Colorado Code
Part 1 - General Provisions
§ 10-16-107. Rate Filing Regulation - Benefits Ratio - Rules






























(3.5) The commissioner shall promulgate rules establishing affordability standards. These standards must include appropriate targets for carrier investments in primary care. In developing these standards, the commissioner shall consider the recommendations of the primary care payment reform collaborative created in section 10-16-150.













































Source: L. 92: Entire article R&RE, p. 1639, § 1, effective July 1; (1) amended and (1.5) and (1.7) added, p. 1774, § 2, effective July 1; (2), (3)(a), and (3)(f) amended, p. 1744, § 4, effective January 1, 1993. L. 94: (3)(d) amended, p. 1629, § 26, effective May 31. L. 96: (5) added, p. 730, § 2, effective July 1. L. 97: (2) and (3)(e) amended, p. 530, § 2, effective April 24; (7) added, p. 416, § 1, effective April 24; (6) added, p. 639, § 6, effective May 1. L. 98: (5)(a) and IP(5)(b)(I) amended, p. 124, § 1, effective January 1, 1999. L. 99: (3)(b)(II)(A) amended, p. 320, § 5, effective July 1; (3)(e)(I) amended, p. 84, § 6, effective July 1. L. 2000: (5.5) added, p. 195, § 1, effective March 27. L. 2001: (1.5)(b) amended, p. 1214, § 42, effective January 1, 2002. L. 2004: (8) added, p. 963, § 1, effective May 21. L. 2005: (1.5)(f) amended, p. 762, § 15, effective June 1. L. 2007: (1), (1.5)(c), and (3)(e)(I) amended, p. 2004, § 2, effective January 1, 2008. L. 2008: (1) amended, p. 2250, § 5, effective June 5; (1.5), (1.7), and (3)(e) amended and (1.6) added, p. 2251, § 6, effective July 1. L. 2009: (6) amended, (HB 09-1012), ch. 188, p. 823, § 2, effective July 1. L. 2010: (6) amended, (HB 10-1160), ch. 283, p. 1327, § 4, effective July 1; (1.5) amended, (HB 10-1008), ch. 40, p. 162, § 1, effective January 1, 2011. L. 2013: Entire section amended with relocations, (HB 13-1266), ch. 217, p. 939, § 12, effective May 13. L. 2019: (2)(a)(I) amended and (3.5) added, (HB 19-1233), ch. 194, p. 2122, § 4, effective May 16; (3)(a)(IV) and (3)(a)(V) amended and (3)(a)(VI) added, (HB 19-1269), ch. 195, p. 2128, § 5, effective May 16; (7) added, (HB 19-1174), ch. 171, p. 1982, § 3, effective January 1, 2020. L. 2020: (8) added, (SB 20-215), ch. 201, p. 997, § 2, effective June 30. L. 2021: (3)(a)(V) amended and (3)(a)(VII) added, (HB 21-1232), ch. 241, p. 1293, § 2, effective June 16.




Cross references: (1) For the federal "Public Health Service Act", see 42 U.S.C. § 201 et seq., and for section 2718 of that act, see 42 U.S.C. § 300gg-18.
(2) For the legislative declaration contained in the 1992 act amending subsection (1) and enacting subsections (1.5) and (1.7), see section 1 of chapter 218, Session Laws of Colorado 1992. For the legislative declaration contained in the 1997 act enacting subsection (6), see section 1 of chapter 154, Session Laws of Colorado 1997. For the legislative declaration contained in the 1999 act amending subsection (3)(b)(II)(A), see section 1 of chapter 111, Session Laws of Colorado 1999. In 2008, subsections (1), (1.5), (1.7), and (3)(e) were amended and subsection (1.6) was 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. For the legislative declaration in HB 19-1233, see section 1 of chapter 194, Session Laws of Colorado 2019.
(3) 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