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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1408 - Colorado prescription drug affordability review board - judicial review

(1)
The following board functions are not final agency actions subject to judicial review under the "State Administrative Procedure Act", article
4
of title
24
:
(a)
Identification of eligible prescription drugs pursuant to section
10-16-1406 (1)
;
(b)
Selection of a prescription drug pursuant to section
10-16-1406 (2)
; and
(c)
Determination that a prescription drug is unaffordable pursuant to section
10-16-1406 (3)
.
(2)
A rule of the board establishing an upper payment limit is a final agency action subject to judicial review under the "State Administrative Procedure Act", article
4
of title
24
. A party seeking judicial review of a rule establishing an upper payment limit may seek review of whether the prescription drug satisfies the necessary criteria in section
10-16-1406
to be eligible for an upper payment limit.
(3)
Repealed.
(4)
Notwithstanding any provision of law to the contrary:
(a)
An individual may request an expedited review, as described in section
10-16-113.5
, of access to a prescription drug that is unavailable to the individual because a manufacturer refuses to make the drug available as a result of an upper payment limit established for the prescription drug by the board; and
(b)
A carrier may disregard the upper payment limit if the independent external review entity that performs the expedited review determines pursuant to such review that the prescription drug should be covered for and available to that individual.
Amended by 2023 Ch. 162,§ 6, eff. 8/7/2023.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
2023 Ch. 162, 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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1410 - Use of savings - report - rules

(1)
Any savings generated for a health benefit plan that are attributable to the establishment of an upper payment limit established by the board pursuant to section
10-16-1407
must be used by the carrier that issues the health benefit plan to reduce costs to consumers, prioritizing the reduction of out-of-pocket costs for prescription drugs.
(2)
On or before March 15, 2023, and on or before March 15 each year thereafter, each state entity and each carrier that issues a health benefit plan or optional participating plan shall submit to the board a report describing the savings achieved during the preceding plan year for each prescription drug for which the board established an upper payment limit during the preceding year and how those savings were used to satisfy the requirement described in subsection (1) of this section.
(3)
On or before November 1, 2022, the board shall promulgate rules establishing a formula for calculating savings for the purpose of complying with subsection (1) of this section.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1411 - Unlawful acts - enforcement - penalties

(1)
On and after January 1, 2022, it is unlawful for any person to purchase or reimburse a payer for a prescription drug for which the board has established an upper payment limit pursuant to section
10-16-1407
at an amount that exceeds the upper payment limit established by the board for that prescription drug, regardless of whether the prescription drug is dispensed or distributed in person, by mail, or by other means.
(2)
On and after January 1, 2023, each state entity, carrier, and optional participating plan shall require compliance with an upper payment limit established by the board.
(3)
The attorney general is authorized to enforce this part 14 on behalf of any state entity or any consumer of prescription drugs.
(4)
Notwithstanding any provision of this part 14 to the contrary, as used in this section, "person" does not include an individual who acquires a prescription drug for the individual's own use or for a family member's use.
(5)
Notwithstanding any provision of this section to the contrary, a carrier or state agency that is required pursuant to state or federal law to purchase or reimburse a payer for a prescription drug for which the board has established an upper payment limit pursuant to section
10-16-1407
is not subject to an enforcement action for a violation of subsection (1) or (2) of this section for that particular prescription drug.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1412 - Notice of withdrawal of prescription drugs with upper payment limits required - rules - penalty

(1)
Any manufacturer that intends to withdraw from sale or distribution within the state a prescription drug for which the board has established an upper payment limit pursuant to section
10-16-1407
shall provide a notice of withdrawal in writing at least one hundred eighty days before the withdrawal to:
(a)
The commissioner;
(b)
The attorney general; and
(c)
Each entity in the state with which the manufacturer has contracted for the sale or distribution of the prescription drug.
(2)
The board shall promulgate rules to notify consumers of the intent of any manufacturer to withdraw a prescription drug from sale or distribution within the state, as described in subsection (1) of this section.
(3)
After providing notice and a hearing as described in section
24-4-105
, the commissioner may require a manufacturer to pay a penalty not to exceed five hundred thousand dollars if the commissioner determines that the manufacturer failed to provide the notice required by subsection (1) of this section before withdrawing from sale or distribution within the state a prescription drug for which the board has established an upper payment limit pursuant to section
10-16-1407
.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1413 - Optional participating plans - notice of election to participate required

An optional participating plan that elects to subject its purchases of or payer reimbursements for prescription drugs in Colorado to the requirements of this part 14 shall notify the commissioner in writing within thirty days after such election.
Added by 2021 Ch. 240,§2, eff. 6/16/2021.
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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1415 - Exemption - prescription drugs derived from cannabis

Notwithstanding any provision of this part 14 to the contrary, the board has no authority to perform an affordability review of, or to establish an upper payment limit for, any prescription drug that is derived in whole or in part from cannabis.
Added by 2021 Ch. 240,§2, eff. 6/16/2021.
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 14 - COLORADO PRESCRIPTION DRUG AFFORDABILITY REVIEW BOARD (§§ 10-16-1401 — 10-16-1416) › Section 10-16-1416 - Repeal of part

This part 14 is repealed, effective September 1, 2031. Before the repeal, the functions of the board are scheduled for review in accordance with section
24-34-104
.
Amended by 2023 Ch. 162,§ 8, eff. 8/7/2023.
Added by 2021 Ch. 240, § 2, eff. 6/16/2021.
2023 Ch. 162, 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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1501 - Short title

The short title of this part 15 is the "Colorado 340B Prescription Drug Program Anti-discrimination Act".
Added by 2022 Ch. 312,§1, eff. 8/10/2022.
2022 Ch. 312, 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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1502 - Legislative declaration

(1)
The general assembly declares that the purpose of this part 15 is to:
(a)
Prohibit a pharmacy benefit manager or carrier from imposing fees, charge backs, or other adjustments on covered entities or contract pharmacies based on their participation in the 340B drug pricing program;
(b)
Prohibit a pharmacy benefit manager or carrier from requiring a claim for a drug to include a modifier to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the medicaid program; and
(c)
Provide for powers and duties of the commissioner and the division.
Added by 2022 Ch. 312,§1, eff. 8/10/2022.
2022 Ch. 312, 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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1503 - Definitions

As used in this part 15, unless the context otherwise requires:
(1)
"340B covered entity" means a covered entity, as defined in section 340B (a)(4) of the federal "Public Health Service Act",
42 U.S.C. sec. 256b (a)(4)
, as amended.
(2)
"340B drug" means a drug purchased through the 340B drug pricing program by a 340B covered entity.
(3)
"340B drug pricing program" or "340B program" means the program described in
42 U.S.C. sec. 256b
.
(4)
"Contract pharmacy" means a pharmacy operating under contract with a 340B covered entity to provide dispensing services to the 340B covered entity as described in 75 Fed. Reg. 10272 (2010) or any superseding guidance.
(5)
(a)
"Drug coverage" means coverage or payment for a prescription drug dispensed by a pharmacy to a patient pursuant to:
(I)
A health coverage plan;
(II)
A managed care organization, as defined in section
25.5-5-403 (5)
; or
(III)
Any other contractual or other legal obligation to provide coverage or payment for a prescription drug dispensed by a pharmacy to a patient.
(b)
"Drug coverage" does not include:
(I)
Reimbursement for covered outpatient drugs, as that term is defined in section
42 U.S.C. sec. 1396r
-
8 (k)(2)
, on a fee-for-service basis under the medicaid program; or
(II)
Any amounts paid by an individual on the individual's own behalf or on behalf of another individual without a contractual or legal obligation to do so.
(6)
"Medicaid program" means the medical assistance program established pursuant to articles
4
to
6
of title
25.5
.
(7)
(a)
"Third party" means:
(I)
A carrier or pharmacy benefit manager that provides or manages drug coverage under a health coverage plan; or
(II)
A system of health insurance for state or local government employees, their dependents, and retirees, including a group benefit plan, as defined in section
24-50-603 (9)
, and a group health-care program designed pursuant to section
24-51-1202
.
(b)
"Third party" does not include:
(I)
An insurer that provides coverage under a policy of property and casualty insurance; or
(II)
An insurer or entity that provides health coverage, benefits, or coverage of prescription drugs as part of coverage required under the "Workers' Compensation Act of Colorado", articles
40
to
47
of title
8
, or workers' compensation coverage required under federal law.
Added by 2022 Ch. 312, § 1, eff. 8/10/2022.
2022 Ch. 312, 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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1504 - Applicability - exclusions

(1)
This part 15 applies to any third party that reimburses 340B covered entities or contract pharmacies in this state.
(2)
Nothing in this part 15:
(a)
Prohibits a third party from maintaining differential reimbursement rates for participating and nonparticipating providers, so long as the rates are not determined on the basis of a provider's status as a 340B covered entity or contract pharmacy;
(b)
Affects a third party's ability to establish coverage guidelines and exclude specific drugs from its prescription drug formularies, so long as the guidelines and exclusions are not determined on the basis of a provider's status as a 340B covered entity or contract pharmacy or of a drug's status as a 340B drug; or
(c)
Requires a third party to contract with a 340B covered entity or contract pharmacy for purposes of participating in the third party's network, so long as the third party's contracting decisions are not determined on the basis of a provider's status as a 340B covered entity or contract pharmacy.
Added by 2022 Ch. 312,§1, eff. 8/10/2022.
2022 Ch. 312, 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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1505 - Prohibition on 340B discrimination

(1)
A third party that reimburses a 340B covered entity or contract pharmacy for 340B drugs shall not:
(a)
Reimburse the 340B covered entity or contract pharmacy for a pharmacy-dispensed drug at a rate lower than the amount paid for the same drug to pharmacies similar in prescription volume that are not 340B covered entities or contract pharmacies;
(b)
Assess any fee, charge back, or other adjustment against the 340B covered entity or contract pharmacy on the basis that the 340B covered entity or contract pharmacy participates in the 340B program;
(c)
Restrict access to the third party's pharmacy network for any 340B covered entity or contract pharmacy on the basis that the 340B covered entity or contract pharmacy participates in the 340B program;
(d)
Require the 340B covered entity or contract pharmacy to enter into a contract with a specific pharmacy or health coverage plan to participate in the third party's pharmacy network;
(e)
Create a restriction or an additional charge on a patient who chooses to receive drugs from a 340B covered entity or contract pharmacy;
(f)
Restrict the methods by which a 340B covered entity or contract pharmacy may dispense or deliver 340B drugs;
(g)
Refuse to provide reimbursement or coverage for 340B drugs; or
(h)
Create any additional requirements or restrictions on a 340B covered entity or contract pharmacy.
(2)
Unless a claim is for payment, directly or indirectly, by the medicaid program, a pharmacy benefit manager or any other third party that reimburses a 340B covered entity or contract pharmacy for 340B drugs shall not require a claim for a 340B drug to include:
(a)
A modifier to indicate that the drug is a 340B drug; or
(b)
Any other method of identifying the claim for a 340B drug.
(3)
With respect to a patient eligible to receive 340B drugs, a pharmacy benefit manager or any other third party that makes payment for the drugs shall not discriminate against a 340B covered entity or contract pharmacy in a manner that prevents or interferes with the patient's choice to receive the drugs from the 340B covered entity or contract pharmacy.
Added by 2022 Ch. 312,§1, eff. 8/10/2022.
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 15 - 340B PRESCRIPTION DRUG PROGRAM ANTI-DISCRIMINATION ACT (§§ 10-16-1501 — 10-16-1506) › Section 10-16-1506 - Enforcement - rules

(1)
A third party that violates this part 15 engages in an unfair or deceptive act or practice in the business of insurance under section
10-3-1104(1)(tt)
, and the act of the third party that violates this part 15 is void and unenforceable.
(2)
The commissioner may adopt rules as necessary to implement this part 15.
Added by 2022 Ch. 312,§1, eff. 8/10/2022.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16.5 - [Repealed] PREPAID DENTAL CARE PLANS (§ 10-16.5-101) › Section 10-16.5-101 - to 10-16.5-116 - [Repealed]

L. 92: Entire article repealed, p. 1728, § 22, effective July 1.
This article was added in 1979. The provisions of this article were relocated to parts 1 and 5 of article
16
of this title.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH MAINTENANCE ORGANIZATIONS (§ 10-17-101) › Article 17 - [Repealed] HEALTH MAINTENANCE ORGANIZATIONS (§ 10-17-101) › Section 10-17-101 - to 10-17-140 - [Repealed]

L. 92: Entire article repealed, p. 1728, § 22, effective July 1.
This article was numbered as article 37 of chapter 72 in C.R.S. 1963. The provisions of this article were relocated to parts 1 and 4 of article
16
of this title. For the location of specific provisions, see the editor's notes following each section in said parts 1 and 4 and the comparative tables located in the back of the index.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-101 - Definitions

As used in this article, unless the context otherwise requires:
(1)
"Applicant" means:
(a)
In the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; or
(b)
In the case of a group medicare supplement policy or subscriber contract, the proposed certificate holder.
(2)
"Certificate" means any certificate issued under a group medicare supplement policy, which certificate has been delivered or issued for delivery in this state.
(3)
"Medicare" means the "Health Insurance for the Aged Act", Title XVIII of the federal "Social Security Act", as amended by the social security amendments of 1965, and as later amended.
(4)
"Medicare supplement policy" means a group or individual policy of sickness and accident insurance or a subscriber contract of a nonprofit hospital and health service corporation or a health maintenance organization, which policy or contract is primarily advertised, marketed, or designed as a supplement to reimbursements under medicare for the hospital, medical, or surgical expenses of persons eligible for medicare.
L. 89: Entire article R&RE, p. 498, § 1, effective July 1. L. 92: (4) amended, p. 1500, § 34, effective July 1.
This section is similar to former § 10-18-101 as it existed prior to 1989.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-102 - Applicability and scope

(1)
Except as otherwise specifically provided, this article shall apply to:
(a)
All medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after July 1, 1989; and
(b)
All certificates issued under group medicare supplement policies or subscriber contracts, which certificates have been delivered or issued for delivery in this state on or after July 1, 1989.
(2)
The provisions of this article shall not apply to a policy or contract for employees, former employees, or any combination of employees or former employees or to a policy or contract for members, former members, or any combination of members and former members of labor organizations, which policy or contract is established by one or more employers or labor organizations or the trustees of a fund established by one or more employers or labor organizations or any combination of such employers, labor organizations, or trustees.
(3)
The provisions of this article shall not apply to insurance policies or health-care benefit plans, including group conversion policies, provided to medicare eligible persons, which policies are not marketed as or held out to be medicare supplement policies or benefit plans.
L. 89: Entire article R&RE, p. 499, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-104 - Minimum standards for benefits and claims payment

The commissioner shall issue reasonable regulations to establish minimum standards for benefits and payment of claims under medicare supplement policies.
L. 89: Entire article R&RE, p. 500, § 1, effective July 1.
This section is similar to former § 10-18-103 as it existed prior to 1989.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-105 - Loss ratio standards and filing requirements

(1)
Every insurer providing group or individual medicare supplement insurance benefits to a resident of this state pursuant to section
10-18-102
shall file a copy of the group master policy or individual policy and any certificate used in this state in accordance with the filing requirements and procedures of sections
10-16-107.2
and
10-16-406
; except that no insurer shall be required to make a filing earlier than thirty days after insurance was provided to a resident of this state under a group master policy issued for delivery outside this state.
(2)
Group and individual medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience or incurred health-care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and on the basis of earned premiums in accordance with accepted actuarial principles and practices. Every entity providing medicare supplement policies or certificates in this state shall file annually its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this state. All filings of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this article.
(3)
No entity shall provide compensation to its agents or other producers which is greater than the renewal compensation which would have been paid on an existing policy if the existing policy had been replaced by another policy with the same company and the new policy benefits had been substantially similar to the benefits under the old policy and the old policy had been issued by the same insurer or insurer group.
Amended by 2013 Ch. 217,§ 55, eff. 5/13/2013.
L. 89: Entire article R&RE, p. 500, § 1, effective July 1. L. 92: (1) amended, p. 1725, § 10, effective July 1. L. 2013: (1) amended, (HB 13-1266), ch. 217, p. 990, § 55, effective May 13.
This section is similar to former § 10-18-104 as it existed prior to 1989.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-107 - Right to examine policy - right to refund of premium

Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within thirty days after its delivery and to have any premium refunded if, after examination of the policy or certificate, the policyholder or certificate holder is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the policyholder or certificate holder by the insurer in a timely manner. If a policyholder or certificate holder decides to cancel a policy or certificate after the first thirty days of coverage and the policyholder or certificate holder provides the insurer notice of the cancellation at least thirty days before cancellation, the insurer shall refund a prorated amount of any prepaid premiums for such policy or certificate based on the subsequent full months of coverage being canceled.
L. 89: Entire article R&RE, p. 502, § 1, effective July 1. L. 2002: Entire section amended, p. 305, § 1, effective 1/1/2003.
This section is similar to former § 10-18-107 as it existed prior to 1989.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-108 - Advertising - copy provided to commissioner

Every insurer, health-care service plan, or other entity providing medicare supplement insurance or benefits in this state that advertises medicare supplement insurance shall provide the commissioner a written copy of the medicare supplement advertisement used in this state. If there is a complaint filed about a radio or television advertisement, the commissioner may request an audio or video recording from those entities.
Amended by 2022 Ch. 421,§19, eff. 8/10/2022.
L. 89: Entire article R&RE, p. 502, § 1, effective July 1.
2022 Ch. 421, 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) › MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Article 18 - MEDICARE SUPPLEMENT INSURANCE (§§ 10-18-101 — 10-18-109) › Section 10-18-109 - Penalties

In addition to any other applicable penalties for violations of this title, the commissioner may order insurers violating any provision of this article or regulations promulgated pursuant to this article to cease marketing any medicare supplement policy or certificate in this state, which policy or certificate is related directly or indirectly to a violation, may order such insurers to take such actions as are necessary to comply with the provisions of this article, or may make both such orders.
L. 89: Entire article R&RE, p. 502, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-101 - Short title

This article shall be known and may be cited as the "Long-term Care Insurance Act".
L. 90: Entire article R&RE, p. 643, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-102 - Legislative declaration

The general assembly hereby declares that the purpose of this article is to promote the public interest and the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.
L. 90: Entire article R&RE, p. 643, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-104 - Scope and applicability of article

The requirements of this article shall apply to policies delivered or issued for delivery in this state on or after July 1, 1990. This article is not intended to supersede the obligations of entities subject to this article to comply with the substance of other applicable insurance laws insofar as they do not conflict with this article; except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance.
L. 90: Entire article R&RE, p. 645, § 1, effective July 1. L. 2007: Entire section amended, p. 198, § 2, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-105 - Extraterritorial jurisdiction - group long-term care insurance

A group long-term care insurance coverage shall not be offered to a resident of this state under a group policy issued in another state to a group described in section
10-19-103(4)(d)
, unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
L. 90: Entire article R&RE, p. 645, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-106 - Rules on disclosure

The commissioner may adopt rules and regulations that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. Such rules and regulations shall be in accordance with the "State Administrative Procedure Act", article
4
of title
24
, C.R.S.
L. 90: Entire article R&RE, p. 645, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-107 - Performance standards

(1)
A long-term care insurance policy may not:
(a)
Be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or
(b)
Contain a provision establishing a new waiting period in the event that existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or
(c)
Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care; or
(d)
Exclude coverage for dementia diseases and related disabilities.
(2)
A long-term care insurance policy shall:
(a)
Offer the policyholder the opportunity to designate an individual who can be contacted in the event the policy is about to lapse. If the policyholder declines to designate someone, the carrier shall obtain a signed statement that the policyholder has been offered this opportunity and declined. The policyholder has the right to periodically update his or her authorized designee.
(b)
Provide a ninety-day reinstatement period for policyholders who have allowed their policies to lapse due to nonpayment of premium, who have a cognitive impairment, and who have regularly paid the required premiums. The reinstated policy shall provide the same benefits, terms, and premiums as the lapsed policy.
Amended by 2018 Ch. 74, § 11, eff. 8/8/2018.
L. 90: Entire article R&RE, p. 646, § 1, effective July 1. L. 95: (2) added, p. 923, § 21, effective May 25. L. 2007: (1)(c) amended, p. 198, § 3, effective 1/1/2008. L. 2018: (1)(d) amended, (HB 18-1091), ch. 74, p. 645, § 11, effective August 8.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-108 - Requirements for preexisting conditions

(1)
A long-term care insurance policy or certificate, other than a policy or certificate thereunder, issued to a group as defined in section
10-19-103 (4)(a)
, shall not use a definition of "preexisting condition" that is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of health-care services within six months preceding the effective date of coverage of an insured person.
(2)
A long-term care insurance policy or certificate, other than a policy or certificate thereunder issued to a group as defined in section
10-19-103 (4)(a)
, shall not exclude coverage for a loss or confinement which is the result of a preexisting condition, unless such loss or confinement begins within six months following the effective date of coverage of an insured person.
(3)
The commissioner may extend the limitation periods set forth in subsections (1) and (2) of this section to specific age group categories or specific policy forms upon findings that the extension is in the best interest of the public.
(4)
The definition of "preexisting condition" in subsection (1) of this section does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant and, on the basis of the answers on the application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection (2) of this section expires. A long-term care insurance policy or certificate shall not exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection (2) of this section.
L. 90: Entire article R&RE, p. 646, § 1, effective July 1. L. 95: (1) amended, p. 923, § 22, effective May 25. L. 2007: (1), (2), and (4) amended, p. 198, § 4, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-109 - Requirements for prior hospitalization or institutionalization

(1)
A long-term care insurance policy shall not be delivered or issued for delivery in this state if such policy:
(a)
Conditions the eligibility for any benefits on a prior hospitalization requirement;
(b)
Conditions the eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
(c)
Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.
(2)
(a)
A long-term care insurance policy containing any limitations or conditions on eligibility for post-confinement, post-acute care, or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" such limitations or conditions, including any required number of days of confinement.
(b)
Effective July 1, 1991, a long-term care insurance policy containing a benefit advertised, marketed, or offered as a home health care or home care benefit shall not condition receipt of benefits on a prior institutionalization requirement.
(c)
A long-term care insurance policy that conditions eligibility for noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty days.
(3)
A long-term care insurance policy which provides benefits only following institutionalization shall not condition such benefits upon admission to a facility for the same or related conditions within a period of less than thirty days after discharge from the institution.
L. 90: Entire article R&RE, p. 647, § 1, effective July 1. L. 2007: (1), (2)(a), and (2)(c) amended, p. 199. § 5, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-110 - Loss ratio standards

The commissioner may adopt rules and regulations establishing loss-ratio standards for long-term care insurance policies if a specific reference to long-term care insurance policies is contained in the regulation. Such rules and regulations shall be in accordance with the "State Administrative Procedure Act", article
4
of title
24
, C.R.S.
L. 90: Entire article R&RE, p. 647, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-111 - Right to return policy - free look

A long-term care insurance applicant has the right to return the policy or certificate within thirty days after its delivery and to have the premium refunded if, after examination of the policy or certificate, other than a certificate issued pursuant to a policy issued to a group defined in section
10-19-103 (4)(a)
, the applicant is not satisfied for any reason. A long-term care insurance policy or certificate shall contain a notice, prominently printed on the first page or attached thereto, stating in substance that the applicant has the right to return the policy or certificate within thirty days after its delivery and to have the premium refunded if, after examination of the policy or certificate, other than a certificate issued pursuant to a policy issued to a group defined in section
10-19-103 (4)(a)
, the applicant is not satisfied for any reason. This section shall also apply to a denial of application. Any refund shall be made within thirty days after the return or denial.
L. 90: Entire article R&RE, p. 647, § 1, effective July 1. L. 2007: Entire section amended, p. 199, § 6, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-113.3 - Incontestability period

(1)
With respect to a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny a long-term care insurance claim under such a policy upon a showing of misrepresentation that is material to the acceptance for coverage.
(2)
With respect to a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and pertains to the condition for which benefits are sought. A policy or certificate that has been in force for two years shall not be contested solely on the grounds of misrepresentation. Such a policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(3)
No long-term care insurance policy or certificate may be field issued based on medical or health status. For purposes of this subsection (3), "field issued" means a policy or certificate is issued by a producer or third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by a carrier and using the insurer's underwriting guidelines.
(4)
If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payment may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(5)
In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In that situation, the remaining death benefits under the policies shall be governed by sections
10-7-102
and
10-7-202
. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
L. 95: Entire section added, p. 924, § 24, effective May 25. L. 2007: (3) and (4) amended and (5) added, p. 204, § 11, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-113.4 - Nonforfeiture benefits - rules

(1)
Except as provided in subsection (2) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period.
(2)
When a group long-term care insurance policy is issued, the offer required in subsection (1) of this section shall be made to the group policyholder; except that, if the policy is issued as group long-term care insurance as defined in section
10-19-103 (4)(d)
, other than to a continuing care retirement community or other similar entity, the offer shall be made to each proposed certificate holder.
(3)
The commissioner shall promulgate rules specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection (1) of this section.
L. 2007: Entire section added, p. 204, § 12, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-113.5 - [Repealed]

L. 95: Entire section added, p. 924, § 24, effective May 25. L. 96: (1) amended, p. 120, § 1, effective March 25. L. 2005: Entire section repealed, p. 405, § 2, effective August 8.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-113.7 - Rules

The commissioner shall adopt rules to promote premium adequacy, to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, producer education, producer compensation, producer examination, penalties, and reporting practices for long-term care insurance. In addition, the commissioner may issue regulations to establish minimum standards concerning suitability.
L. 95: Entire section added, p. 924, § 24, effective May 25. L. 96: Entire section amended, p. 1354, § 1, effective June 1. L. 2005: Entire section amended, p. 406, § 3, effective August 8. L. 2007: Entire section amended, p. 206, § 13, effective 1/1/2008.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-114 - Compliance

No policy may be advertised, marketed, or offered as long-term care or nursing home insurance unless it complies with the provisions of this article.
L. 90: Entire article R&RE, p. 649, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-114.5 - Penalties

In addition to any other penalties provided by the laws of Colorado, any carrier or any producer who violates any requirement of Colorado law relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars, whichever is greater.
L. 95: Entire section added, p. 924, § 24, effective May 25.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LONG-TERM CARE (§§ 10-19-101 — 10-19-115) › Article 19 - LONG-TERM CARE INSURANCE (§§ 10-19-101 — 10-19-115) › Section 10-19-115 - Severability

If any provision of this article or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the article and the application of such provision to other persons or circumstances shall not be affected thereby.
L. 90: Entire article R&RE, p. 649, § 1, effective July 1.
2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › LIFE AND HEALTH INSURANCE PROTECTION (§§ 10-20-101 — 10-20-120) › Article 20 - LIFE AND HEALTH INSURANCE PROTECTION ASSOCIATION (§§ 10-20-101 — 10-20-120) › Section 10-20-101 - Short title

The short title of this article 20 is the "Life and Health Insurance Protection Association Act".
Amended by 2023 Ch. 195,§ 2, eff. 5/15/2023.
L. 91: Entire article added, p. 1256, § 1, effective July 1.