Colorado Code
Title 10 - Insurance
Article 16 - Health-Care Coverage

§ 10-16-104. Mandatory Coverage Provisions - Definitions - Rules - (1.3) Early intervention services. (1.4) Autism spectrum disorders. (1.5) (Deleted...

§ 10-16-104.1. Prohibition on Discrimination for Organ Transplants Based Solely on Disability - Definition - Source: L. 2021: Entire section added, (HB 21-1169), ch. 99,...

§ 10-16-104.2. Coverage for Contraception - Definitions - Source: L. 2017: Entire section added, (HB 17-1186), ch. 324,...

§ 10-16-104.3. Health Coverage for Persons Under Twenty-Six Years of Age - Coverage for Students Who Take Medical Leave of Absence - Source: L. 2005: Entire section added, p. 1503, § 1,...

§ 10-16-104.6. Off-Label Use of Cancer Drugs - Source: L. 2010: Entire section added, (HB 10-1355), ch. 229,...

§ 10-16-104.7. Substance Use Disorders - Court-Ordered Treatment Coverage - Source: L. 2002: Entire section added, p. 750, § 1,...

§ 10-16-104.8. Behavioral, Mental Health, or Substance Use Disorder Services Coverage - Court-Ordered - Source: L. 2006: Entire section added, p. 159, § 1,...

§ 10-16-104.9. Geographic Areas for Small Employers - Source: L. 2002: Entire section added, p. 1294, § 7,...

§ 10-16-105. Guaranteed Issuance of Health Insurance Coverage - Individual and Small Employer Health Benefit Plans - Source: L. 92: Entire article R&RE, p. 1634, § 1,...

§ 10-16-105.1. Guaranteed Renewability - Exceptions - Individual and Small Employer Health Benefit Plans - Rules - (A) Provides notice of the decision to discontinue coverage, at...

§ 10-16-105.2. Small Employer Health Insurance Availability Program - (1.5) Notwithstanding any other provision of law, a small employer...

§ 10-16-105.3. Health Benefit Plans - Not Prohibited - Source: L. 2003: Entire section added, p. 1778, § 12,...

§ 10-16-105.6. Rate Usage - Source: L. 2013: Entire section added with relocations, (HB 13-1266),...

§ 10-16-105.7. Health Benefit Plan Open Enrollment Periods - Special Enrollment Periods - Rules - (F.5) An uninsured individual was included in the calculation of...

§ 10-16-106. Group Replacement - Extension of Benefits - Source: L. 92: Entire article R&RE, p. 1637, § 1,...

§ 10-16-106.3. Uniform Claims - Billing Codes - Electronic Claim Forms - Source: L. 2002: Entire section added, p. 312, § 1,...

§ 10-16-106.5. Prompt Payment of Claims - Legislative Declaration - Rules - (2.5) This section shall apply to claims made as a...

§ 10-16-106.7. Assignment of Health Insurance Benefits - Source: L. 2005: Entire section added, p. 489, § 1,...

§ 10-16-107. Rate Filing Regulation - Benefits Ratio - Rules - (3.5) The commissioner shall promulgate rules establishing affordability standards. These...

§ 10-16-107.1. False or Misleading Information - Penalties - Source: L. 2008: Entire section added, p. 2255, § 7,...

§ 10-16-107.2. Filing of Health Policies - Rules - Source: L. 92: Entire section added, p. 1745, § 5,...

§ 10-16-107.3. Health Insurance Policies - Plain Language Required - Rules - Source: L. 2010: Entire section added, (HB 10-1166), ch. 143,...

§ 10-16-107.5. Uniform Application Form - Use by All Carriers - Rules - Source: L. 2013: Entire section added with relocations, (HB 13-1266),...

§ 10-16-107.7. Nondiscrimination Against Providers - Source: L. 2013: Entire section added, (HB 13-1266), ch. 217,...

§ 10-16-108. Continuation Privileges - Source: L. 92: Entire article R&RE, p. 1643, § 1,...

§ 10-16-108.5. Fair Marketing Standards - Rules - Source: L. 94: Entire section added, p. 1913, § 9,...

§ 10-16-109. Rules - Pursuant to article 4 of title 24, C.R.S., the commissioner...

§ 10-16-110. Fees Paid by Health Coverage Entities - Source: L. 92: Entire article R&RE, p. 1655, § 1,...

§ 10-16-111. Annual Statements and Reports - Rules - Source: L. 92: Entire article R&RE, p. 1656, § 1,...

§ 10-16-112. Private Utilization Review - Health-Care Coverage Entity Responsibility - Definitions - Source: L. 93: Entire section added, p. 494, § 2,...

§ 10-16-112.5. Prior Authorization for Health- Care Services - Disclosures and Notice - Determination Deadlines - Criteria - Limits and Exceptions - Definitions - Rules - Source: L. 2019: Entire section added, (HB 19-1211), ch. 165,...

§ 10-16-113. Procedure for Denial of Benefits - Internal Review - Rules - Definitions - Source: L. 97: Entire section added, p. 1334, § 1,...

§ 10-16-113.5. Independent External Review of Adverse Determinations - Legislative Declaration - Definitions - Rules - (I) The independent external review entity shall ensure that cases...

§ 10-16-113.7. Reporting the Denial of Benefits to Division - Each carrier shall report the number and outcome of second-level...

§ 10-16-116. Catastrophic Health Insurance - Coverage - Premium Payments - Reporting Requirements - Definitions - Short Title - Source: L. 94: Entire section added, p. 742, § 1,...

§ 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,... - Source: L. 2018: Entire section added, (SB 18-132), ch. 194,...

§ 10-16-118. Prohibition Against Preexisting Condition Exclusions - A carrier offering an individual or small employer health benefit...

§ 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 - Source: L. 94: Entire section added, p. 1913, § 9,...

§ 10-16-119.5. Stop-Loss Health Insurance for Small Employers of Not More Than Fifty Employees - Requirements - Definitions - Rules - Source: L. 2013: Entire section added, (HB 13-1290), ch. 339,...

§ 10-16-121. Required Contract Provisions in Contracts Between Carriers and Providers - Definitions - Source: L. 96: Entire section added, p. 569, § 3,...

§ 10-16-121.5. Prohibited Contract Provisions in Contracts Between Carriers and Providers for Dental Services - Definition - Source: L. 2017: Entire section added, (SB 17-190), ch. 147,...

§ 10-16-121.7. Prohibited Contract Provisions in Contracts Between Carriers and Eye Care Providers - Definitions - Source: L. 2018: Entire section added, (HB 18-1012), ch. 79,...

§ 10-16-122. Access to Prescription Drugs - Source: L. 98: Entire section added, p. 1188, § 1,...

§ 10-16-122.1. Contracts Between Pbms and Pharmacies - Carrier Submit List of Pbms - Prohibited Practices - Exception - Short Title - Definitions - Source: L. 2021: Entire section added, (HB 21-1297), ch. 452,...

§ 10-16-122.3. Pharmacy Benefit Management Firm Payments - Retroactive Reduction Prohibited - Enforcement - Rules - Definitions - Source: L. 2020: Entire section added, (HB 20-1078), ch. 98,...

§ 10-16-122.5. Pharmacy Benefit Manager - Audit of Pharmacies - Time Limits on On-Site Audits - (5.5) Except under circumstances specified in subsection (5) of this...

§ 10-16-122.7. Disclosures Between Pharmacists and Patients - Carrier Prohibitions - Short Title - Legislative Declaration - Preemption by Federal Law - Source: L. 2018: Entire section added, (HB 18-1284), ch. 181,...

§ 10-16-122.9. Prescription Drug Benefits - Real-Time Access to Benefit Information - Definitions - Source: L. 2021: Entire section added, (HB 21-1297), ch. 452,...

§ 10-16-123. Telehealth - Definitions - Source: L. 2001: Entire section added, p. 1153, § 3,...

§ 10-16-124. Prescription Information Cards - Legislative Declaration - Source: L. 2002: Entire section added, p. 1311, § 1,...

§ 10-16-124.5. Prior Authorization Form - Drug Benefits - Rules of Commissioner - Definitions - Source: L. 2013: Entire section added, (SB 13-277), ch. 229,...

§ 10-16-124.7. Opioid Analgesics With Abuse-Deterrent Properties - Study - Definitions - Source: L. 2015: Entire section added, (HB 15-1214), ch. 175,...

§ 10-16-124.8. Colorado Consortium for Prescription Drug Abuse Prevention - Create Process for Recovery - Report - Source: L. 2018: Entire section added, (HB 18-1003), ch. 224,...

§ 10-16-125. Reimbursement to Nurses - Source: L. 2002: Entire section added, p. 1295, § 8,...

§ 10-16-126. Fee-for-Service Dental Plans - Source: L. 2003: Entire section added, p. 1740, § 1,...

§ 10-16-127. Coinsurance and Deductibles - A carrier subject to the provisions of parts 2, 3,...

§ 10-16-128. Annual Report to General Assembly - Notwithstanding section 24-1-136 (11)(a)(I), the commissioner shall report to the...

§ 10-16-129. Health Savings Accounts - Any carrier authorized to conduct business in this state that...

§ 10-16-130. Disclosure of Rate Increases to Public Entities - Legislative Declaration - Definitions - Source: L. 2005: Entire section added, p. 849, § 1,...

§ 10-16-133. Health Carrier Information Disclosure - Website - Insurance Producer Fees and Disclosure Requirements - Legislative Declaration - Rules - Source: L. 2008: Entire section added, p. 2067, § 1,...

§ 10-16-134. Health-Care Transparency - Information Required - Website - Definition - Source: L. 2008: Entire section added, p. 1265, § 4,...

§ 10-16-135. Health Benefit Plan Information Cards - Rules - Standardization - Contents - Source: L. 2008: Entire section added, p. 2008, § 1,...

§ 10-16-137. Policy Forms - Explanation of Benefits - Standardization of Forms - Rules - Source: L. 2010: Entire section added, (HB 10-1004), ch. 141,...

§ 10-16-138. Pathology Services - Direct Billing Required - Source: L. 2012: Entire section added, (HB 12-1221), ch. 41,...

§ 10-16-139. Access to Care - Rules - Definitions - Source: L. 2013: Entire section added with relocations, (HB 13-1266),...

§ 10-16-140. Grace Periods - Premium Payments - Rules - Source: L. 2013: Entire section added, (HB 13-1266), ch. 217,...

§ 10-16-141. Medication Synchronization Services - Cost Sharing for Partial Refills - Dispensing Fees - Source: L. 2014: Entire section added, (HB 14-1359), ch. 221,...

§ 10-16-142. Physical Rehabilitation Services - Copayments and Coinsurance - Research - Source: L. 2015: Entire section added, (HB 15-1083), ch. 321,...

§ 10-16-143.5. Pharmacy Reimbursement - Substance Use Disorders - Injections - Patient Counseling - Source: L. 2018: Entire section added, (HB 18-1007), ch. 225,...

§ 10-16-144. Health-Care Services Provided by Pharmacists - Source: L. 2016: Entire section added, (SB 16-135), ch. 239,...

§ 10-16-145. Step Therapy - Prohibited - Definition - Source: L. 2017: Entire section added, (SB 17-203), ch. 296,...

§ 10-16-145.5. Step Therapy Prohibited - Stage Four Advanced Metastatic Cancer - Definition - [ Editor's note: This version of this section is effective...

§ 10-16-145.5. Step Therapy - Prior Authorization - Prohibited - Stage Four Advanced Metastatic Cancer - Opioid Prescription - Definitions - [ Editor's note: This version of this section is effective...

§ 10-16-146. Periodic Updates to Provider Directory - Each carrier shall, at least every thirty days, update its...

§ 10-16-147. Parity Reporting - Commissioner - Carriers - Rules - Examination of Complaints - Source: L. 2018: Entire section added, (HB 18-1357), ch. 252,...

§ 10-16-148. Medication-Assisted Treatment - Limitations on Carriers - Rules - Definition - (1.5) The commissioner, in consultation with the department of public...

§ 10-16-149. Commissioner Report - Parity Effects on Premiums - Repeal - Source: L. 2019: Entire section added, (HB 19-1269), ch. 195,...

§ 10-16-150. Primary Care Payment Reform Collaborative - Created - Powers and Duties - Report - Definition - Repeal - Source: L. 2019: Entire section added, (HB 19-1233), ch. 194,...

§ 10-16-151. Cost Sharing in Prescription Insulin Drugs - Limits - Definition - Rules - Source: L. 2019: Entire section added, (HB 19-1216), ch. 248,...

§ 10-16-152. Hiv Prevention Medication - Limitations on Carriers - Step Therapy - Prior Authorization - A carrier shall not require a covered person to undergo...

§ 10-16-153. Coverage for Opiate Antagonists Provided by a Hospital - Definition - Source: L. 2020: Entire section added, (HB 20-1065), ch. 287,...

§ 10-16-154. Disclosures - Physical Therapists - Occupational Therapists - Chiropractors - Acupuncturists - Patients - Carrier Prohibitions - Enforcement - Source: L. 2021: Entire section added, (HB 21-1276), ch. 364,...

Part 2 - Sickness and Accident Insurance

§ 10-16-201. Form and Content of Individual Sickness and Accident Insurance Policies - Source: L. 92: Entire article R&RE, p. 1658, § 1,...

§ 10-16-202. Required Provisions in Individual Sickness and Accident Policies - "(The foregoing policy provision does not affect any legal requirement...

§ 10-16-203. Optional Provisions in Individual Sickness and Accident Insurance Policies - Insurance effective at any one time on the insured under...

§ 10-16-204. Inapplicable or Inconsistent Provisions in Individual Policies of Sickness and Accident Insurance - If any provision of part 1 of this article or...

§ 10-16-205. Order of Certain Policy Provisions in Individual Policies of Sickness and Accident Insurance - The provisions which are the subject of sections 10-16-202 and...

§ 10-16-206. Third-Party Ownership of Individual Sickness and Accident Insurance Policies - The word "insured", as used in part 1 of this...

§ 10-16-207. Requirements of Other Jurisdictions - Source: L. 92: Entire article R&RE, p. 1670, § 1,...

§ 10-16-208. Conforming to Statute - Source: L. 92: Entire article R&RE, p. 1670, § 1,...

§ 10-16-209. Application for Policy - Source: L. 92: Entire article R&RE, p. 1670, § 1,...

§ 10-16-210. Notice - Waiver - The acknowledgment by any insurer of the receipt of notice...

§ 10-16-211. Age Limit - If any such policy contains a provision establishing, as an...

§ 10-16-212. Exemption From Attachment and Execution - So much of any benefits under all policies of sickness...

§ 10-16-213. Industrial Sickness and Accident Insurance - Source: L. 92: Entire article R&RE, p. 1672, § 1,...

§ 10-16-214. Group Sickness and Accident Insurance - Source: L. 92: Entire article R&RE, p. 1673, § 1,...

§ 10-16-215. Blanket Sickness and Accident Insurance - Source: L. 92: Entire article R&RE, p. 1679, § 1,...

§ 10-16-216. Examinations - Source: L. 92: Entire article R&RE, p. 1679, § 1,...

§ 10-16-216.5. Hearing Procedure and Judicial Review - Violations - Penalty - Source: L. 92: Entire section added, p. 1593, § 116,...

§ 10-16-217. Application of Part 1 of This Article and Part 2 - Source: L. 92: Entire article R&RE, p. 1680, § 1,...

§ 10-16-218. Judicial Review - Any final action of the commissioner pursuant to part 1...

§ 10-16-219. Benefits for Care in Tax-Supported Institutions - Behavioral Health Disorders - Mental Health Disorders - Intellectual and Developmental Disabilities - Source: L. 92: Entire article R&RE, p. 1680, § 1,...

§ 10-16-220. Minimum Standards for Sickness and Accident Plans - The commissioner may promulgate regulations prescribing minimum standards applicable to...

§ 10-16-221. Statewide Health Care Review Committee - Creation - Membership - Duties - Repeal - Source: L. 2005: Entire section added, p. 1026, § 2,...

§ 10-16-222. Termination of Policies - A carrier shall not retroactively terminate a policy issued pursuant...

Part 3 - Nonprofit Hospital, Medical-Surgical, and Health Service Corporations

§ 10-16-301. Legislative Declaration - Source: L. 92: Entire article R&RE, p. 1681, § 1,...

§ 10-16-302. Incorporation and Organization - Exemptions - Source: L. 92: Entire article R&RE, p. 1681, § 1,...

§ 10-16-303. Filing of Articles of Incorporation - Source: L. 92: Entire article R&RE, p. 1682, § 1,...

§ 10-16-304. Contents of Articles - Source: L. 92: Entire article R&RE, p. 1683, § 1,...

§ 10-16-305. Directors - Source: L. 92: Entire article R&RE, p. 1683, § 1,...

§ 10-16-306. Contracts - Benefits for Long-Term Care Insurance - Corporations subject to the provisions of part 1 of this...

§ 10-16-307. Authority to Do Business - No corporation subject to the provisions of part 1 of...

§ 10-16-308. Automatic Extension of Certificate - When the annual statement of a corporation subject to the...

§ 10-16-309. Requirements for Certificate of Authority - Source: L. 92: Entire article R&RE, p. 1685, § 1,...

§ 10-16-310. Surplus - Guarantee Fund Deposit - Regulations - Source: L. 92: Entire article R&RE, p. 1685, § 1,...

§ 10-16-311. Group Benefits for Depositors of Banks - Benefits for Subscribers in Public Institutions - Source: L. 92: Entire article R&RE, p. 1686, § 1,...

§ 10-16-312. Contracts With Other Organizations - Any corporation subject to the provisions of part 1 of...

§ 10-16-314. Payment for Examinations of Corporations - A corporation periodically examined by the commissioner shall pay to...

§ 10-16-315. Revocation of Certificate - Appeal - Source: L. 92: Entire article R&RE, p. 1689, § 1,...

§ 10-16-316. Complaints - Any individual subscriber of a corporation subject to the provisions...

§ 10-16-317. Exemption of Direct Payment Methods - Nothing contained in part 1 of this article or this...

§ 10-16-317.5. Assignment of Benefits - Source: L. 92: Entire section added, p. 1772, § 1,...

§ 10-16-318. Prospective Reimbursement - Source: L. 92: Entire article R&RE, p. 1691, § 1,...

§ 10-16-319. Effective Date - Sections 10-16-317 and 10-16-318 shall take effect January 1, 1974,...

§ 10-16-320. Investment of Funds - The investable funds of a corporation subject to the provisions...

§ 10-16-321. Medicare Supplement Benefit Standards - The provisions of article 18 of this title shall apply...

§ 10-16-322. Filing of Health Policies - Nonprofit hospital and health service corporations shall be subject to...

§ 10-16-324. Conversion of Corporation to a Stock Insurance Company - Source: L. 96: Entire section added, p. 1861, § 1,...

§ 10-16-325. Termination of Health Policies - A corporation shall not retroactively terminate a policy issued pursuant...

Part 4 - Health Maintenance Organizations

§ 10-16-401. Establishment of Health Maintenance Organizations - Source: L. 92: Entire article R&RE, p. 1694, § 1,...

§ 10-16-402. Issuance of Certificate of Authority - Denial - Source: L. 92: Entire article R&RE, p. 1696, § 1,...

§ 10-16-403. Powers of Health Maintenance Organizations - Source: L. 92: Entire article R&RE, p. 1698, § 1,...

§ 10-16-404. Governing Body - Source: L. 92: Entire article R&RE, p. 1700, § 1,...

§ 10-16-405. Fiduciary Responsibilities - Any director, officer, or partner of a health maintenance organization...

§ 10-16-406. Evidence of Coverage - Rules - Source: L. 92: Entire article R&RE, p. 1700, § 1,...

§ 10-16-407. Information to Enrollees - STATEMENT OF UNDERSTANDING I, ______________, understand that I am enrolling...

§ 10-16-408. Open Enrollment - Source: L. 92: Entire article R&RE, p. 1701, § 1,...

§ 10-16-409. Complaint System - Source: L. 92: Entire article R&RE, p. 1701, § 1,...

§ 10-16-410. Investments - With the exception of investments made in accordance with section...

§ 10-16-411. Protection Against Insolvency - Source: L. 92: Entire article R&RE, p. 1702, § 1,...

§ 10-16-412. Statutory Deposit - Source: L. 92: Entire article R&RE, p. 1704, § 1,...

§ 10-16-413. Prohibited Practices - Source: L. 92: Entire article R&RE, p. 1705, § 1,...

§ 10-16-413.5. Return to Home - Legislative Declaration - Definitions - Source: L. 99: Entire section added, p. 1095, § 1,...

§ 10-16-414. Regulation of Agents - The commissioner may, after notice and hearing, promulgate such reasonable...

§ 10-16-415. Powers of Insurers and Nonprofit Hospital, Medical-Surgical, and Health Service Corporations - Source: L. 92: Entire article R&RE, p. 1706, § 1,...

§ 10-16-416. Examination - Source: L. 92: Entire article R&RE, p. 1706, § 1,...

§ 10-16-417. Suspension or Revocation of Certificate of Authority - Source: L. 92: Entire article R&RE, p. 1708, § 1,...

§ 10-16-418. Rehabilitation, Liquidation, or Conservation of Health Maintenance Organization - Source: L. 92: Entire article R&RE, p. 1709, § 1,...

§ 10-16-419. Administrative Procedures - Source: L. 92: Entire article R&RE, p. 1710, § 1,...

§ 10-16-420. Penalties and Enforcement - Source: L. 92: Entire article R&RE, p. 1710, § 1,...

§ 10-16-421. Statutory Construction and Relationship to Other Laws - Source: L. 92: Entire article R&RE, p. 1712, § 1,...

§ 10-16-421.5. Acquisition of Control of or Merger of a Health Maintenance Organization - No person may make a tender for or a request...

§ 10-16-422. Filings and Reports as Public Documents - All applications, filings, and reports required under part 1 of...

§ 10-16-423. Confidentiality of Health Information - Any data or information pertaining to the diagnosis, treatment, or...

§ 10-16-424. Commissioner's Authority to Contract - The commissioner, in carrying out his or her obligations pursuant...

§ 10-16-425. Applicability of Provisions - Nothing contained in part 1 of this article or this...

§ 10-16-426. Medicare Supplement Benefit Standards - Except for the requirements of section 10-18-105, the provisions of...

§ 10-16-427. Contractual Relations - Source: L. 92: Entire article R&RE, p. 1713, § 1,...

§ 10-16-429. Termination of Contract - A health maintenance organization shall not retroactively terminate a policy...

Part 5 - Prepaid Dental Care Plans

§ 10-16-501. Legislative Declaration - It is the policy of the general assembly and the...

§ 10-16-502. Establishment of Prepaid Dental Care Plan Organizations - Source: L. 92: Entire article R&RE, p. 1714, § 1,...

§ 10-16-503. Application for Certificate of Authority - Source: L. 92: Entire article R&RE, p. 1715, § 1,...

§ 10-16-504. Issuance of Certificate of Authority - Source: L. 92: Entire article R&RE, p. 1717, § 1,...

§ 10-16-505. Guarantee Fund Deposit - Source: L. 92: Entire article R&RE, p. 1717, § 1,...

§ 10-16-506. Reserve Requirement - Exception - Source: L. 92: Entire article R&RE, p. 1718, § 1,...

§ 10-16-507. Enrollee Coverage by Prepaid Dental Care Plan Organizations - Form Filing Requirements - Source: L. 92: Entire article R&RE, p. 1719, § 1,...

§ 10-16-508. Examination of Prepaid Dental Care Plan Organization - Source: L. 92: Entire article R&RE, p. 1719, § 1,...

§ 10-16-509. Operational Expenses - No more than thirty percent of prepaid charges in the...

§ 10-16-510. Suspension or Revocation of Certificate of Authority - Source: L. 92: Entire article R&RE, p. 1720, § 1,...

§ 10-16-511. Rehabilitation, Liquidation, or Conservation of Prepaid Dental Care Plan Organization - Any rehabilitation, liquidation, or conservation of a prepaid dental care...

§ 10-16-512. Other Laws Applicable - In addition to the provisions of part 1 of this...

Part 6 - Accountability of Independent Medical Examiners to Their Patients

§ 10-16-601. Legislative Declaration - The general assembly declares that the intent of this part...

§ 10-16-602. Definitions - As used in this part 6, unless the context otherwise...

§ 10-16-603. Independent Medical Examinations - Governing Standard - All independent medical examinations performed by a doctor shall be...

§ 10-16-604. Financial Interest in Future Care of Patient Prohibited - No doctor that performs an independent medical examination shall have...

§ 10-16-605. Independence of Examiners - No insurer, employer, employee, patient, or agent or representative thereof...

§ 10-16-606. Applicability - Nothing in this part 6 shall be construed to apply...

Part 7 - Consumer Protection Standards Act for the Operation of Managed Care Plans

§ 10-16-701. Short Title - This part 7 shall be known and may be cited...

§ 10-16-702. Legislative Declaration - Source: L. 97: Entire part added, p. 1325, § 2,...

§ 10-16-703. Applicability - This part 7 applies to all managed care plans, except...

§ 10-16-704. Network Adequacy - Rules - Legislative Declaration - Definitions - (A) The nonparticipating provider's bill charges; (B) A negotiated rate;...

§ 10-16-705. Requirements for Carriers and Participating Providers - (6.5) A carrier that has entered into a contract with...

§ 10-16-705.5. Participating Provider Networks - Definitions - Selection Standards - Informal Reconsideration - Enforcement - Legislative Declaration - Source: L. 2017: Entire section added, (SB 17-088), ch. 135,...

§ 10-16-705.7. Timely Credentialing of Physicians by Carriers - Notice of Receipt Required - Notice of Incomplete Applications Required - Delegated Credentialing Agreements - Discrepancies - Denials of Claims Prohibited - Disclosures - Recredentialin... - Source: L. 2021: Entire section added, (SB 21-126), ch. 443,...

§ 10-16-706. Intermediaries - Source: L. 97: Entire part added, p. 1331, § 2,...

§ 10-16-707. Enforcement - Source: L. 97: Entire part added, p. 1332, § 2,...

§ 10-16-708. Rule-Making Authority of Commissioner - The commissioner may promulgate rules as necessary for carrying out...

§ 10-16-709. Evaluation - Nonparticipating Health-Care Providers - Legislative Declaration - Rules - Source: L. 2004: Entire section added, p. 965, § 4,...

§ 10-16-710. Reporting to Commissioner - Medication-Assisted Treatment - Rules - Source: L. 2020: Entire section added, (SB 20-007), ch. 286,...

Part 10 - Health-Care Coverage Cooperatives

§ 10-16-1001. Legislative Declaration - Source: L. 2004: Entire part added, p. 992, § 14,...

§ 10-16-1002. Definitions - As used in this part 10, unless the context otherwise...

§ 10-16-1003. Privacy of Health Information - Source: L. 2004: Entire part added, p. 995, § 14,...

§ 10-16-1004. Health-Care Coverage Cooperatives - Establishment - Fees - Source: L. 2004: Entire part added, p. 996, § 14,...

§ 10-16-1005. Issuance of Certificate of Authority by Commissioner for Cooperative to Purchase Health-Care Coverage - Source: L. 2004: Entire part added, p. 997, § 14,...

§ 10-16-1006. Authority to Deny Application For, Revoke, or Suspend Certificate of Authority - Source: L. 2004: Entire part added, p. 999, § 14,...

§ 10-16-1007. Prohibition on Cooperatives Transacting Insurance Business - A cooperative shall not perform any activity included in the...

§ 10-16-1008. Administrative Structure of Cooperatives - Board of Directors - Officers - Employees - Source: L. 2004: Entire part added, p. 999, § 14,...

§ 10-16-1009. Powers, Duties, and Responsibilities of Cooperatives - Source: L. 2004: Entire part added, p. 1000, § 14,...

§ 10-16-1010. Marketing Requirements of Cooperatives - Source: L. 2004: Entire part added, p. 1004, § 14,...

§ 10-16-1013. Violations of Article by Persons Involved With Operations of Cooperatives - Enforcement - Penalties - Source: L. 2004: Entire part added, p. 1007, § 14,...

§ 10-16-1014. Technical Assistance to Authorized Cooperatives From Division of Insurance - Source: L. 2004: Entire part added, p. 1008, § 14,...

§ 10-16-1015. Health-Care Cooperatives - Rule-Making Authority - The commissioner may promulgate rules consistent with this part 10...

§ 10-16-1016. State Innovation Waiver - Authority to Apply - As necessary to implement this part 10, the commissioner may...

Part 11 - Colorado Reinsurance Program

§ 10-16-1101. Short Title - The short title of this part 11 is the "Colorado...

§ 10-16-1102. Legislative Declaration - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

§ 10-16-1103. Definitions - As used in this part 11, unless the context otherwise...

§ 10-16-1104. Commissioner Powers and Duties - Rules - Study and Report - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

§ 10-16-1105. Reinsurance Program - Creation - Enterprise Status - Subject to Waiver or Funding Approval - Operation - Payment Parameters - Calculation of Reinsurance Payments - Eligible Carrier Requests - Definition - (I) A reduction in claims costs of between thirty and...

§ 10-16-1106. Accounting - Reports - Audits - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

§ 10-16-1107. Funding for Reinsurance Program - Sources - Permitted Uses - Reinsurance Program Cash Fund - Calculation of Total Funding for Program - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

§ 10-16-1109. State Innovation Waiver - Federal Funding - Colorado Reinsurance Program - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

§ 10-16-1110. Repeal of Part - Notice to Revisor of Statutes - Source: L. 2019: Entire part added, (HB 19-1168), ch. 204,...

Part 12 - Health Insurance Affordability Act

§ 10-16-1201. Short Title - The short title of this part 12 is the "Health...

§ 10-16-1202. Legislative Declaration - Source: L. 2020: Entire part added, (SB 20-215), ch. 201,...

§ 10-16-1203. Definitions - As used in this part 12, unless the context otherwise...

§ 10-16-1204. Health Insurance Affordability Enterprise - Creation - Powers and Duties - Assess and Allocate Health Insurance Affordability Fee and Special Assessment - Source: L. 2020: Entire part added, (SB 20-215), ch. 201,...

§ 10-16-1205. Health Insurance Affordability Fee - Special Assessment on Hospitals - Allocation of Revenues - (A) First, up to three percent for actual administrative costs...

§ 10-16-1206. Health Insurance Affordability Cash Fund - Creation - Source: L. 2020: Entire part added, (SB 20-215), ch. 201,...

§ 10-16-1207. Health Insurance Affordability Board - Creation - Membership - Powers and Duties - Subject to Open Meetings and Public Records Laws - Commissioner Rules - Source: L. 2020: Entire part added, (SB 20-215), ch. 201,...

§ 10-16-1208. Limitation on Authority - Public Option - Nothing in this part 12 authorizes the enterprise, the board,...

Part 13 - Colorado Standardized Health Benefit Plan

§ 10-16-1301. Short Title - The short title of this part 13 is the "Colorado...

§ 10-16-1302. Legislative Declaration - Intent - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1303. Definitions - As used in this part 13, unless the context otherwise...

§ 10-16-1304. Standardized Health Benefit Plan - Established - Components - Rules - Independent Analysis - Repeal - (I) Include as part of its network access plan a...

§ 10-16-1305. Standardized Health Benefit Plan - Carriers Required to Offer - Premium Rates - Rules - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1306. Rate Filings - Failure to Meet Premium Requirements - Notice - Public Hearing - Rules - (I) Prevented a carrier from meeting the premium rate requirements...

§ 10-16-1307. Advisory Board - Members - Rules - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1308. Federal Waiver - Commissioner Application - Use of Money - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1309. Standardized Plan - Cost Shift - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1310. Reports Required - Repeal - (I) A quality metric adjustment; and (II) An acuity adjustment...

§ 10-16-1311. State Measurement for Accountable, Responsive, and Transparent (Smart) Government Act Report - Source: L. 2021: Entire part added, (HB 21-1232), ch. 241,...

§ 10-16-1312. Rules - The commissioner may promulgate rules as necessary to develop, implement,...

§ 10-16-1313. Severability - If any provision of this part 13 or application thereof...

Part 14 - Colorado Prescription Drug Affordability Review Board

§ 10-16-1401. Definitions - As used in this part 14, unless the context otherwise...

§ 10-16-1402. Colorado Prescription Drug Affordability Review Board - Created - Membership - Terms - Conflicts of Interest - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1403. Colorado Prescription Drug Affordability Review Board - Powers and Duties - Rules - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1404. Colorado Prescription Drug Affordability Review Board Meetings - Required to Be Public - Exceptions - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1405. Colorado Prescription Drug Affordability Review Board - Reports From Carriers and Pharmacy Benefit Management Firms Required - Confidential Materials - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1406. Colorado Prescription Drug Affordability Review Board - Affordability Reviews of Prescription Drugs - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1407. Colorado Prescription Drug Affordability Review Board - Upper Payment Limits for Certain Prescription Drugs - Rules - Severability - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1408. Colorado Prescription Drug Affordability Review Board - Appeals - Rules - Judicial Review - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1409. Colorado Prescription Drug Affordability Advisory Council - Created - Membership - Powers and Duties - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1410. Use of Savings - Report - Rules - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1411. Unlawful Acts - Enforcement - Penalties - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1412. Notice of Withdrawal of Prescription Drugs With Upper Payment Limits Required - Rules - Penalty - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1413. Optional Participating Plans - Notice of Election to Participate Required - An optional participating plan that elects to subject its purchases...

§ 10-16-1414. Reports - Source: L. 2021: Entire part added, (SB 21-175), ch. 240,...

§ 10-16-1415. Exemption - Prescription Drugs Derived From Cannabis - Notwithstanding any provision of this part 14 to the contrary,...

§ 10-16-1416. Repeal of Part - This part 14 is repealed, effective September 1, 2026. Before...

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Colorado Code Title 10 - Insurance Article 16 - Health-Care Coverage

Colorado Code
Title 10 - Insurance
Article 16 - Health-Care Coverage