Colorado Code
Part 1 - General Provisions
§ 10-16-102. Definitions

As used in this article 16, unless the context otherwise requires:



































(16.5) "Dementia diseases and related disabilities" is a condition where mental ability declines and is severe enough to interfere with an individual's ability to perform everyday tasks. Dementia diseases and related disabilities includes Alzheimer's disease, mixed dementia, Lewy body dementia, vascular dementia, frontotemporal dementia, and other types of dementia.



































(27.5) "FDA" means the food and drug administration in the United States department of health and human services, or any successor entity.





































(38.5) "HIV infection prevention drug" means preexposure prophylaxis, post-exposure prophylaxis, or other drugs approved by the FDA for the prevention of HIV infection.














(43.5) "MHPAEA" means the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008", Pub.L. 110-343, as amended, and all of its implementing and related regulations.













(50.5) "Post-exposure prophylaxis" means a drug or drug combination that meets the same clinical eligibility recommendations provided in CDC guidelines, as defined in section 12-280-125.7.
(50.7) "Preexposure prophylaxis" means a drug or drug combination that meets the same clinical eligibility recommendations provided in CDC guidelines, as defined in section 12-280-125.7.












































Have you or any other person to be insured been covered under two or more nonrenewable short-term policies during the past twelve months? If "yes", then this policy cannot be issued. You must wait six months from the date of your last such policy to apply for a short-term policy.
This policy does not provide portability of prior coverage. As a result, any injury, sickness, or pregnancy for which you have incurred charges, received medical treatment, consulted a health care professional, or taken prescription drugs within twelve months before the effective date of this policy will not be covered under this policy.
Source: L. 92: Entire article R&RE, p. 1617, § 1, effective July 1. L. 93: (3) amended, p. 200, § 1, effective March 31. L. 94: (1) and (40) amended and (2) to (11), (13) to (15), (18), (21), (24) to (26), (28), (31), (35), (37) to (39), (41), and (42) added, p. 1896, § 6, effective July 1. L. 96: (6) amended, p. 392, § 1, effective July 1; (13.5), (22.5), (25.5), and (26.5) added, p. 568, § 2, effective July 1; (22.5) and (26.5) added, p. 729, § 1, effective July 1. L. 97: (10)(b)(II) amended, p. 117, § 1, effective March 24; (2.5), (5.5), (13.7), (24.5), and (45) added and (9), (21), (26), (37), and (43) amended, p. 630, § 3, effective May 1; (27.5) and (28.5) added, p. 1324, § 1, effective July 1. L. 98: (21)(b) amended, p. 373, § 1, effective April 21; (28.7) added, p. 329, § 1, effective July 1. L. 99: (23)(a) amended, p. 84, § 5, effective July 1; (43.5) added, p. 319, § 3, effective July 1; (6) amended, p. 225, § 1, effective August 4. L. 2001: (10.5) and (20.5) added and (13.7)(d) amended, pp. 1048, 1051, §§ 31, 37, effective July 1; (6)(a), IP(10)(b), and (15) amended, p. 811, § 2, effective January 1, 2002; (22) amended and (26.3) added, p. 1153, § 2, effective January 1, 2002; (29.5) added, p. 1230, § 1, effective January 1, 2002. L. 2002: (6)(d) added and (10)(b)(II) and (40) amended, pp. 1291, 1290, §§ 2, 1, effective January 1, 2003; (6)(d) added and (40) amended, p. 1283, §§ 2, 1, effective January 1, 2003; (11)(a)(II) and (11)(a)(III) amended and (11)(a)(IV) added, p. 331, § 2, effective January 1, 2003. L. 2003: (10)(b)(II) amended, p. 1988, § 20, effective May 22; (10)(b)(IV), (10)(b)(V), (10)(b)(VI), (10)(b)(VII), and (15)(c) added and (10)(c) amended, p. 1774, §§ 7, 8, 6, effective July 1. L. 2004: (1), (11), and (40)(a) amended, p. 980, § 3, effective August 4; (7) amended, p. 1190, § 16, effective August 4. L. 2005: (42) and (43) amended, p. 762, § 14, effective June 1. L. 2007: (13.7)(a) amended and (26)(e) added, p. 470, §§ 1, 2, effective July 1; (10)(b)(IV), (10)(b)(V), (10)(b)(VI), and (10)(b)(VII) amended, p. 1752, § 1, effective January 1, 2009. L. 2008: (5.3), (36.5), and (43.7) added, p. 2249, § 3, effective July 1; (5.6), (15.5), and (26.4) added, p. 578, § 1, effective August 5; (24.7) and (27.3) added, p. 2006, § 2, effective January 1, 2009. L. 2009: (14) and (26)(d) amended, (HB 09-1260), ch. 107, p. 439, § 3, effective July 1; (26)(e) amended and (26)(f) and (26)(g) added, (HB 09-1338), ch. 353, p. 1843, § 3, effective July 1. L. 2010: (26.3) amended, (HB 10-1220), ch. 197, p. 856, § 22, effective July 1. L. 2011: (10.3) and (36.3) added, (SB 11-128), ch. 133, p. 467, § 2, effective April 29. L. 2013: Entire section amended with relocations, (HB 13-1266), ch. 217, p. 903, § 1, effective May 13; (17) amended, (SB 13-011), ch. 49, p. 160, § 7, effective January 1, 2014. L. 2015: (33) amended, (HB 15-1029), ch. 38, p. 95, § 2, effective January 1, 2017. L. 2017: IP, (22)(b)(VI), and (33) amended, (SB 17-242), ch. 263, p. 1263, § 34, effective May 25; IP, (20), and (46) amended, (SB 17-249), ch. 283, p. 1548, § 18, effective June 1. L. 2018: (16.5) added, (HB 18-1091), ch. 74, p. 644, § 8, effective August 8; (37)(b) amended, (SB 18-091), ch. 35, p. 381, § 3, effective August 8. L. 2019: (43.5) added, (HB 19-1269), ch. 195, p. 2125, § 2, effective May 16; (54) amended, (HB 19-1172), ch. 136, p. 1653, § 40, effective October 1. L. 2020: (22)(a) and (29) amended, (HB 20-1402), ch. 216, p. 1043, § 16, effective June 30; (27.5), (38.5), (50.5), and (50.7) added, (HB 20-1061), ch. 281, p. 1374, § 1, effective July 13. L. 2021: (40.5) added, (HB 21-1068), ch. 439, p. 2908, § 3, effective July 6; (49) amended, (HB 21-1297), ch. 452, p. 2991, § 2, effective July 6.








Cross references: (1) For chapter 55 of title 10 of the United States Code, see 10 U.S.C. § 1071 et seq.; for chapter 89 of title 5 of the United States Code, see 5 U.S.C. § 8901 et seq.; for the "Higher Education Act of 1965", see 20 U.S.C. § 1001 et seq.
(2) For the legislative declaration contained in the 1996 act enacting subsections (13.5), (22.5), (25.5), and (26.5), see section 1 of chapter 122, Session Laws of Colorado 1996. For the legislative declaration contained in the 1997 act enacting subsections (2.5), (5.5), (13.7), (24.5), and (45) and amending subsections (9), (21), (26), (37), and (43), see section 1 of chapter 154, Session Laws of Colorado 1997. For the legislative declaration contained in the 1999 act enacting subsection (43.5), see section 1 of chapter 111, Session Laws of Colorado 1999. For the legislative declaration contained in the 2001 act amending subsection (22) and enacting subsection (26.3), see section 1 of chapter 300, Session Laws of Colorado 2001. For the legislative declaration contained in the 2002 act amending subsections (11)(a)(II) and (11)(a)(III) and enacting subsection (11)(a)(IV), see section 1 of chapter 117, Session Laws of Colorado 2002. For the legislative declaration in the 2011 act adding subsections (10.3) and (36.3), see section 1 of chapter 133, Session Laws of Colorado 2011. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in SB 18-091, see section 1 of chapter 35, Session Laws of Colorado 2018. For the legislative declaration in HB 21-1068, see section 1 of chapter 439, Session Laws of Colorado 2021. For the legislative declaration in HB 21-1297, see section 1 of chapter 452, Session Laws of Colorado 2021.
(3) In 2008, subsections (5.3), (36.5), and (43.7) were enacted by the "Fair Accountable Insurance Rates Act". For the short title and legislative declaration, see sections 1 and 2 of chapter 439, Session Laws of Colorado 2008.
(4) For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019.

Structure Colorado Code

Colorado Code

Title 10 - Insurance

Article 16 - Health-Care Coverage

Part 1 - General Provisions

§ 10-16-101. Short Title

§ 10-16-102. Definitions

§ 10-16-103. Proposal of Mandatory Health- Care Coverage Provisions

§ 10-16-103.4. Essential Health Benefits - Requirements - Rules

§ 10-16-103.5. Payment of Premiums - Required Term in Contract - Rules - Definition

§ 10-16-104. Mandatory Coverage Provisions - Definitions - Rules

§ 10-16-104.1. Prohibition on Discrimination for Organ Transplants Based Solely on Disability - Definition

§ 10-16-104.2. Coverage for Contraception - Definitions

§ 10-16-104.3. Health Coverage for Persons Under Twenty-Six Years of Age - Coverage for Students Who Take Medical Leave of Absence

§ 10-16-104.6. Off-Label Use of Cancer Drugs

§ 10-16-104.7. Substance Use Disorders - Court-Ordered Treatment Coverage

§ 10-16-104.8. Behavioral, Mental Health, or Substance Use Disorder Services Coverage - Court-Ordered

§ 10-16-104.9. Geographic Areas for Small Employers

§ 10-16-105. Guaranteed Issuance of Health Insurance Coverage - Individual and Small Employer Health Benefit Plans

§ 10-16-105.1. Guaranteed Renewability - Exceptions - Individual and Small Employer Health Benefit Plans - Rules

§ 10-16-105.2. Small Employer Health Insurance Availability Program

§ 10-16-105.3. Health Benefit Plans - Not Prohibited

§ 10-16-105.6. Rate Usage

§ 10-16-105.7. Health Benefit Plan Open Enrollment Periods - Special Enrollment Periods - Rules

§ 10-16-106. Group Replacement - Extension of Benefits

§ 10-16-106.3. Uniform Claims - Billing Codes - Electronic Claim Forms

§ 10-16-106.5. Prompt Payment of Claims - Legislative Declaration - Rules

§ 10-16-106.7. Assignment of Health Insurance Benefits

§ 10-16-107. Rate Filing Regulation - Benefits Ratio - Rules

§ 10-16-107.1. False or Misleading Information - Penalties

§ 10-16-107.2. Filing of Health Policies - Rules

§ 10-16-107.3. Health Insurance Policies - Plain Language Required - Rules

§ 10-16-107.5. Uniform Application Form - Use by All Carriers - Rules

§ 10-16-107.7. Nondiscrimination Against Providers

§ 10-16-108. Continuation Privileges

§ 10-16-108.5. Fair Marketing Standards - Rules

§ 10-16-109. Rules

§ 10-16-110. Fees Paid by Health Coverage Entities

§ 10-16-111. Annual Statements and Reports - Rules

§ 10-16-112. Private Utilization Review - Health-Care Coverage Entity Responsibility - Definitions

§ 10-16-112.5. Prior Authorization for Health- Care Services - Disclosures and Notice - Determination Deadlines - Criteria - Limits and Exceptions - Definitions - Rules

§ 10-16-113. Procedure for Denial of Benefits - Internal Review - Rules - Definitions

§ 10-16-113.5. Independent External Review of Adverse Determinations - Legislative Declaration - Definitions - Rules

§ 10-16-113.7. Reporting the Denial of Benefits to Division

§ 10-16-116. Catastrophic Health Insurance - Coverage - Premium Payments - Reporting Requirements - Definitions - Short Title

§ 10-16-116.5. 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,...

§ 10-16-118. Prohibition Against Preexisting Condition Exclusions

§ 10-16-119. 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 - Rules

§ 10-16-119.5. Stop-Loss Health Insurance for Small Employers of Not More Than Fifty Employees - Requirements - Definitions - Rules

§ 10-16-121. Required Contract Provisions in Contracts Between Carriers and Providers - Definitions

§ 10-16-121.5. Prohibited Contract Provisions in Contracts Between Carriers and Providers for Dental Services - Definition

§ 10-16-121.7. Prohibited Contract Provisions in Contracts Between Carriers and Eye Care Providers - Definitions

§ 10-16-122. Access to Prescription Drugs

§ 10-16-122.1. Contracts Between Pbms and Pharmacies - Carrier Submit List of Pbms - Prohibited Practices - Exception - Short Title - Definitions

§ 10-16-122.3. Pharmacy Benefit Management Firm Payments - Retroactive Reduction Prohibited - Enforcement - Rules - Definitions

§ 10-16-122.5. Pharmacy Benefit Manager - Audit of Pharmacies - Time Limits on On-Site Audits

§ 10-16-122.7. Disclosures Between Pharmacists and Patients - Carrier Prohibitions - Short Title - Legislative Declaration - Preemption by Federal Law

§ 10-16-122.9. Prescription Drug Benefits - Real-Time Access to Benefit Information - Definitions

§ 10-16-123. Telehealth - Definitions

§ 10-16-124. Prescription Information Cards - Legislative Declaration

§ 10-16-124.5. Prior Authorization Form - Drug Benefits - Rules of Commissioner - Definitions

§ 10-16-124.7. Opioid Analgesics With Abuse-Deterrent Properties - Study - Definitions

§ 10-16-124.8. Colorado Consortium for Prescription Drug Abuse Prevention - Create Process for Recovery - Report

§ 10-16-125. Reimbursement to Nurses

§ 10-16-126. Fee-for-Service Dental Plans

§ 10-16-127. Coinsurance and Deductibles

§ 10-16-128. Annual Report to General Assembly

§ 10-16-129. Health Savings Accounts

§ 10-16-130. Disclosure of Rate Increases to Public Entities - Legislative Declaration - Definitions

§ 10-16-133. Health Carrier Information Disclosure - Website - Insurance Producer Fees and Disclosure Requirements - Legislative Declaration - Rules

§ 10-16-134. Health-Care Transparency - Information Required - Website - Definition

§ 10-16-135. Health Benefit Plan Information Cards - Rules - Standardization - Contents

§ 10-16-137. Policy Forms - Explanation of Benefits - Standardization of Forms - Rules

§ 10-16-138. Pathology Services - Direct Billing Required

§ 10-16-139. Access to Care - Rules - Definitions

§ 10-16-140. Grace Periods - Premium Payments - Rules

§ 10-16-141. Medication Synchronization Services - Cost Sharing for Partial Refills - Dispensing Fees

§ 10-16-142. Physical Rehabilitation Services - Copayments and Coinsurance - Research

§ 10-16-143.5. Pharmacy Reimbursement - Substance Use Disorders - Injections - Patient Counseling

§ 10-16-144. Health-Care Services Provided by Pharmacists

§ 10-16-145. Step Therapy - Prohibited - Definition

§ 10-16-145.5. Step Therapy Prohibited - Stage Four Advanced Metastatic Cancer - Definition

§ 10-16-145.5. Step Therapy - Prior Authorization - Prohibited - Stage Four Advanced Metastatic Cancer - Opioid Prescription - Definitions

§ 10-16-146. Periodic Updates to Provider Directory

§ 10-16-147. Parity Reporting - Commissioner - Carriers - Rules - Examination of Complaints

§ 10-16-148. Medication-Assisted Treatment - Limitations on Carriers - Rules - Definition

§ 10-16-149. Commissioner Report - Parity Effects on Premiums - Repeal

§ 10-16-150. Primary Care Payment Reform Collaborative - Created - Powers and Duties - Report - Definition - Repeal

§ 10-16-151. Cost Sharing in Prescription Insulin Drugs - Limits - Definition - Rules

§ 10-16-152. Hiv Prevention Medication - Limitations on Carriers - Step Therapy - Prior Authorization

§ 10-16-153. Coverage for Opiate Antagonists Provided by a Hospital - Definition

§ 10-16-154. Disclosures - Physical Therapists - Occupational Therapists - Chiropractors - Acupuncturists - Patients - Carrier Prohibitions - Enforcement