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 10-16-105.7 - Health benefit plan open enrollment periods - special enrollment periods - rules

(1)
(a)
A carrier offering an individual health benefit plan in this state shall permit an individual to purchase an individual health benefit plan during the initial and annual open enrollment periods.
(b)
The initial open enrollment period begins October 1, 2013, and extends through March 31, 2014.
(c)
For benefit years beginning on or after January 1, 2015, the annual open enrollment period begins October 15 and extends through December 7 of the preceding calendar year.
(d)
For purposes of this subsection (1), the benefit year for health benefit plans purchased during the initial and annual enrollment periods is a calendar year.
(e)
The commissioner shall establish rules in accordance with federal law for the implementation of this subsection (1).
(2)
(a)
A carrier offering a group health benefit plan in this state shall permit an employer to purchase a group health benefit plan at any point during the year.
(b)
In the case of health benefit plans offered in the small group market, a carrier may decline to offer coverage to a small employer that is unable to comply with a material plan provision relating to employer contribution or group participation rules, as required by section
10-16-105 (3)(b)
, and that carrier may limit the availability of coverage for a group it has declined to an enrollment period that begins November 15 and ends December 15 of each year or begins and ends on dates set by the commissioner by rule.
(c)
The coverage is effective consistent with the dates determined by the commissioner by rule.
(3)
(a)
(I)
A carrier offering an individual health benefit plan in this state shall establish special enrollment periods during which an individual for whom a triggering event has occurred may enroll in an individual health benefit plan offered by the carrier.
(II)
A triggering event occurs when:
(A)
An individual involuntarily loses existing creditable coverage for any reason other than fraud, misrepresentation, or failure to pay a premium;
(B)
An individual gains a dependent or becomes a dependent through marriage, civil union, birth, adoption, or placement for adoption or by entering into a designated beneficiary agreement pursuant to article
22
of title
15
, C.R.S.;
(C)
An individual's enrollment or nonenrollment in a health benefit plan is unintentional, inadvertent, or erroneous and is the result of an error, misrepresentation, or inaction of the carrier, producer, or exchange established pursuant to article
22
of this title;
(D)
An individual adequately demonstrates to the commissioner that the health benefit plan in which the individual is enrolled has substantially violated a material provision of its contract in relation to the individual;
(E)
The exchange established pursuant to article
22
of this title determines an individual to be newly eligible or newly ineligible for the federal advance payment tax credit or cost-sharing reductions available through the exchange pursuant to federal law;
(F)
An individual gains access to other creditable coverage as a result of a permanent change of residence;
(F.5)
An uninsured individual was included in the calculation of "family size" as defined in the federal "Internal Revenue Code of 1986",
26 U.S.C. sec. 36B (d)(1)
, as amended, by a tax filer who filed an income tax return for the prior calendar year by the April 15 tax deadline, and the exchange notifies the individual based on information provided through the Colorado affordable health care coverage easy enrollment program created in section
10-22-113
that the individual qualifies for a subsidized health benefit plan;
(G)
Any other event or circumstance occurs as set forth in rules of the commissioner defining triggering events; or
(H)
Beginning January 1, 2024, an individual who does not have existing creditable coverage receives certification from a health-care provider acting within the provider's scope of practice that the individual is pregnant. Coverage is deemed effective as of the first month in which the individual receives certification of the pregnancy, unless the individual elects to have coverage effective on the first day of the month following the date that the individual makes a plan selection. Any person or entity enrolling an individual in coverage pursuant to this special enrollment period shall provide a notice, developed by the department through a stakeholder process, to the individual regarding the individual's option to begin coverage either prospectively or retroactively and the financial and tax implications of those options. The notice must be in, at a minimum, English and Spanish.
(III)
For the purposes of subsection (3)(a)(II)(F.5) of this section, a carrier is not required to further verify that an individual is eligible for a special enrollment period.
(b)
(I)
A carrier offering a group health benefit plan in this state shall establish special enrollment periods during which an individual for whom a qualifying event has occurred may enroll in a group health benefit plan offered by the carrier.
(II)
A qualifying event occurs when:
(A)
An individual loses coverage under a health benefit plan due to the death of a covered employee; the termination or reduction in number of hours of the covered employee's employment; or the covered employee becoming eligible for benefits under Title XVIII of the federal "Social Security Act", as amended;
(B)
An individual loses coverage under a health benefit plan due to the divorce or legal separation of the covered employee from the covered employee's spouse or partner in a civil union;
(C)
An individual becomes a dependent of a covered person through marriage, civil union, birth, adoption, or placement for adoption, by entering into a designated beneficiary agreement pursuant to article
22
of title
15
, C.R.S., or pursuant to a court or administrative order mandating that the individual be covered;
(D)
An individual loses other creditable coverage due to the termination of his or her employment or eligibility for the coverage; reduction in number of hours of employment; involuntary termination of coverage; or reduction or elimination of his or her employer's contributions toward the coverage;
(E)
An individual loses eligibility under the "Colorado Medical Assistance Act", articles
4
to
6
of title
25.5
, C.R.S., or the children's basic health plan, article
8
of title
25.5
, C.R.S.; or
(F)
Any other event or circumstance occurs as set forth in rules of the commissioner defining qualifying events.
(c)
The commissioner shall adopt rules in accordance with federal law for the implementation of this section. The commissioner may adopt rules to allow individuals enrolled in a health benefit plan through an exchange established under article
22
of this title to enroll in or change from one health benefit plan to another under circumstances specified in the rules.
Amended by 2022 Ch. 399, § 4, eff. 6/7/2022.
Amended by 2020 Ch. 236, § 1, eff. 9/14/2020.
Added by 2013 Ch. 217, § 10, eff. 5/13/2013.
L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 936, § 10, effective May 13.