuant to subsection (2) of this section, shall be issued by a carrier:
(I)
When a person enrolls in a health benefit plan that offers prescription drug coverage; and
(II)
When a person's coverage changes and the change affects data contained on the card or device.
(b)
Newly issued cards or devices shall be updated with the latest coverage information and shall conform to the national council for prescription drug programs' standards then in effect and to the implementation guide then in use.
(4)
No health maintenance organization that supplies benefits to its plan subscribers through an in-house drug or pharmacy outlet and has received a certificate of authority pursuant to part 4 of this article shall be subject to this section.
(5)
The provisions of the section shall not apply to the children's basic health plan as described in article
8
of title
25.5
, C.R.S.
L. 2002: Entire section added, p. 1311, § 1, effective 1/1/2003. L. 2006: (5) amended, p. 1999, § 36, effective July 1.
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 10-16-124.6 - [Effective 8/7/2024] Drugs used for substance use disorder - prior authorization prohibited

A carrier that provides coverage under a health benefit plan for a drug used to treat a substance use disorder shall not require prior authorization, as defined in section 10-16-112.5 (7)(d), for the drug based solely on the dosage amount.
Added by 2024 Ch. 470,§ 1, eff. 8/7/2024.
2024 Ch. 470, 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 10-16-124.7 - Opioid analgesics with abuse-deterrent properties - study - definitions

(1)
The governor shall direct the Colorado consortium for prescription drug abuse prevention to study the barriers to the use of abuse-deterrent opioid analgesic drug products as a way to reduce abuse and diversion of opioid drug products. On or before January 15, 2017, the consortium shall report its findings to the public health care and human services committee and the health, insurance, and environment committee of the house of representatives and the health and human services committee of the senate, or their successor committees.
(2)
Moneys from the general fund shall not be used for the implementation of this section.
(3)
As used in this section:
(a)
"Abuse-deterrent opioid analgesic drug product" means a brand or generic opioid analgesic drug product approved by the FDA with abuse-deterrence labeling claims that indicate that the drug product is expected to result in a meaningful reduction in abuse.
(b)
"Opioid analgesic drug product" means a drug product in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release or long-acting form, that may be combined with other drug substances to form a single drug product or dosage form.
Amended by 2022 Ch. 126,§4, eff. 8/10/2022.
Added by 2015 Ch. 175,§1, eff. 5/11/2015.
L. 2015: Entire section added, (HB 15-1214), ch. 175, p. 570, § 1, effective May 11.
2022 Ch. 126, 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 10-16-124.8 - Colorado consortium for prescription drug abuse prevention - create process for recovery - report

(1)
The governor shall direct the Colorado consortium for prescription drug abuse prevention within the university of Colorado to:
(a)
Create a process with the substance abuse recovery community to develop a strategic plan that addresses the full continuum of recovery services, including detoxification services and reintegration into the community with peer support, for individuals who experience substance use disorders;
(b)
Develop a definition for recovery residences and issue recommendations regarding whether recovery residences should be licensed; and
(c)
Report the recommendations pursuant to this section to the general assembly on or before January 1, 2020.
(2)
Money in the general fund may not be used for the implementation of this section.
Added by 2018 Ch. 224,§ 2, eff. 5/21/2018.
L. 2018: Entire section added, (HB 18-1003), ch. 224, p. 1427, § 2, effective May 21.
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 10-16-125 - Reimbursement to nurses

(1)
In counties of the state that are neither part of a metropolitan statistical area nor a primary statistical area, a carrier offering a health benefit plan shall not discriminate between a physician and an advanced practice registered nurse not practicing under the direction of a physician when establishing reimbursement rates for covered services that could be provided by an advanced practice registered nurse or a physician.
(2)
In order to improve access to primary care and choices of providers, a carrier providing a health benefit plan shall evaluate an application for status as a participating provider from an advanced practice registered nurse utilizing objective and reasonable criteria and shall take into account the provider-to-covered-person ratio for the covered benefits that appropriately may be provided by the advanced practice registered nurse. The carrier shall make a determination on an application for participating provider status submitted by an advanced practice registered nurse, and notify the applicant of its determination, within the same period in which the carrier makes a participating provider determination for physicians. If the application is denied, the carrier shall specify the reason for the denial. If the application is approved, the carrier shall list the advanced practice registered nurse in the provider directory for the health benefit plan.
L. 2002: Entire section added, p. 1295, § 8, effective June 7. L. 2008: Entire section amended, p. 121, § 1, effective 1/1/2009.
This section was originally enacted as §
10-16-124
in House Bill 02-1003 but has been 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 10-16-126 - Fee-for-service dental plans

(1)
Notwithstanding any provision of this title to the contrary, a fee-for-service dental plan for which premiums are not charged is not subject to the provisions of this title and the offering of such a plan shall not be considered transacting the business of insurance pursuant to section
10-3-903
. The offeror of a fee-for-service dental plan shall have no liability for payment of claims and the fees paid to the provider of the services shall be paid directly by the consumer.
(2)
Any offeror of such fee-for-service dental plan shall advise the consumer that the plan is not an insurance plan and that the consumer shall be solely responsible for full payment to the provider of any fees or charges incurred by the consumer.
L. 2003: Entire section added, p. 1740, § 1, effective August 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 10-16-127 - Coinsurance and deductibles

A carrier subject to the provisions of parts 2, 3, and 4 of this article may offer one or more health coverage plans that contain deductibles or coinsurance without any limitation or restriction on the maximum out-of-pocket payable by the insured.
L. 2003: Entire section added, p. 1785, § 16, effective 1/1/2004.
This section was originally numbered as §
10-16-126
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 10-16-128 - Annual report to general assembly

Notwithstanding section
24-1-136(11)(a)(I)
, the commissioner shall report to the business affairs and labor committee of the house of representatives and the business, labor, and technology committee of the senate, or any successor committees, no later than October 1, 2004, and every October 1 thereafter. The report shall be an indication of the number, nature, and outcome of complaints against insurers during the preceding twelve months.
Amended by 2017 Ch. 4,§ 4, eff. 8/9/2017.
L. 2003: Entire section added, p. 2494, § 3, effective June 5. L. 2007: Entire section amended, p. 2020, § 12, effective June 1. L. 2017: Entire section amended, (SB 17-044), ch. 4, p. 7, § 4, effective August 9.
This section was originally numbered as §
10-16-126
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 10-16-129 - Health savings accounts

Any carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article may offer a high deductible health plan that would qualify for and may be offered in conjunction with a health savings account pursuant to
26 U.S.C. sec. 223
, as amended. A carrier offering a high deductible health plan that may be offered in conjunction with a health savings account may apply the deductible to mandatory health benefits for prostate cancer screening and prosthetic devices pursuant to section
10-16-104 (10) and (14)
if those mandatory benefits are not considered by the federal department of treasury to be preventive or to have an acceptable deductible amount.
Amended by 2013 Ch. 217, § 23, eff. 5/13/2013.
L. 2004: Entire section added, p. 764, § 2, effective July 1. L. 2009: Entire section amended, (HB 09 -1204), ch. 344, p. 1808, § 6, effective 1/1/2010. L. 2013: Entire section amended, (HB 13-1266), ch. 217, p. 973, § 23, effective May 13.
For the legislative declaration contained in the 2009 act amending this section, see section 1 of chapter 344, Session Laws of Colorado 2009.
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 10-16-130 - Disclosure of rate increases to public entities - legislative declaration - definitions

(1)
The general assembly hereby finds, determines, and declares that variability in premiums by carriers offering health benefit coverage to a public entity present difficulties for fiscal planning for the public entity. Therefore, it is in the best interest of the state to promote greater accountability to the public and sound fiscal policy by public entities through disclosure by health insurance carriers of information concerning the public entity's rate, loss ratio, and the total number of claims exceeding ten thousand dollars for the public entity.
(2)
A carrier authorized to conduct business in this state that offers coverage pursuant to part 2, 3, or 4 of this article to a public entity, with one hundred or more employees enrolled in such coverage, shall disclose to the public entity, at the request of the public entity, once annually and concurrent with the issuance of the employer's rate renewal, the following information as it relates to the amounts of coverage being considered for calculating the renewal:
(a)
The total number of employees covered by the carrier for the public entity;
(b)
The total dollar amount of claims paid by the carrier on behalf of the public entity;
(c)
Total of premiums paid; and
(d)
The number of claims that exceed ten thousand dollars for any one covered person under health benefit coverage for the public entity.
(3)
As used in this section, unless the context otherwise requires:
(a)
"Loss ratio" means the total claims paid for the coverage period divided by the total amount of premiums paid by a public entity.
(b)
"Public entity" shall have the same meaning as that provided in section
24-10-103 (5)
, C.R.S.
L. 2005: Entire section added, p. 849, § 1, effective 1/1/2006.
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 10-16-131 - [Repealed]

L. 2006: Entire section added, p. 1626, § 2, effective June 2. L. 2007: IP(3)(a) amended and (3)(a)(IV) and (3)(b)(III) added, p. 167, §§ 1, 2, effective March 22; (2), (3)(d)(V), (4)(a), (4)(b)(III), (4)(b)(IV), (5)(a), and (5)(c) amended and (4.5) and (5.5) added, p. 1993, § 1, effective June 1. L. 2008: (5.3) added and (6) amended, p. 809, § 1, effective May 14.
Subsection (6)(a) provided for the repeal of subsections (1) to (5) and (5.5), effective July 1, 2008. (See L. 2006, p. 1626.) Subsection (5.3)(b) provided for the repeal of subsection (5.3), effective July 1, 2009. (See L. 2008, p. 809.) Subsection (6)(b) provided for the repeal of subsection (6), effective July 1, 2009. (See L. 2008, p. 809.)
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 10-16-132 - [Repealed]

L. 2007: Entire section added, p. 2101, § 1, effective June 4. L. 2008: (2)(c) amended, p. 1881, § 14, effective August 5.
Subsection (4) provided for the repeal of this section, effective January 15, 2009. (See L. 2007, p. 2101.)
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 10-16-134 - [Repealed]

Repealed by 2024 Ch. 34,§ 1, eff. 3/22/2024.
L. 2008: Entire section added, p. 1265, § 4, effective May 27.
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 10-16-136 - [Repealed]

Amended by 2013 Ch. 338, § 10, eff. 3/31/2015.
Amended by 2013 Ch. 217, § 24, eff. 5/13/2013.
L. 2009: Entire section added, (HB 09 -1012), ch. 188, p. 819, § 1, effective July 1. L. 2010: (1), (2)(a), (2)(b), (3)(a), (3)(c), (3)(d), and (5) amended and (3)(f), (3.5), (3.7), (6.5), (6.7), (7)(a.5), and (8) added, (HB 10-1160), ch. 283, pp. 1321, 1326, 1327, §§ 1, 2, 3, effective July 1. L. 2013: (2)(a), (3.5)(a), and (5)(b) amended and (5)(a)(III)(A) repealed, (HB 13-1266), ch. 217, p. 973, § 24, effective May 13; (7)(a) repealed, (HB 13-1115), ch. 338, p. 1972, § 10, effective 3/31/2015.
Subsection (8) provided for the repeal of this section, effective July 1, 2015. (See L. 2010, p. 1321.)
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 10-16-137 - Policy forms - explanation of benefits - standardization of forms - rules

(1)
The commissioner shall convene a group of stakeholders, including carriers, providers, and consumers, to develop a standardized format for the following regarding health benefit plans, limited benefit health insurance, and dental plans:
(a)
Section names and the placement of those sections in the policy forms issued by all carriers; and
(b)
The required information for carriers to provide on an explanation of benefits form sent to covered persons or providers making a claim for benefits under a health benefit plan, limited benefit health insurance, or dental plan.
(2)
The commissioner shall adopt rules after considering the input from carriers, providers, consumers, and other stakeholders in developing the standardized format for policy forms and explanation of benefits forms. The rules shall apply to health benefit plans, limited benefit health insurance, and dental plans issued or delivered on or after January 1, 2012.
L. 2010: Entire section added, (HB 10-1004), ch. 141, p. 477, §1, effective August 11.
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 10-16-140 - Grace periods - premium payments - rules

(1)
For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons receiving a subsidy under the federal act, the commissioner shall establish, by rule that complies with federal law, a requirement that all individual and small employer health benefit plans contain a provision specifying that the policyholder is entitled to a three-month grace period for the payment of any premium due, other than the first premium, during which period the plan continues in force unless the policyholder submits written notice to the carrier, prior to discontinuance of the plan in accordance with the terms of the plan, that the policyholder is discontinuing the coverage. In accordance with federal law, the commissioner's rule may provide that the policyholder is liable to the carrier for the payment of a pro rata premium for the time the coverage was in force during the grace period.
(2)
For individual and small employer health benefit plans issued or renewed for coverage to begin on or after January 1, 2014, for persons who are not receiving a subsidy under the federal act, the commissioner shall adopt a rule requiring a thirty-one-day grace period for the payment of any premium due other than the first premium.
(3)
If the covered person fails to pay all or part of the premium, the carrier shall notify the covered person of the nonpayment of premium within the grace period established pursuant to this section and in accordance with section
10-16-222
,
10-16-325
, or
10-16-429
, as applicable.
(4)
The commissioner may adopt rules as necessary to implement and administer this section.
Added by 2013 Ch. 217,§ 26, eff. 5/13/2013.
L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 977, § 26, 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-141 - Medication synchronization services - cost sharing for partial refills - dispensing fees

(1)
A carrier offering an individual or group health coverage plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services developed by the carrier that allow for the alignment of refill dates for a covered person's prescription drugs that are covered benefits.
(2)
Under its medication synchronization services, a carrier shall:
(a)
Not charge an amount in excess of the otherwise applicable copayment amount under the health coverage plan for dispensing a prescription drug in a quantity that is less than the prescribed amount if:
(I)
The pharmacy dispenses the prescription drug in accordance with the medication synchronization services offered under the health coverage plan; and
(II)
A network pharmacy dispenses the prescription drug; and
(b)
Provide a full dispensing fee to the pharmacy that dispenses the medication to the covered person.
Added by 2014 Ch. 221,§ 1, eff. 5/17/2014.
L. 2014: Entire section added, (HB 14-1359), ch. 221, p. 828, § 1, effective May 17.
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 10-16-142 - Physical rehabilitation services - copayments and coinsurance - research

(1)
The Colorado commission on affordable health care created in section
25-46-103
, C.R.S., shall conduct a study concerning the costs, including patient cost sharing for physical rehabilitation services. The study shall analyze costs to the health-care system, including payers and individual patients, as well as whether patient cost sharing creates barriers to the effective use of physical rehabilitation services.
(2)
On or before November 1, 2015, the commission shall report its findings to the health and human services committee of the senate and the public health care and human services committee and the health, insurance, and environment committee of the house of representatives.
(3)
For the purposes of this section, "physical rehabilitation services" means physical therapy, occupational therapy, or chiropractic services for the treatment of a person who has sustained an illness, medical condition, or injury, with the goal of returning the person to his or her prior skill and function level or maintaining the person's current skill and function level.
Added by 2015 Ch. 321, § 1, eff. 6/5/2015.
L. 2015: Entire section added, (HB 15-1083), ch. 321, p. 1305, § 1, effective June 5.
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 10-16-143 - [Repealed]

Added by 2016 Ch. 168,§1, eff. 5/17/2016.
L. 2016: Entire section added, (HB 16-1336), ch. 168, p. 533, § 1, effective May 17.
Subsection (3) provided for the repeal of this section, effective December 31, 2016. (See L. 2016, p. 533.)
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 10-16-143.5 - Pharmacy reimbursement - substance use disorders - injections - patient counseling

(1)
If a pharmacy has entered into a collaborative pharmacy practice agreement with one or more physicians pursuant to section
12-280-602
to administer injectable antagonist medication for medication-assisted treatment for substance use disorders, the pharmacy administering the drug shall receive an enhanced dispensing fee.
(2)
If a pharmacy dispenses an opioid that is a schedule II or schedule III drug pursuant to section
18-18-204
or
18-18-205
to a patient who has not previously received an opioid prescription and the pharmacy provides counseling concerning the risk of opioids to the patient, the dispensing pharmacy shall receive an enhanced dispensing fee.
(3)
Subsection (2) of this section does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.
Amended by 2019 Ch. 136, § 51, eff. 10/1/2019.
Amended by 2019 Ch. 276, § 1, eff. 5/23/2019.
Added by 2018 Ch. 225, § 4, eff. 1/1/2019.
L. 2018: Entire section added, (HB 18-1007), ch. 225, p. 1432, § 4, effective 1/1/2019.
Amendments to this section by SB 19-228 and HB 19-1172 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 1 - GENERAL PROVISIONS (§§ 10-16-101 — 10-16-169) › Section 10-16-144 - [Effective Until 8/7/2024] Health-care services provided by pharmacists

(1)
Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health-care services under a specific treatment protocol provided by a pharmacist if:
(a)
The pharmacist meets the requirements in part 6 of article
280
of title
12
;
(b)
The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice registered nurse;
(c)
The pharmacist is included in the health benefit plan's network of participating providers; and
(d)
A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.
(2)
(a)
A health benefit plan described in subsection (1) of this section shall provide coverage for health-care services provided by a pharmacist within a health professional shortage area, as defined in
42 U.S.C. sec. 254e
, if the conditions specified in subsection (1) of this section are met.
(b)
This subsection (2) does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.
Amended by 2019 Ch. 136, § 52, eff. 10/1/2019.
Amended by 2018 Ch. 112, § 1, eff. 8/8/2018.
Added by 2016 Ch. 239, § 1, eff. 8/10/2016.
L. 2016: Entire section added, (SB 16-135), ch. 981, p. 981, § 1, effective August 10. L. 2018: (2) added, (HB 18-1112), ch. 806, p. 806, § 1, effective August 8. L. 2019: (1)(a) amended, (HB 19-1172), ch. 1657, p. 1657, § 52, effective October 1.
This section is set out more than once due to postponed, multiple, or conflicting amendments.
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 10-16-144 - [Effective 8/7/2024] Health-care services provided by pharmacists

(1)
Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health-care services under a specific treatment protocol provided by a pharmacist if:
(a)
The pharmacist meets the requirements in part 6 of article
280
of title
12
;
(b)
The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice registered nurse;
(c)
The pharmacist is included in the health benefit plan's network of participating providers; and
(d)
A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.
(2)
(a)
A health benefit plan described in subsection (1) of this section shall provide coverage for health-care services provided by a pharmacist within a health professional shortage area, as defined in
42 U.S.C. sec. 254e
, if the conditions specified in subsection (1) of this section are met.
(b)
This subsection (2) does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.
(3)
(a)
Notwithstanding the provisions of subsection (1) of this section to the contrary, a health benefit plan described in subsection (1) of this section that provides treatment for substance use disorders shall reimburse a licensed pharmacist acting within the licensed pharmacist's scope of practice, and in accordance with the requirements in part 6 of article 280 of title 12, for the provision of medication-assisted treatment services if the health benefit plan provides coverage for the same services provided by a licensed physician or an advanced practice registered nurse.
(b)
A health benefit plan reimbursing a licensed pharmacist pursuant to subsection (3)(a) of this section shall reimburse a licensed pharmacist at the same rate that the health benefit plan reimburses a licensed physician or an advanced practice registered nurse within the health benefit plan's network of participating providers for the same services.
Amended by 2024 Ch. 470,§ 2, eff. 8/7/2024.
Amended by 2019 Ch. 136, § 52, eff. 10/1/2019.
Amended by 2018 Ch. 112, § 1, eff. 8/8/2018.
Added by 2016 Ch. 239, § 1, eff. 8/10/2016.
L. 2016: Entire section added, (SB 16-135), ch. 981, p. 981, § 1, effective August 10. L. 2018: (2) added, (HB 18-1112), ch. 806, p. 806, § 1, effective August 8. L. 2019: (1)(a) amended, (HB 19-1172), ch. 1657, p. 1657, § 52, effective October 1.
2024 Ch. 470, was passed without a safety clause. See Colo. Const. art. V, § 1(3).
This section is set out more than once due to postponed, multiple, or conflicting amendments.