2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 2 - SICKNESS AND ACCIDENT INSURANCE (§§ 10-16-201 — 10-16-222) › Section 10-16-201 - Form and content of individual sickness and accident insurance policies

(1)
No such policy shall be delivered or issued for delivery in this state unless:
(a)
The entire money and other considerations therefor are expressed therein; and
(b)
The time at which insurance takes effect and terminates is expressed therein; and
(c)
It purports to insure only one person, except as provided in sections
10-16-214
and
10-16-215
, and except that a policy or contract may be issued upon the application of an adult member of a family, who shall be deemed the policyholder, covering members of any one family, including husband, wife, dependent children or any children under the age of nineteen, and other dependents living with the family; and
(d)
Every printed portion of the text matter and of any endorsements or attached papers is printed in uniform type of which the face is not less than ten-point; the "text" shall include all printed matter except the name and address of the insurer, name and title of the policy, captions, subcaptions, and form numbers; but, notwithstanding any provision of this article, the commissioner shall not disapprove any such policy on the ground that every printed portion of its text matter or of any endorsement or attached paper is not printed in uniform type if it is shown that the type used is required to conform to the laws of another state in which the insurer is licensed; and
(e)
The exceptions and reductions of indemnity are adequately captioned and clearly set forth in the policy or contract; and
(f)
Each such form, including riders and endorsements, is identified by a form number in the lower left-hand corner of the first page thereof.
(2)
If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state has advised the commissioner that any such policy is not subject to approval or disapproval by such official, the commissioner may by ruling require that such policy meet the standards set forth in this section and sections
10-16-202
and
10-16-203
.
(3)
(a)
Each policy in which the insurer reserves the right to refuse renewal on an individual basis shall provide, in substance, in a provision thereof or in an endorsement thereon or in a rider attached thereto, that, subject to the right to terminate the policy upon nonpayment of premium when due, the right to refuse renewal shall not be exercised before the renewal date occurring on, or after and nearest, each anniversary or, in the case of lapse and reinstatement at the renewal date, occurring on, or after and nearest, each anniversary of the last reinstatement and that any refusal of renewal shall be without prejudice to any claim originating while the policy is in force. This paragraph (a) shall not apply to accident only policies.
(b)
In addition, each policy shall provide, in substance, in a provision thereof or in an endorsement thereon or in a rider attached thereto, that an insurer shall not exercise its right to refuse to renew the policy on an individual basis after two years from its date of issue or, in the event the policy has been reinstated, two years from the date of its last reinstatement and before the age or other limitation upon renewal stated in the policy solely because of deterioration in the physical or mental condition or the health of any person covered thereunder.
(c)
Nothing in this subsection (3) negates the renewability requirements for health benefit plans specified in section
10-16-105.1
.
(4)
(a)
No policy of sickness and accident insurance issued, renewed, or reinstated shall contain any provision which limits or excludes payments under hospital or medical benefits coverage to or on behalf of the insured because the insured 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 (4) shall apply to all such policies issued, renewed, or reinstated on or after August 1, 1984.
(5)
(a)
If a person is deployed by or called to active duty in the United States military and the person's individual sickness and accident insurance policy lapses during the deployment or activation, the insurer who insured the person shall issue, upon application, the same individual coverage to the person. The application shall contain reasonable evidence of the individual sickness and accident insurance that covered the person prior to the deployment or activation. The insurer shall not:
(I)
Restrict benefits or increase premiums for the coverage as a result of the lapse in coverage;
(II)
Use any health condition originating or newly treated during the lapse in coverage to rate the policy; or
(III)
Limit benefits by an exclusionary rider or by applying a preexisting condition limitation provision to the policy.
(b)
Nothing in this subsection (5) shall be construed to limit the ability of an insurer to increase premiums for such policies based on general rate increases that are applicable to all policyholders.
(6)
An individual policy of sickness and accident insurance, other than a long-term care policy, disability income policy, or supplemental policy covering a specified disease or other limited benefit, issued, renewed, or reinstated on or after January 1, 2007, shall not contain any provision that limits or excludes payments under hospital or medical benefits coverage to or on behalf of the insured because the insured or a covered dependent sustained an injury while intoxicated or under the influence of a controlled substance, as defined in section
18-18-102 (5)
, C.R.S.
Amended by 2013 Ch. 217, § 49, eff. 5/13/2013.
L. 92: Entire article R&RE, p. 1658, § 1, effective July 1. L. 2004: (3)(c) added, p. 990, § 10, effective August 4. L. 2005: (5) added, p. 220, § 2, effective April 14. L. 2006: (4)(a) amended, p. 1999, § 37, effective July 1; (6) added, p. 408, § 1, effective 1/1/2007. L. 2013: (3)(c) amended, (HB 13-1266), ch. 217, p. 988, § 49, effective May 13.
The provisions of this section are similar to several former provisions of § 10-8-103 as they existed prior to 1992.
For the limitations concerning medical health insurance under the "Colorado Medical Treatment Decision Act", see § 15-18-111 .