§ 10-16-101. Short Title
This article shall be known and may be cited as the “Colorado Health Care Coverage Act”. Source: L. 92: Entire article R&RE, p. 1617, § 1, effective July 1.
§ 10-16-102. Definitions
As used in this article 16, unless the context otherwise requires: “Actuarial certification” means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with the provisions of part 10 of this article, based upon the person’s examination, […]
§ 10-16-103. Proposal of Mandatory Health- Care Coverage Provisions
Every person or organization which seeks legislative action which would mandate a health coverage or offering of a health coverage by an insurance carrier, nonprofit hospital and health-care service corporation, health maintenance organization, or prepaid dental care plan organization as a component of individual or group policies shall submit a report to the legislative committee […]
§ 10-16-103.4. Essential Health Benefits – Requirements – Rules
Carriers offering individual or small group health benefit plans in this state shall ensure that the coverage includes the essential health benefits package. This subsection (1) does not apply to grandfathered health benefit plans. Except as provided in subsection (3) of this section, carriers subject to subsection (1) of this section shall offer health benefit […]
§ 10-16-103.5. Payment of Premiums – Required Term in Contract – Rules – Definition
Every contract for a health benefit plan between a carrier and a policyholder shall require the policyholder to pay premiums for each individual covered under the policyholder’s policy: Through the date that the policyholder notifies the carrier that the individual covered under the policy is no longer eligible or covered; Through the date that the […]
§ 10-16-104. Mandatory Coverage Provisions – Definitions – Rules
Newborn children. All group and individual sickness and accident insurance policies and all service or indemnity contracts issued by any entity subject to part 3 or 4 of this article shall provide coverage for a dependent newborn child of the insured or subscriber from the moment of birth. Coverage for a hospital stay for a […]
§ 10-16-104.1. Prohibition on Discrimination for Organ Transplants Based Solely on Disability – Definition
A carrier that offers, issues, or renews a health benefit plan that provides coverage for anatomical gifts, organ transplants, or related treatments or services shall not, solely on the basis of a covered person’s disability: Deny coverage to a covered person for an organ transplant or related treatment or services; Decline or limit coverage of […]
§ 10-16-104.2. Coverage for Contraception – Definitions
As part of the coverage required for contraception pursuant to section 10-16-104 (3)(a)(I) or (18), as applicable, entities subject to part 2, 3, or 4 of this article 16 that issue policies, contracts, or plans subject to the coverage requirements in section 10-16-104 (3)(a)(I) or (18) shall reimburse a participating provider or dispensing entity that […]
§ 10-16-104.3. Health Coverage for Persons Under Twenty-Six Years of Age – Coverage for Students Who Take Medical Leave of Absence
A carrier that offers a health benefit plan in the state and that makes dependent coverage for children available under the health benefit plan shall make the coverage available for a child who is under twenty-six years of age. The carrier shall not deny or restrict coverage for a child who is under twenty-six years […]
§ 10-16-104.6. Off-Label Use of Cancer Drugs
A health benefit plan that provides coverage for prescription drugs shall not limit or exclude coverage for any drug approved by the United States food and drug administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States food and drug administration for the […]
§ 10-16-104.7. Substance Use Disorders – Court-Ordered Treatment Coverage
An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for treatment of a substance use disorder must provide coverage for such treatment regardless of whether the treatment is voluntary […]
§ 10-16-104.8. Behavioral, Mental Health, or Substance Use Disorder Services Coverage – Court-Ordered
An individual or group health benefit plan delivered or issued for delivery within this state by an entity subject to the provisions of part 2, 3, or 4 of this article 16 that provides coverage for behavioral, mental health, or substance use disorder services must provide coverage for behavioral, mental health, or substance use disorder […]
§ 10-16-104.9. Geographic Areas for Small Employers
The commissioner shall promulgate a rule concerning geographic case characteristics, which may include metropolitan statistical areas for small employers. In promulgating such rule, the commissioner shall take testimony from all interested parties, including, but not limited to, consumer advocates and consumers, insurers, health-care providers, the state demographer, and producers. The rule shall include, without limitation, […]
§ 10-16-105. Guaranteed Issuance of Health Insurance Coverage – Individual and Small Employer Health Benefit Plans
Subject to subsections (2) and (4) to (6) of this section, each carrier that offers an individual health benefit plan in this state shall issue any applicable health benefit plan to any eligible individual who applies for the plan and agrees to make the required premium payments and satisfy the other reasonable provisions of the […]
§ 10-16-105.1. Guaranteed Renewability – Exceptions – Individual and Small Employer Health Benefit Plans – Rules
Except as otherwise provided in subsection (2) of this section, a carrier providing coverage under a health benefit plan shall renew or continue the coverage at the option of the policyholder. A carrier may refuse to renew or discontinue coverage under a health benefit plan only for the following reasons: Nonpayment of the required premium […]
§ 10-16-105.2. Small Employer Health Insurance Availability Program
Except as provided in paragraphs (b) and (d) of this subsection (1), this article applies to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met: Any portion of the premium or benefit is paid by or on behalf of […]
§ 10-16-105.3. Health Benefit Plans – Not Prohibited
A carrier shall not be prohibited from offering to a small employer additional options of health benefit plans that: Provide for different benefits for insureds and dependents of such insureds covered by the same policy; and Encourage appropriate health-care condition management based on clinical guidelines by providing case management benefits to covered persons. Source: L. […]
§ 10-16-105.6. Rate Usage
A carrier offering an individual or group health benefit plan shall not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or, for group plans, a contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the […]
§ 10-16-105.7. Health Benefit Plan Open Enrollment Periods – Special Enrollment Periods – Rules
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. The initial open enrollment period begins October 1, 2013, and extends through March 31, 2014. For benefit years beginning on or after January 1, 2015, […]
§ 10-16-106. Group Replacement – Extension of Benefits
This section shall indicate which carrier is liable where one carrier’s group contract replaces a plan of similar benefits of another carrier within thirty-one days after the termination, cancellation, or expiration of the contract that is being replaced. The prior carrier remains liable only to the extent of its accrued liabilities, extensions of benefits as […]