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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-418 - Rehabilitation, liquidation, or conservation of health maintenance organization

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

(1)
When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least twenty days but, in the case of a denial, not more than sixty days thereafter for a hearing on the matter.
(2)
After a hearing held pursuant to subsection (1) of this section or upon the failure of the health maintenance organization to appear at the hearing, the commissioner shall take action as is deemed advisable on written findings, which shall be mailed to the health maintenance organization.
(3)
The provisions of article
4
of title
24
, C.R.S., shall apply to proceedings under this section to the extent they are not in conflict with subsections (1) and (2) of this section, and any final action of the commissioner pursuant to this section shall be subject to judicial review by the court of appeals.
Amended by 2017 Ch. 283,§ 11, eff. 6/1/2017.
L. 92: Entire article R&RE, p. 1710, § 1, effective July 1; (3) amended, p. 1600, § 125, effective July 1. L. 2017: (1) and (2) amended, (SB 17-249), ch. 283, p. 1547, § 11, effective June 1.
This section is similar to former § 10-17-122 as it existed prior to 1992.
For judicial review by the court of appeals, see § 24-4-106.
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 10-16-421 - Statutory construction and relationship to other laws

(1)
Except for sections
10-1-102
,
10-1-116
,
10-1-117
,
10-1-118
,
10-3-128
, and
10-3-208
, part 2 of article
1
of this title, and parts 4 to 8 of article
3
of this title, and as otherwise provided in this article, the provisions of the insurance law and provisions of nonprofit hospital, medical-surgical, and health service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this part 4.
(2)
Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed as violating any provision of law relating to solicitation or advertising by health professionals; but such health professionals shall be individually subject to the laws, rules and regulations, and ethical provisions governing their individual profession.
(3)
Any health maintenance organization authorized under part 1 of this article and this part 4 shall not be deemed to be practicing medicine and shall be exempt from the provisions of laws relating to the practice of medicine.
Amended by 2016 Ch. 210, § 17, eff. 6/6/2016.
Amended by 2014 Ch. 295,§ 10, eff. 1/1/2015.
Amended by 2014 Ch. 295,§ 9, eff. 1/1/2015.
Amended by 2013 Ch. 338, § 12, eff. 3/31/2015.
L. 92: Entire article R&RE, p. 1712, § 1, effective July 1; (1) amended, p. 1600, § 127, effective July 1. L. 94: (1) amended, p. 1630, § 30, effective May 31. L. 97: (1) amended, p. 93, § 4, effective March 24. L. 99: (1) amended, p. 84, § 4, effective July 1. L. 2001: (1) amended, p. 287, § 13, effective March 30; (1) amended, p. 1050, § 34, effective July 1. L. 2003: (1) amended, p. 618, § 19, effective July 1. L. 2004: (1) amended, p. 991, § 13, effective August 4. L. 2013: (1) amended, (HB 13-1115), ch. 338, p. 1972, § 12, effective 3/31/2015. L. 2014: (1) amended, (HB 14-1315), ch. 295, p. 1218, §§ 9, 10, effective 1/1/2015. L. 2016: (1) amended, (SB 16-189), ch. 210, p. 757, § 17, effective June 6.
(1) This section is similar to former § 10-17-125 as it existed prior to 1992.
(2) Amendments to subsection (1) by House Bill 01-1064 and House Bill 01-1319 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-421.5 - Acquisition of control of or merger of a health maintenance organization

No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person would, directly or indirectly, (or by conversion or by exercise of any right to acquire) be in control of the health maintenance organization, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request, or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the health maintenance organization information required by sections
10-3-801
,
10-3-802
,
10-3-803(2) to (11)
, and
10-3-803.5
and the offer, request, invitation, agreement, or acquisition has been approved by the commissioner.
Amended by 2014 Ch. 312,§ 3, eff. 7/1/2014.
L. 92: Entire section added, p. 1600, § 128, effective July 1. L. 2014: Entire section amended, (SB 14-152), ch. 312, p. 1354, § 3, effective July 1.
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 10-16-422 - Filings and reports as public documents

All applications, filings, and reports required under part 1 of this article and this part 4 shall be treated as public documents.
L. 92: Entire article R&RE, p. 1712, § 1, effective July 1.
This section is similar to former § 10-17-126 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 10-16-423 - Confidentiality of health information

Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of part 1 of this article or this part 4; or upon the express consent of the enrollee or applicant; or pursuant to statute or court order for the production of evidence or the discovery thereof; or in the event of claim or litigation between such person and the health maintenance organization wherein such data or information is pertinent; or as otherwise required or permitted by state or federal law. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure that the provider, who furnished such information to the health maintenance organization, is entitled to claim.
L. 92: Entire article R&RE, p. 1712, § 1, effective July 1. L. 2003: Entire section amended, p. 1785, § 18, effective July 1.
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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-424 - Commissioner's authority to contract

The commissioner, in carrying out his or her obligations pursuant to sections
10-16-402(1)(b)
and
10-16-417(1)
, may contract with qualified persons concerning the determinations required to be made by the commissioner.
Amended by 2017 Ch. 283,§ 14, eff. 6/1/2017.
L. 92: Entire article R&RE, p. 1713, § 1, effective July 1. L. 2017: Entire section amended, (SB 17-249), ch. 283, p. 1548, § 14, effective June 1.
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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-425 - Applicability of provisions

Nothing contained in part 1 of this article or this part 4 shall be construed to affect or apply to any trust, association, or nonprofit corporation which is established and administered by an employer, a labor organization or labor organizations, or jointly by an employer and a labor organization or labor organizations, and which on or after July 6, 1973, provides or arranges for health-care services only for employees of such employer and members of the families of such employees, or only for members of such labor organization or labor organizations and the families of such members, and for no other person or persons.
L. 92: Entire article R&RE, p. 1713, § 1, effective July 1.
This section is similar to former § 10-17-129 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 10-16-426 - Medicare supplement benefit standards

Except for the requirements of section
10-18-105
, the provisions of article
18
of this title shall not apply to all health maintenance organizations granted a certificate of authority under part 1 of this article or this part 4.
L. 92: Entire article R&RE, p. 1713, § 1, effective July 1.
This section is similar to former § 10-17-132 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 10-16-427 - Contractual relations

(1)
Every contract between a health maintenance organization and a medical group, independent practice association, or health professional employed by a health maintenance organization shall be written and include a hold harmless provision which shall provide that in the event a health maintenance organization fails to pay for health-care services rendered to an enrollee pursuant to a written contract between the health maintenance organization and a medical group, independent practice association, or health professional employed by the health maintenance organization, the enrollee shall not be liable for any moneys owed by the health maintenance organization.
(2)
No medical group, independent practice association, or health professional employed by a health maintenance organization referred to in subsection (1) of this section or any agent, trustee, or contractee thereof may maintain any action against an enrollee for sums owed by the health maintenance organization.
L. 92: Entire article R&RE, p. 1713, § 1, effective July 1.
This section is similar to former § 10-17-133 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 4 - HEALTH MAINTENANCE ORGANIZATIONS (§§ 10-16-401 — 10-16-429) › Section 10-16-428 - [Repealed]

L. 92: Entire article R&RE, p. 1714, § 1, effective July 1. L. 94: Entire section repealed, p. 1594, § 2, effective July 1.
This section was similar to former § 10-17-134 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 10-16-429 - Termination of contract

A health maintenance organization shall not retroactively terminate a policy or contract issued pursuant to this part 4 except for fraud or intentional misrepresentation. For any termination other than for fraud or intentional misrepresentation, the health maintenance organization shall provide notice thirty days in advance of the cancellation of the policy or contract.
Added by 2013 Ch. 217,§ 34, eff. 5/13/2013.
L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 981, § 34, 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-501 - Legislative declaration

It is the policy of the general assembly and the intent and purpose of this part 5 to promote the availability and assure the competent quality of dental care on a prepaid basis, and to thereby promote the health and welfare of the people of Colorado. 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 5 in this article should in no way be construed so as to alter the distinct organizational and functional character of prepaid dental care plans or to alter the legal distinctions between such plans and other health-care coverage entities.
L. 92: Entire article R&RE, p. 1714, § 1, effective July 1. L. 94: Entire section amended, p. 1649, § 92, effective May 31.
This section is similar to former § 10-16.5-102 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-502 - Establishment of prepaid dental care plan organizations

(1)
No person, unless otherwise authorized pursuant to this title, may establish or operate a prepaid dental care plan organization in this state or sell or offer to sell, or solicit offers to purchase, or receive advanced or periodic consideration in conjunction with a prepaid dental care plan without obtaining and maintaining a certificate of authority pursuant to part 1 of this article and this part 5.
(2)
Within ninety days after January 1, 1980, every prepaid dental care plan organization operating in this state and pursuant to part 1 of this article and this part 5 shall submit an application for a certificate of authority to the commissioner. Each such applicant may continue to operate as an organization until the commissioner acts upon the application.
(3)
A prepaid dental care plan organized under part 1 of this article and this part 5 shall be subject to part 5 and part 11 of article
3
of this title but shall not be subject to any other laws of this state relating to insurance or insurance companies.
L. 92: Entire article R&RE, p. 1714, § 1, effective July 1.
This section is similar to former § 10-16.5-104 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-504 - Issuance of certificate of authority

(1)
Issuance of a certificate of authority shall be granted by the commissioner if the commissioner is satisfied that the following conditions are met:
(a)
The requirements of section
10-16-503
have been fulfilled;
(b)
The prepaid dental care plan organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees;
(c)
The agreement with providers for the provision of prepaid dental care services has been deemed sufficient;
(d)
Each officer responsible for conducting the affairs of the prepaid dental care plan organization has filed with the commissioner, subject to the commissioner's approval, a fidelity bond in the amount of fifty thousand dollars.
(2)
A certificate of authority shall expire at 12 midnight on June 30 next following the date of issuance or renewal and shall be renewed as provided in section
10-3-117
. A prepaid dental care plan organization shall pay a renewal fee as prescribed pursuant to section
10-3-207
.
L. 92: Entire article R&RE, p. 1717, § 1, effective July 1; (2) amended, p. 1601, § 130, effective July 1.
This section is similar to former § 10-16.5-106 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-505 - Guarantee fund deposit

(1)
A prepaid dental care plan organization subject to the provisions of part 1 of this article and this part 5 shall place on deposit with the commissioner a guarantee fund of cash, approved securities, or letter of credit approved by the commissioner in the amount of two dollars per enrollee for all enrollees entitled to dental care services pursuant to contracts issued by the prepaid dental care plan or ten thousand dollars, whichever is greater.
(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)
An unpaid final judgment arising upon an enrollee coverage shall be a lien on the deposit prescribed by subsection (1) of this section, subject to execution after thirty days from the entry of final judgment. If the deposit is reduced, it shall be replenished within ninety days by the prepaid dental care plan organization.
(4)
Upon liquidation or dissolution of a prepaid dental care plan organization formed under part 1 of this article and this part 5 and the satisfaction of all its debts and liabilities, any balance remaining of the deposit prescribed in subsection (1) of this section together with any other assets of the prepaid dental care plan organization shall be returned by the commissioner to the prepaid dental care plan organization.
(5)
The deposit prescribed by subsection (1) of this section shall not apply with respect to a prepaid dental care plan organization which is funded by a federal, state, or municipal government or by any political subdivision thereof to the extent and for such period of time that the prepaid dental care plan organization can demonstrate to the commissioner the presence of operational commitments from such sources equivalent to such deposit.
L. 92: Entire article R&RE, p. 1717, § 1, effective July 1; (2) amended, p. 1601, § 131, effective July 1. L. 96: (2) amended, p. 97, § 3, effective July 1.
This section is similar to former § 10-16.5-107 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-506 - Reserve requirement - exception

(1)
A prepaid dental care plan organization formed under part 1 of this article and this part 5 at all times shall maintain for protection of enrollees a financial reserve consisting of two percent of prepaid charges collected from enrollees for the plan, until such reserve totals five hundred thousand dollars. Such reserve shall be in addition to the deposit prescribed by section
10-16-505
.
(2)
The reserve prescribed by subsection (1) of this section shall not apply with respect to a prepaid dental care plan organization which is funded by a federal, state, or municipal government or by any political subdivision thereof and which meets the requirements of section
10-16-505(5)
.
L. 92: Entire article R&RE, p. 1718, § 1, effective July 1.
This section is similar to former § 10-16.5-108 as it existed prior to 1992.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-508 - Examination of prepaid dental care plan organization

(1)
The commissioner may visit once in each six months for the first three years after organization and once each year thereafter, or more often if deemed necessary by the commissioner, each prepaid dental care plan organization organized under part 1 of this article and this part 5 and examine its financial condition and its ability to meet its liabilities and its compliance with the laws of this state affecting the conduct of its business. The commissioner may visit and examine annually each prepaid dental care plan organization not organized under the laws of this state but authorized to transact business in this state.
(2)
The commissioner may in like manner examine each prepaid dental care plan organization applying for an initial certificate of authority to do business in this state under part 1 of this article and this part 5.
(3)
In lieu of making an examination, the commissioner may accept a full report of the most recent examination of a foreign or alien prepaid dental care plan organization, certified to by the appropriate examining official of another state, territory, commonwealth, or district of the United States.
L. 92: Entire article R&RE, p. 1719, § 1, effective July 1.
This section is similar to former § 10-16.5-110 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-509 - Operational expenses

No more than thirty percent of prepaid charges in the first year of any contract, twenty-five percent of prepaid charges in the second year of any contract, and twenty percent of prepaid charges in any subsequent contract year shall be used for the marketing and administrative expenses of a prepaid dental care plan organization, including all costs related to soliciting enrollees and providers.
L. 92: Entire article R&RE, p. 1720, § 1, effective July 1.
This section is similar to former § 10-16.5-112 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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-511 - Rehabilitation, liquidation, or conservation of prepaid dental care plan organization

Any rehabilitation, liquidation, or conservation of a prepaid dental care plan organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurer and shall be conducted pursuant to part 5 of article
3
of this title.
L. 92: Entire article R&RE, p. 1723, § 1, effective July 1; entire section amended, p. 1499, § 31, effective July 1.
(1) This section is similar to former § 10-16.5-115 as it existed prior to 1992.
(2) Amendments made to § 10-16.5-115 by section 31 of chapter 203, Session Laws of Colorado 1992, have been harmonized with this section since article 16.5 was repealed and the substantive provisions of former § 10-16.5-115 were moved to this section.
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 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-512 - Other laws applicable

In addition to the provisions of part 1 of this article and this part 5, the laws governing insurance companies, except as they are inconsistent with the provisions or purposes of this article, shall apply to prepaid dental care plans regulated pursuant to the provisions of part 1 of this article and this part 5.
L. 92: Entire section added, p. 1602, § 133, 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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-601 - Legislative declaration

The general assembly declares that the intent of this part 6, which shall only apply to this title and not to articles
40
to
47
of title
8
, C.R.S., is to ensure that patients have access to the best possible health-care decisions and information and to increase the confidence of consumers that doctors will be truly independent medical examiners.
L. 96: Entire part added, p. 566, § 1, effective April 24.
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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-602 - Definitions

As used in this part 6, unless the context otherwise requires:
(1)
"Doctor" means a person licensed as a doctor under title
12
, C.R.S., to provide health care to a patient.
(2)
"Insurer" means a sickness and accident insurer and any health maintenance organization; fraternal benefit society; nonprofit hospital, medical-surgical, and health services corporation; prepaid health plans; or other entity providing health-care coverage or health benefits or health-care services, whether as a principal, indemnitor, surety, or contractor, authorized by the commissioner to conduct business in Colorado. "Insurer" also includes a self-insurer providing any health coverage or health benefit or health-care services certificate, agreement, contract, policy, or plan; except that the term "insurer" under this part 6 shall apply only to this part 6 and shall not include an insurer or self-insured employer under articles
40
to
47
of title
8
, C.R.S.
(3)
"Patient" means an individual covered by, or denoted as an insured, subscriber, enrollee, or purchaser under any health coverage or health benefit or health-care services certificate, agreement, contract, policy, or plan. "Patient" also includes a covered employee or dependent of an insured person.
L. 96: Entire part added, p. 566, § 1, effective April 24. L. 2004: (2) amended, p. 903, § 25, 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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-603 - Independent medical examinations - governing standard

All independent medical examinations performed by a doctor shall be performed in accordance with generally accepted professional standards of practice or care. It shall be unprofessional conduct for a doctor to perform an independent medical examination not in accordance with generally accepted professional standards of practice or care.
L. 96: Entire part added, p. 567, § 1, effective April 24.
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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-604 - Financial interest in future care of patient prohibited

No doctor that performs an independent medical examination shall have a financial or economic interest in the type or duration of treatment or the results of the examination.
L. 96: Entire part added, p. 567, § 1, effective April 24.
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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-605 - Independence of examiners

No insurer, employer, employee, patient, or agent or representative thereof shall attempt to dictate to any doctor performing an independent medical examination the type or duration of treatment or the results of the examination.
L. 96: Entire part added, p. 567, § 1, effective April 24.
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 6 - ACCOUNTABILITY OF INDEPENDENT MEDICAL EXAMINERS TO THEIR PATIENTS (§§ 10-16-601 — 10-16-606) › Section 10-16-606 - Applicability

Nothing in this part 6 shall be construed to apply to any action under articles
40
to
47
of title
8
, C.R.S.
L. 96: Entire part added, p. 567, § 1, effective April 24.
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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-701 - Short title

This part 7 shall be known and may be cited as the "Consumer Protection Standards Act for the Operation of Managed Care Plans".
L. 97: Entire part added, p. 1325, § 2, 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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-702 - Legislative declaration

(1)
The general assembly hereby finds, determines, and declares that the purposes of this part 7 are:
(a)
To incorporate consumer protections in the creation and maintenance of provider networks by carriers;
(b)
To establish standards to assure the adequacy, accessibility, and quality of health-care services offered under a managed care plan; and
(c)
To establish requirements for written agreements between carriers offering managed care plans and participating providers regarding the standards, terms, and provisions under which the participating provider will provide services to covered persons.
L. 97: Entire part added, p. 1325, § 2, 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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-703 - Applicability

This part 7 applies to all managed care plans, except for workers' compensation and automobile insurance contracts, that are issued, renewed, extended, or modified on or after January 1, 1998.
L. 97: Entire part added, p. 1325, § 2, 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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-706 - Intermediaries

(1)
In addition to any other applicable requirements of this part 7, a contract between a carrier and an intermediary shall satisfy all the requirements of this section.
(2)
Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of section
10-16-705
.
(3)
The responsibility to ensure that participating providers have the capacity and legal authority to furnish covered benefits shall be retained by the carrier.
(4)
A carrier shall have the right to approve or disapprove participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits to the carrier's covered persons.
(5)
A carrier shall maintain copies of all intermediary health-care subcontracts.
(6)
If applicable, an intermediary shall transmit utilization documentation and claims paid documentation to the carrier. The carrier shall monitor the timeliness and appropriateness of payments made to participating providers and health-care services received by covered persons.
(7)
If applicable, an intermediary shall maintain books, records, financial information, and documentation of services provided to covered persons at the intermediary's place of business in this state.
(8)
An intermediary shall allow the commissioner access to the intermediary's books, records, financial information, and any documentation of services provided to covered persons as necessary to determine compliance with this part 7.
(9)
A carrier shall have the right, in the event of the intermediary's insolvency, to require the assignment to the carrier of the provisions of a participating provider's contract addressing the provider's obligation to furnish covered services.
L. 97: Entire part added, p. 1331, § 2, 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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-707 - Enforcement

(1)
If it is determined that a carrier has not contracted with enough participating providers to assure that covered persons have accessible health-care services in a geographic area, that a carrier's access plan does not assure reasonable access to covered benefits, that a carrier has entered into a contract that does not comply with this part 7, or that a carrier has not complied with a provision of this part 7, the commissioner may institute a corrective action that shall be followed by the carrier or may use any of the commissioner's other enforcement powers to obtain the carrier's compliance with this part 7.
(2)
The commissioner shall not act to arbitrate, mediate, or settle disputes between a managed care plan and a provider concerning a provider's inclusion or termination from the network.
(3)
Failure of a provider to comply with the requirements of section
10-16-705 (16)
shall preclude a carrier from contracting with a provider.
L. 97: Entire part added, p. 1332, § 2, effective July 1. L. 2002: (3) added, p. 1299, § 15, effective 1/1/2003.
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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-708 - Rule-making authority of commissioner

The commissioner may promulgate rules as necessary for carrying out the commissioner's duties under this part 7.
L. 97: Entire part added, p. 1332, § 2, 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 7 - CONSUMER PROTECTION STANDARDS ACT FOR THE OPERATION OF MANAGED CARE PLANS (§§ 10-16-701 — 10-16-710) › Section 10-16-710 - Reporting to commissioner - medication-assisted treatment - rules

(1)
A carrier shall report to the commissioner:
(a)
The number of in-network providers who are federally licensed to prescribe medication-assisted treatment for substance use disorders, including buprenorphine; and
(b)
The number of prescriptions filled by enrollees for medication-assisted treatment for substance use disorders; and
(c)
The carrier's efforts to ensure sufficient capacity for and access to medication-assisted treatment for substance use disorders.
(2)
The commissioner shall promulgate rules concerning the reporting requirements specified in subsection (1) of this section, including the reporting period, the frequency of reporting, and any other provisions necessary to comply with the reporting requirement.
Added by 2020 Ch. 286,§ 9, eff. 7/13/2020.
L. 2020: Entire section added, (SB 20-007), ch. 1391, p. 1391, § 9, effective July 13.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 8 - TASK FORCE TO EVALUATE HEALTH CARE NEEDS FOR COLORADO (§ 10-16-801) › Section 10-16-801 - [Repealed]

L. 2003: Entire part repealed, p. 1785, § 17, effective July 1.
This part 8 was added in 2001 and was not amended prior to its repeal in 2003. For the text of this part 8 prior to 2003, consult the 2002 Colorado Revised Statutes.
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 9 - [Repealed] MULTIPLE EMPLOYER WELFARE ARRANGEMENT PILOT PROGRAM (§ 10-16-901) › Section 10-16-901 - to 10-16-910 - [Repealed]

(1) This part 9 was added in 2003.
(2) Section 10-16-910(1) provided for the repeal of this part 9, effective July 1, 2008. (See L. 2003, p. 1779.)
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 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1003 - Privacy of health information

(1)
Individually identifiable health information collected for or by a cooperative is subject to HIPAA.
(2)
(a)
All disclosures of individually identifiable health information shall be restricted to the minimum amount of information necessary to accomplish the purpose for which the information is being disclosed.
(b)
Any cooperative shall implement administrative, technical, and physical safeguards for the security of identifiable health information.
(3)
(a)
Subject to appropriate procedures established by a cooperative, an individual has the right to know whether any individual or entity uses or maintains individually identifiable health information concerning the individual and for what purpose the information may be used or maintained.
(b)
Subject to appropriate procedures established by a cooperative, an individual has the right, with respect to identifiable health information concerning the individual that is recorded in any form or medium, to:
(I)
See such information;
(II)
Copy such information; and
(III)
Have a notation made with or in such information including suggestions for amendments or corrections to such information requested by the individual or the individual's representative.
(4)
Provider networks and providers in a network shall maintain the confidentiality of medical records as otherwise required by section
18-4-412
, C.R.S., or other applicable law.
Amended by 2019 Ch. 205,§ 4, eff. 8/2/2019.
L. 2004: Entire part added, p. 995, § 14, effective August 4.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, 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 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1006 - Authority to deny application for, revoke, or suspend certificate of authority

(1)
On and after August 4, 2004, the commissioner may deny an application for a certificate of authority pursuant to section
10-16-1005
or revoke or suspend a certificate of authority of any cooperative found to be in violation of this part 10.
(2)
(a)
Any party may request a hearing pursuant to article
4
of title
24
, C.R.S., on any action of the commissioner denying an application for a certificate of authority or revoking or suspending a certificate of authority.
(b)
Any hearing conducted under this section shall be conducted pursuant to article
4
of title
24
, C.R.S., and section
10-1-127
, and the commissioner may use the services of an administrative law judge appointed pursuant to part 10 of article
30
of title
24
, C.R.S.
(c)
Any final decision of the commissioner under this part 10 shall be subject to judicial review by the court of appeals pursuant to section
24-4-106(11)
, C.R.S.
L. 2004: Entire part added, p. 999, § 14, effective August 4.
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 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1007 - Prohibition on cooperatives transacting insurance business

A cooperative shall not perform any activity included in the definition of transacting insurance business in this state, as provided in section
10-3-903
, except as otherwise authorized in the powers, duties, and responsibilities of cooperatives as set forth in section
10-16-1009
. A cooperative shall not establish or engage in the activities of a health maintenance organization.
Amended by 2013 Ch. 217,§ 53, eff. 5/13/2013.
L. 2004: Entire part added, p. 999, § 14, effective August 4. L. 2013: Entire section amended, (HB 13-1266), ch. 217, p. 990, § 53, 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 10 - HEALTH-CARE COVERAGE COOPERATIVES (§§ 10-16-1001 — 10-16-1016) › Section 10-16-1008 - Administrative structure of cooperatives - board of directors - officers - employees

(1)
(a)
(I)
The affairs of the cooperative shall be managed in accordance with the legal structure required of the entity and, except as provided in subsection (1)(a)(II) of this section, governed by persons elected by the members from their own number. The governing body of the cooperative shall adopt bylaws and rules for the cooperative.
(II)
The members of the cooperative may elect to the governing body up to three individuals who are not able to join the cooperative as members, but at least eighty percent of the governing board must consist of members of the cooperative.
(b)
Members of a cooperative shall be entitled to equal participation and benefit from the cooperative; except that a cooperative at its option may extend voting rights to eligible employees.
(c)
The governing body of the cooperative shall meet at such times and places as it determines necessary to operate the cooperative in accordance with this part 10.
(2)
A cooperative may provide fair remuneration for the time actually spent by its officers and directors in its service and for the service of the members of its executive committee.
(3)
An individual who is a member of a governing body of a cooperative may not be a person with financial interest in the cooperative's business during his or her term on the governing body or during the twelve-month period immediately before or after service on such governing body.
(4)
The bylaws may provide that no member of the governing body of a cooperative shall occupy any position in the cooperative except the chief executive officer and secretary on regular salary or substantially full-time pay. The bylaws may provide for an executive committee and may allot to the executive committee all the functions and powers of the board of directors, subject to general direction and control by the board.
(5)
When a vacancy occurs on the governing body of a cooperative other than by expiration of a member's term, the remaining members of the governing body shall fill the vacancy by majority vote.
(6)
The governing body of a cooperative may appoint a chief executive officer of the cooperative and other staff necessary to administer the cooperative. The chief executive officer and other staff serve at the pleasure of the governing body.
(7)
No cooperative may assume any liability for payment for health-care services covered by a plan purchased through the cooperative.
Amended by 2019 Ch. 205,§ 6, eff. 8/2/2019.
L. 2004: Entire part added, p. 999, § 14, effective August 4.
For the legislative declaration in SB 19-004, see section 1 of chapter 205, Session Laws of Colorado 2019.