Health-care Coverage
C.R.S. tit. 10, art. 16
in effectContents
section10-16-101. Short titlesection10-16-102. Definitionssection10-16-103. Proposal of mandatory health-care coverage provisionssection10-16-103.3. Commission on mandated health insurance benefits - cash fund - purpose - creation - duties - repealsection10-16-103.4. Essential health benefits - requirements - rulessection10-16-103.5. Payment of premiums - required term in contract - rules - definitionsection10-16-103.6. Copayment-only prescription payment structures - required inclusion in health benefit plans - rulessection10-16-104. Mandatory coverage provisions - definitions - rules - applicabilitysection10-16-104.1. Prohibition on discrimination for organ transplants based solely on disability - definitionsection10-16-104.2. Coverage for contraception - rules - definitionssection10-16-104.3. Health coverage for persons under twenty-six years of age - coverage for students who take medical leave of absencesection10-16-104.4. Child-only plans - legislative declaration - open enrollment - reporting requirements - repealsection10-16-104.5. Autism - treatment - not mental illness - repealsection10-16-104.6. Off-label use of cancer drugssection10-16-104.7. Substance use disorders - court-ordered treatment coveragesection10-16-104.8. Behavioral, mental health, or substance use disorder services coverage - court-orderedsection10-16-104.9. Geographic areas for small employerssection10-16-105. Guaranteed issuance of health insurance coverage - individual and small employer health benefit planssection10-16-105.1. Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules - notice to revisor of statutessection10-16-105.2. Small employer health insurance availability programsection10-16-105.3. Health benefit plans - not prohibitedsection10-16-105.5. Individual health plans - federally eligible individual - limited guarantee issuesection10-16-105.6. Rate usagesection10-16-105.7. Health benefit plan open enrollment periods - special enrollment periods - rulessection10-16-105.9. Health benefit plan - carrier insolvency - covered persons - deductible amounts - rules - definitionsection10-16-106. Group replacement - extension of benefitssection10-16-106.3. Uniform claims - billing codes - electronic claim formssection10-16-106.5. Prompt payment of claims - legislative declaration - rulessection10-16-106.7. Assignment of health insurance benefitssection10-16-107. Rate filing regulation - benefits ratio - rulessection10-16-107.1. False or misleading information - penaltiessection10-16-107.2. Filing of health policies - rulessection10-16-107.3. Health insurance policies - plain language required - rulessection10-16-107.4. Health-care sharing plan or arrangement - required reporting and certification - noncompliance - information posted on division website - rulessection10-16-107.5. Uniform application form - use by all carriers - rulessection10-16-107.7. Nondiscrimination against providerssection10-16-108. Continuation privilegessection10-16-108.3. Continuation privileges - special election period - notice requirements - definitions - repealsection10-16-108.5. Fair marketing standards - rulessection10-16-109. Rulessection10-16-110. Fees paid by health coverage entitiessection10-16-111. Annual statements and reports - rulessection10-16-112. Private utilization review - health-care coverage entity responsibility - definitionssection10-16-112.5. Prior authorization for health-care services - disclosures and notice - determination deadlines - criteria - limits and exceptions - enforcement - definitions - rulessection10-16-113. Procedure for denial of benefits - internal review - rules - definitionssection10-16-113.5. Independent external review of adverse determinations - legislative declaration - definitions - rulessection10-16-113.7. Reporting the denial of benefits to divisionsection10-16-114. Short titlesection10-16-115. Definitionssection10-16-116. Catastrophic health insurance - coverage - premium payments - reporting requirements - definitions - short title - rules - repealsection10-16-116.5. State innovation waiver for nonemployer catastrophic health plans - notice of decision by secretary - effect of secretary's decision - notice to revisor of statutes - definitions - rules - state measurement for accountable, responsive, and transparent (SMART) government act report - repealsection10-16-117. Premium payments - pre-tax - election - reporting requirementssection10-16-118. Prohibition against preexisting condition exclusionssection10-16-119. Requirements for excess loss or stop-loss health insurance used in conjunction with self-insured employer benefit plans under the federal "Employee Retirement Income Security Act" - data collection 2013-18 - rulessection10-16-119.5. Stop-loss health insurance for small employers of not more than fifty employees - requirements - definitions - rulessection10-16-120. Legislative review of requirements for guaranteed issue of basic and standard health benefit planssection10-16-121. Required contract provisions in contracts between carriers and providers - definitionssection10-16-121.3. Limitations on provisions in contracts between carriers and licensed health-care providers - methods of payment - fees - definitionssection10-16-121.5. Prohibited contract provisions in contracts between carriers and providers for dental services - definitionsection10-16-121.7. Prohibited contract provisions in contracts between carriers and eye care providers - definitionssection10-16-122. Access to prescription drugssection10-16-122.1. Contracts between PBMs and pharmacies - carrier submit list of PBMs - PBM registration - fees - prohibited practices - exception - rules - enforcement - short title - definitionssection10-16-122.3. Pharmacy benefit management firm payments - retroactive reduction prohibited - enforcement - rules - definitionssection10-16-122.4. Pharmacy benefits - formulary change prohibition - exceptions - enforcement - definition - rulessection10-16-122.5. Pharmacy benefit manager - audit of pharmacies - time limits on on-site audits - enforcement - rulessection10-16-122.6. Pharmacy benefit managers - contracts with pharmacies - maximum allowable cost pricing - enforcement - rulessection10-16-122.7. Disclosures between pharmacists and patients - carrier and PBM prohibitions - enforcement - short title - legislative declaration - preemption by federal law - rulessection10-16-122.9. Prescription drug benefits - real-time access to benefit information - enforcement - definitions - rulessection10-16-123. Telehealth - definitionssection10-16-124. Prescription information cards - legislative declarationsection10-16-124.5. Prior authorization form - drug benefits - program - rules of commissioner - definitions - repealsection10-16-124.6. Drugs used for substance use disorder - prior authorization prohibitedsection10-16-124.7. Opioid analgesics with abuse-deterrent properties - study - definitionssection10-16-124.8. Colorado consortium for prescription drug abuse prevention - create process for recovery - reportsection10-16-125. Reimbursement to nursessection10-16-126. Fee-for-service dental planssection10-16-127. Coinsurance and deductiblessection10-16-128. Annual report to general assemblysection10-16-129. Health savings accountssection10-16-130. Disclosure of rate increases to public entities - legislative declaration - definitionssection10-16-131. Health care reform project - blue ribbon commission for health care reform - repealsection10-16-132. Study of factors driving health care costs in Pueblo county - repealsection10-16-133. Health carrier information disclosure - website - insurance producer fees and disclosure requirements - legislative declaration - rulessection10-16-134. Health-care transparency - information required - website - definitionsection10-16-135. Health coverage plan information cards - rules - standardization - contentssection10-16-136. Wellness and prevention programs - individual and small group health coverage plans - voluntary participation - incentives or rewards - rules - definitions - legislative declaration - repealsection10-16-137. Policy forms - explanation of benefits - standardization of forms - rulessection10-16-138. Pathology services - direct billing requiredsection10-16-139. Access to care - rules - definitionssection10-16-140. Grace periods - premium payments - rulessection10-16-141. Medication synchronization services - cost sharing for partial refills - dispensing feessection10-16-142. Physical rehabilitation services - copayments and coinsurance - researchsection10-16-143. Single geographic rating area - individual plans - study - report - repealsection10-16-143.5. Pharmacy reimbursement - substance use disorders - injections - patient counselingsection10-16-144. Health-care services provided by pharmacistssection10-16-145. Step therapy - limitations - exceptions - definitions - rulessection10-16-145.5. Step therapy - prior authorization - prohibited - stage four advanced metastatic cancer - opioid prescription - definitionssection10-16-146. Periodic updates to provider directorysection10-16-147. Parity reporting - commissioner - carriers - rules - examination of complaintssection10-16-148. Medication-assisted treatment - limitations on carriers - rulessection10-16-149. Commissioner report - parity effects on premiums - repealsection10-16-150. Primary care payment reform collaborative - created - powers and duties - report - definition - repealsection10-16-151. Cost sharing in prescription insulin drugs - limits - definition - rulessection10-16-152. HIV prevention and treatment medication - limitations on carriers - step therapy - prior authorization - study - repealsection10-16-153. Coverage for opioid antagonists provided by a hospital - definitionsection10-16-154. Disclosures - physical therapists - occupational therapists - chiropractors - acupuncturists - patients - carrier prohibitions - enforcementsection10-16-155. Actuarial reviews of proposed health-care legislation - division to contract with third parties - required considerations - confidentiality - limits on expenditures - rate filings - repealsection10-16-155.5. Actuarial review of doula services - report - definitionsection10-16-156. Prescription drugs - rebates - consumer cost reduction - point of sale - study - report - rules - definitionssection10-16-157. Alternative payment model parameters - parameters to include an aligned quality measure set - primary care providers - requirement for carriers to submit alternative payment models to the division - legislative declaration - report - rules - definitionssection10-16-158. Treatment of sexually transmitted infection - cost sharing - rules - definitionsection10-16-159. Coverage for sterilization services - cost sharingsection10-16-160. Cost sharing - prescription epinephrine - limits - rules - definitionsection10-16-161. Calculation of contribution to out-of-pocket and cost-sharing requirements - exception - definition - rulessection10-16-162. Prohibition on discrimination for coverage based solely on natural medicine consumption - definitionssection10-16-163. Contracts - health benefit plans - pharmacy benefit managers - policyholders - transparency requirements - rules - definitionssection10-16-164. Hospital facility fee report - data collectionsection10-16-165. Dental coverage plans - dental loss ratio - rules - definitionssection10-16-166. Prohibition on using the body mass index or ideal body weight - medical necessity criteria - rulessection10-16-167. Medical aid-in-dying - carrier prohibitionssection10-16-168. Carriers - health care - price transparency - rules - legislative declaration - definitionssection10-16-169. Carriers - prescription drug coverage - transparencysection10-16-201. Form and content of individual sickness and accident insurance policiessection10-16-201.5. Renewability of health benefit plans - modification of health benefit planssection10-16-202. Required provisions in individual sickness and accident policiessection10-16-203. Optional provisions in individual sickness and accident insurance policiessection10-16-204. Inapplicable or inconsistent provisions in individual policies of sickness and accident insurancesection10-16-205. Order of certain policy provisions in individual policies of sickness and accident insurancesection10-16-206. Third-party ownership of individual sickness and accident insurance policiessection10-16-207. Requirements of other jurisdictionssection10-16-208. Conforming to statutesection10-16-209. Application for policysection10-16-210. Notice - waiversection10-16-211. Age limitsection10-16-212. Exemption from attachment and executionsection10-16-213. Industrial sickness and accident insurancesection10-16-214. Group sickness and accident insurancesection10-16-215. Blanket sickness and accident insurancesection10-16-216. Examinationssection10-16-216.5. Hearing procedure and judicial review - violations - penaltysection10-16-217. Application of part 1 of this article and part 2section10-16-218. Judicial reviewsection10-16-219. Benefits for care in tax-supported institutions - behavioral health disorders - mental health disorders - intellectual and developmental disabilitiessection10-16-220. Minimum standards for sickness and accident planssection10-16-221. Statewide health care review committee - creation - membership - duties - repealsection10-16-222. Termination of policiessection10-16-301. Legislative declarationsection10-16-302. Incorporation and organization - exemptionssection10-16-303. Filing of articles of incorporationsection10-16-304. Contents of articlessection10-16-305. Directorssection10-16-306. Contracts - benefits for long-term care insurancesection10-16-307. Authority to do businesssection10-16-308. Automatic extension of certificatesection10-16-309. Requirements for certificate of authoritysection10-16-310. Surplus - guarantee fund deposit - regulationssection10-16-311. Group benefits for depositors of banks - benefits for subscribers in public institutionssection10-16-312. Contracts with other organizationssection10-16-313. Licensing of representativessection10-16-314. Payment for examinations of corporationssection10-16-315. Revocation of certificate - appealsection10-16-316. Complaintssection10-16-317. Exemption of direct payment methodssection10-16-317.5. Assignment of benefitssection10-16-318. Prospective reimbursementsection10-16-319. Effective datesection10-16-320. Investment of fundssection10-16-321. Medicare supplement benefit standardssection10-16-322. Filing of health policiessection10-16-323. Conversion of corporation to mutual insurance companysection10-16-324. Conversion of corporation to a stock insurance companysection10-16-325. Termination of health policiessection10-16-401. Establishment of health maintenance organizationssection10-16-402. Issuance of certificate of authority - denialsection10-16-403. Powers of health maintenance organizationssection10-16-404. Governing bodysection10-16-405. Fiduciary responsibilitiessection10-16-406. Evidence of coverage - rulessection10-16-407. Information to enrolleessection10-16-408. Open enrollmentsection10-16-409. Complaint systemsection10-16-410. Investmentssection10-16-411. Protection against insolvencysection10-16-412. Statutory depositsection10-16-413. Prohibited practicessection10-16-413.5. Return to home - legislative declaration - definitionssection10-16-414. Regulation of agentssection10-16-415. Powers of insurers and nonprofit hospital, medical-surgical, and health service corporationssection10-16-416. Examinationsection10-16-417. Suspension or revocation of certificate of authoritysection10-16-418. Rehabilitation, liquidation, or conservation of health maintenance organizationsection10-16-419. Administrative proceduressection10-16-420. Penalties and enforcementsection10-16-421. Statutory construction and relationship to other lawssection10-16-421.5. Acquisition of control of or merger of a health maintenance organizationsection10-16-422. Filings and reports as public documentssection10-16-423. Confidentiality of health informationsection10-16-424. Commissioner's authority to contractsection10-16-425. Applicability of provisionssection10-16-426. Medicare supplement benefit standardssection10-16-427. Contractual relationssection10-16-428. Prohibition concerning state-funded medical assistancesection10-16-429. Termination of contractsection10-16-501. Legislative declarationsection10-16-502. Establishment of prepaid dental care plan organizationssection10-16-503. Application for certificate of authoritysection10-16-504. Issuance of certificate of authoritysection10-16-505. Guarantee fund depositsection10-16-506. Reserve requirement - exceptionsection10-16-507. Enrollee coverage by prepaid dental care plan organizations - form filing requirementssection10-16-508. Examination of prepaid dental care plan organizationsection10-16-509. Operational expensessection10-16-510. Suspension or revocation of certificate of authoritysection10-16-511. Rehabilitation, liquidation, or conservation of prepaid dental care plan organizationsection10-16-512. Other laws applicablesection10-16-601. Legislative declarationsection10-16-602. Definitionssection10-16-603. Independent medical examinations - governing standardsection10-16-604. Financial interest in future care of patient prohibitedsection10-16-605. Independence of examinerssection10-16-606. Applicabilitysection10-16-701. Short titlesection10-16-702. Legislative declarationsection10-16-703. Applicabilitysection10-16-704. Network adequacy - required disclosures - balance billing - rules - legislative declaration - definitionssection10-16-705. Requirements for carriers and participating providers - definitions - rulessection10-16-705.5. Participating provider networks - definitions - selection standards - informal reconsideration - enforcement - legislative declarationsection10-16-705.7. Timely credentialing of physicians by carriers - notice of receipt required - notice of incomplete applications required - delegated credentialing agreements - discrepancies - denials of claims prohibited - disclosures - recredentialing - enforcement - rules - definitionssection10-16-706. Intermediariessection10-16-707. Enforcementsection10-16-708. Rule-making authority of commissionersection10-16-709. Evaluation - nonparticipating health-care providers - legislative declaration - rulessection10-16-710. Reporting to commissioner - medication-assisted treatment - rulessection10-16-1001. Legislative declarationsection10-16-1002. Definitionssection10-16-1003. Privacy of health informationsection10-16-1004. Health-care coverage cooperatives - establishment - feessection10-16-1005. Issuance of certificate of authority by commissioner for cooperative to purchase health-care coveragesection10-16-1006. Authority to deny application for, revoke, or suspend certificate of authoritysection10-16-1007. Prohibition on cooperatives transacting insurance businesssection10-16-1008. Administrative structure of cooperatives - board of directors - officers - employeessection10-16-1009. Powers, duties, and responsibilities of cooperativessection10-16-1010. Marketing requirements of cooperativessection10-16-1011. Requirements for waivered health care coverage cooperatives - rulessection10-16-1012. Application of rating factors inside a waivered cooperativesection10-16-1013. Violations of article by persons involved with operations of cooperatives - enforcement - penaltiessection10-16-1014. Technical assistance to authorized cooperatives from division of insurancesection10-16-1015. Health-care cooperatives - rule-making authoritysection10-16-1016. State innovation waiver - authority to applysection10-16-1101. Short titlesection10-16-1102. Legislative declarationsection10-16-1103. Definitionssection10-16-1104. Commissioner powers and duties - rules - study and reportsection10-16-1105. Reinsurance program - creation - enterprise status - subject to waiver or funding approval - operation - payment parameters - calculation of reinsurance payments - eligible carrier requests - definitionsection10-16-1106. Accounting - reports - auditssection10-16-1107. Funding for reinsurance program - sources - permitted uses - reinsurance program cash fund - calculation of total funding for programsection10-16-1108. Special assessments against hospitals and carriers - rules - enforcementsection10-16-1109. State innovation waiver - federal funding - Colorado reinsurance programsection10-16-1110. Repeal of part - notice to revisor of statutessection10-16-1201. Short titlesection10-16-1202. Legislative declarationsection10-16-1203. Definitionssection10-16-1204. Health insurance affordability enterprise - creation - powers and duties - assess and allocate health insurance affordability fee and special assessmentsection10-16-1205. Health insurance affordability fee - special assessment on hospitals - allocation of revenuessection10-16-1206. Health insurance affordability cash fund - creation - repealsection10-16-1207. Health insurance affordability board - creation - membership - powers and duties - subject to open meetings and public records laws - commissioner rulessection10-16-1208. Limitation on authority - public optionsection10-16-1301. Short titlesection10-16-1302. Legislative declaration - intentsection10-16-1303. Definitionssection10-16-1304. Standardized health benefit plan - established - components - rules - independent analysis - repealsection10-16-1305. Standardized health benefit plan - carriers required to offer - premium rates - rulessection10-16-1305.5. Rate filingssection10-16-1306. Failure to meet premium rate requirements - notice - public hearing - rulessection10-16-1307. Advisory board - members - rulessection10-16-1308. Federal waiver - commissioner application - use of moneysection10-16-1309. Standardized plan - cost shiftsection10-16-1310. Reports required - repealsection10-16-1311. State measurement for accountable, responsive, and transparent (SMART) government act reportsection10-16-1312. Rulessection10-16-1313. Severabilitysection10-16-1401. Definitionssection10-16-1402. Colorado prescription drug affordability review board - created - membership - terms - conflicts of interestsection10-16-1403. Colorado prescription drug affordability review board - powers and duties - rulessection10-16-1404. Colorado prescription drug affordability review board meetings - required to be public - exceptionssection10-16-1405. Colorado prescription drug affordability review board - reports from carriers and pharmacy benefit management firms required - confidential materialssection10-16-1406. Colorado prescription drug affordability review board - affordability reviews of prescription drugs - repealsection10-16-1407. Colorado prescription drug affordability review board - upper payment limits for certain prescription drugs - rules - severabilitysection10-16-1408. Colorado prescription drug affordability review board - judicial reviewsection10-16-1409. Colorado prescription drug affordability advisory council - created - membership - powers and dutiessection10-16-1410. Use of savings - report - rulessection10-16-1411. Unlawful acts - enforcement - penaltiessection10-16-1412. Notice of withdrawal of prescription drugs with upper payment limits required - rules - penaltysection10-16-1413. Optional participating plans - notice of election to participate requiredsection10-16-1414. Reportssection10-16-1415. Exemption - prescription drugs derived from cannabissection10-16-1416. Repeal of partsection10-16-1501. Short titlesection10-16-1502. Legislative declarationsection10-16-1503. Definitionssection10-16-1504. Applicability - exclusionssection10-16-1505. Prohibition on 340B discriminationsection10-16-1506. Enforcement - rules
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-10.docxFetched: 10/6/2026