Article

Health-care Coverage

C.R.S. § 10-16-101— Short title
C.R.S. § 10-16-102— Definitions
C.R.S. § 10-16-103— Proposal of mandatory health-care coverage provisions
C.R.S. § 10-16-103.4— Essential health benefits
C.R.S. § 10-16-103.5— Payment of premiums
C.R.S. § 10-16-103.6— Copayment-only prescription payment structures
C.R.S. § 10-16-104— Mandatory coverage provisions
C.R.S. § 10-16-104.1— Prohibition on discrimination for organ transplants based solely on disability
C.R.S. § 10-16-104.2— Coverage for contraception
C.R.S. § 10-16-104.3— Health coverage for persons under twenty-six years of age
C.R.S. § 10-16-104.6— Off-label use of cancer drugs
C.R.S. § 10-16-104.7— Substance use disorders
C.R.S. § 10-16-104.8— Behavioral, mental health, or substance use disorder services coverage
C.R.S. § 10-16-104.9— Geographic areas for small employers
C.R.S. § 10-16-105— Guaranteed issuance of health insurance coverage
C.R.S. § 10-16-105.1— Guaranteed renewability
C.R.S. § 10-16-105.2— Small employer health insurance availability program
C.R.S. § 10-16-105.3— Health benefit plans
C.R.S. § 10-16-105.6— Rate usage
C.R.S. § 10-16-105.7— Health benefit plan open enrollment periods
C.R.S. § 10-16-106— Group replacement
C.R.S. § 10-16-106.3— Uniform claims
C.R.S. § 10-16-106.5— Prompt payment of claims
C.R.S. § 10-16-106.7— Assignment of health insurance benefits
C.R.S. § 10-16-107— Rate filing regulation
C.R.S. § 10-16-107.1— False or misleading information
C.R.S. § 10-16-107.2— Filing of health policies
C.R.S. § 10-16-107.3— Health insurance policies
C.R.S. § 10-16-107.4— Health-care sharing plan or arrangement
C.R.S. § 10-16-107.5— Uniform application form
C.R.S. § 10-16-107.7— Nondiscrimination against providers
C.R.S. § 10-16-108— Continuation privileges
C.R.S. § 10-16-108.5— Fair marketing standards
C.R.S. § 10-16-109— Rules
C.R.S. § 10-16-110— Fees paid by health coverage entities
C.R.S. § 10-16-111— Annual statements and reports
C.R.S. § 10-16-112— Private utilization review
C.R.S. § 10-16-112.5— Prior authorization for health-care services
C.R.S. § 10-16-113— Procedure for denial of benefits
C.R.S. § 10-16-113.5— Independent external review of adverse determinations
C.R.S. § 10-16-113.7— Reporting the denial of benefits to division
C.R.S. § 10-16-116— Catastrophic health insurance
C.R.S. § 10-16-118— Prohibition against preexisting condition exclusions
C.R.S. § 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"
C.R.S. § 10-16-119.5— Stop-loss health insurance for small employers of not more than fifty employees
C.R.S. § 10-16-121— Required contract provisions in contracts between carriers and providers
C.R.S. § 10-16-121.3— Limitations on provisions in contracts between carriers and licensed health-care providers
C.R.S. § 10-16-121.5— Prohibited contract provisions in contracts between carriers and providers for dental services
C.R.S. § 10-16-121.7— Prohibited contract provisions in contracts between carriers and eye care providers
C.R.S. § 10-16-122— Access to prescription drugs
C.R.S. § 10-16-122.1— Contracts between PBMs and pharmacies
C.R.S. § 10-16-122.3— Pharmacy benefit management firm payments
C.R.S. § 10-16-122.4— Pharmacy benefits
C.R.S. § 10-16-122.5— Pharmacy benefit manager
C.R.S. § 10-16-122.6— Pharmacy benefit managers
C.R.S. § 10-16-122.7— Disclosures between pharmacists and patients
C.R.S. § 10-16-122.9— Prescription drug benefits
C.R.S. § 10-16-123— Telehealth
C.R.S. § 10-16-124— Prescription information cards
C.R.S. § 10-16-124.5— Prior authorization form
C.R.S. § 10-16-124.7— Opioid analgesics with abuse-deterrent properties
C.R.S. § 10-16-124.8— Colorado consortium for prescription drug abuse prevention
C.R.S. § 10-16-125— Reimbursement to nurses
C.R.S. § 10-16-126— Fee-for-service dental plans
C.R.S. § 10-16-127— Coinsurance and deductibles
C.R.S. § 10-16-128— Annual report to general assembly
C.R.S. § 10-16-129— Health savings accounts
C.R.S. § 10-16-130— Disclosure of rate increases to public entities
C.R.S. § 10-16-133— Health carrier information disclosure
C.R.S. § 10-16-134— Health-care transparency
C.R.S. § 10-16-135— Health coverage plan information cards
C.R.S. § 10-16-137— Policy forms
C.R.S. § 10-16-138— Pathology services
C.R.S. § 10-16-139— Access to care
C.R.S. § 10-16-140— Grace periods
C.R.S. § 10-16-141— Medication synchronization services
C.R.S. § 10-16-142— Physical rehabilitation services
C.R.S. § 10-16-143.5— Pharmacy reimbursement
C.R.S. § 10-16-144— Health-care services provided by pharmacists
C.R.S. § 10-16-145— Step therapy
C.R.S. § 10-16-145.5— Step therapy
C.R.S. § 10-16-146— Periodic updates to provider directory
C.R.S. § 10-16-147— Parity reporting
C.R.S. § 10-16-148— Medication-assisted treatment
C.R.S. § 10-16-150— Primary care payment reform collaborative
C.R.S. § 10-16-151— Cost sharing in prescription insulin drugs
C.R.S. § 10-16-152— HIV prevention and treatment medication
C.R.S. § 10-16-153— Coverage for opiate antagonists provided by a hospital
C.R.S. § 10-16-154— Disclosures
C.R.S. § 10-16-155— Actuarial reviews of proposed health-care legislation
C.R.S. § 10-16-155.5— Actuarial review of doula services
C.R.S. § 10-16-156— Prescription drugs
C.R.S. § 10-16-157— Alternative payment model parameters
C.R.S. § 10-16-158— Treatment of sexually transmitted infection
C.R.S. § 10-16-159— Coverage for sterilization services
C.R.S. § 10-16-160— Cost sharing
C.R.S. § 10-16-161— Calculation of contribution to out-of-pocket and cost-sharing requirements
C.R.S. § 10-16-162— Prohibition on discrimination for coverage based solely on natural medicine consumption
C.R.S. § 10-16-163— Contracts
C.R.S. § 10-16-164— Hospital facility fee report
C.R.S. § 10-16-165— Dental coverage plans
C.R.S. § 10-16-166— Prohibition on using the body mass index or ideal body weight
C.R.S. § 10-16-201— Form and content of individual sickness and accident insurance policies
C.R.S. § 10-16-202— Required provisions in individual sickness and accident policies
C.R.S. § 10-16-203— Optional provisions in individual sickness and accident insurance policies
C.R.S. § 10-16-204— Inapplicable or inconsistent provisions in individual policies of sickness and accident insurance
C.R.S. § 10-16-205— Order of certain policy provisions in individual policies of sickness and accident insurance
C.R.S. § 10-16-206— Third-party ownership of individual sickness and accident insurance policies
C.R.S. § 10-16-207— Requirements of other jurisdictions
C.R.S. § 10-16-208— Conforming to statute
C.R.S. § 10-16-209— Application for policy
C.R.S. § 10-16-210— Notice
C.R.S. § 10-16-211— Age limit
C.R.S. § 10-16-212— Exemption from attachment and execution
C.R.S. § 10-16-213— Industrial sickness and accident insurance
C.R.S. § 10-16-214— Group sickness and accident insurance
C.R.S. § 10-16-215— Blanket sickness and accident insurance
C.R.S. § 10-16-216— Examinations
C.R.S. § 10-16-216.5— Hearing procedure and judicial review
C.R.S. § 10-16-217— Application of part 1 of this article and part 2
C.R.S. § 10-16-218— Judicial review
C.R.S. § 10-16-219— Benefits for care in tax-supported institutions
C.R.S. § 10-16-220— Minimum standards for sickness and accident plans
C.R.S. § 10-16-221— Statewide health care review committee
C.R.S. § 10-16-222— Termination of policies
C.R.S. § 10-16-301— Legislative declaration
C.R.S. § 10-16-302— Incorporation and organization
C.R.S. § 10-16-303— Filing of articles of incorporation
C.R.S. § 10-16-304— Contents of articles
C.R.S. § 10-16-305— Directors
C.R.S. § 10-16-306— Contracts
C.R.S. § 10-16-307— Authority to do business
C.R.S. § 10-16-308— Automatic extension of certificate
C.R.S. § 10-16-309— Requirements for certificate of authority
C.R.S. § 10-16-310— Surplus
C.R.S. § 10-16-311— Group benefits for depositors of banks
C.R.S. § 10-16-312— Contracts with other organizations
C.R.S. § 10-16-314— Payment for examinations of corporations
C.R.S. § 10-16-315— Revocation of certificate
C.R.S. § 10-16-316— Complaints
C.R.S. § 10-16-317— Exemption of direct payment methods
C.R.S. § 10-16-317.5— Assignment of benefits
C.R.S. § 10-16-318— Prospective reimbursement
C.R.S. § 10-16-319— Effective date
C.R.S. § 10-16-320— Investment of funds
C.R.S. § 10-16-321— Medicare supplement benefit standards
C.R.S. § 10-16-322— Filing of health policies
C.R.S. § 10-16-324— Conversion of corporation to a stock insurance company
C.R.S. § 10-16-325— Termination of health policies
C.R.S. § 10-16-401— Establishment of health maintenance organizations
C.R.S. § 10-16-402— Issuance of certificate of authority
C.R.S. § 10-16-403— Powers of health maintenance organizations
C.R.S. § 10-16-404— Governing body
C.R.S. § 10-16-405— Fiduciary responsibilities
C.R.S. § 10-16-406— Evidence of coverage
C.R.S. § 10-16-407— Information to enrollees
C.R.S. § 10-16-408— Open enrollment
C.R.S. § 10-16-409— Complaint system
C.R.S. § 10-16-410— Investments
C.R.S. § 10-16-411— Protection against insolvency
C.R.S. § 10-16-412— Statutory deposit
C.R.S. § 10-16-413— Prohibited practices
C.R.S. § 10-16-413.5— Return to home
C.R.S. § 10-16-414— Regulation of agents
C.R.S. § 10-16-415— Powers of insurers and nonprofit hospital, medical-surgical, and health service corporations
C.R.S. § 10-16-416— Examination
C.R.S. § 10-16-417— Suspension or revocation of certificate of authority
C.R.S. § 10-16-418— Rehabilitation, liquidation, or conservation of health maintenance organization
C.R.S. § 10-16-419— Administrative procedures
C.R.S. § 10-16-420— Penalties and enforcement
C.R.S. § 10-16-421— Statutory construction and relationship to other laws
C.R.S. § 10-16-421.5— Acquisition of control of or merger of a health maintenance organization
C.R.S. § 10-16-422— Filings and reports as public documents
C.R.S. § 10-16-423— Confidentiality of health information
C.R.S. § 10-16-424— Commissioner’s authority to contract
C.R.S. § 10-16-425— Applicability of provisions
C.R.S. § 10-16-426— Medicare supplement benefit standards
C.R.S. § 10-16-427— Contractual relations
C.R.S. § 10-16-429— Termination of contract
C.R.S. § 10-16-501— Legislative declaration
C.R.S. § 10-16-502— Establishment of prepaid dental care plan organizations
C.R.S. § 10-16-503— Application for certificate of authority
C.R.S. § 10-16-504— Issuance of certificate of authority
C.R.S. § 10-16-505— Guarantee fund deposit
C.R.S. § 10-16-506— Reserve requirement
C.R.S. § 10-16-507— Enrollee coverage by prepaid dental care plan organizations
C.R.S. § 10-16-508— Examination of prepaid dental care plan organization
C.R.S. § 10-16-509— Operational expenses
C.R.S. § 10-16-510— Suspension or revocation of certificate of authority
C.R.S. § 10-16-511— Rehabilitation, liquidation, or conservation of prepaid dental care plan organization
C.R.S. § 10-16-512— Other laws applicable
C.R.S. § 10-16-601— Legislative declaration
C.R.S. § 10-16-602— Definitions
C.R.S. § 10-16-603— Independent medical examinations
C.R.S. § 10-16-604— Financial interest in future care of patient prohibited
C.R.S. § 10-16-605— Independence of examiners
C.R.S. § 10-16-606— Applicability
C.R.S. § 10-16-701— Short title
C.R.S. § 10-16-702— Legislative declaration
C.R.S. § 10-16-703— Applicability
C.R.S. § 10-16-704— Network adequacy
C.R.S. § 10-16-705— Requirements for carriers and participating providers
C.R.S. § 10-16-705.5— Participating provider networks
C.R.S. § 10-16-705.7— Timely credentialing of physicians by carriers
C.R.S. § 10-16-706— Intermediaries
C.R.S. § 10-16-707— Enforcement
C.R.S. § 10-16-708— Rule-making authority of commissioner
C.R.S. § 10-16-709— Evaluation
C.R.S. § 10-16-710— Reporting to commissioner
C.R.S. § 10-16-1001— Legislative declaration
C.R.S. § 10-16-1002— Definitions
C.R.S. § 10-16-1003— Privacy of health information
C.R.S. § 10-16-1004— Health-care coverage cooperatives
C.R.S. § 10-16-1005— Issuance of certificate of authority by commissioner for cooperative to purchase health-care coverage
C.R.S. § 10-16-1006— Authority to deny application for, revoke, or suspend certificate of authority
C.R.S. § 10-16-1007— Prohibition on cooperatives transacting insurance business
C.R.S. § 10-16-1008— Administrative structure of cooperatives
C.R.S. § 10-16-1009— Powers, duties, and responsibilities of cooperatives
C.R.S. § 10-16-1010— Marketing requirements of cooperatives
C.R.S. § 10-16-1013— Violations of article by persons involved with operations of cooperatives
C.R.S. § 10-16-1014— Technical assistance to authorized cooperatives from division of insurance
C.R.S. § 10-16-1015— Health-care cooperatives
C.R.S. § 10-16-1016— State innovation waiver
C.R.S. § 10-16-1101— Short title
C.R.S. § 10-16-1102— Legislative declaration
C.R.S. § 10-16-1103— Definitions
C.R.S. § 10-16-1104— Commissioner powers and duties
C.R.S. § 10-16-1105— Reinsurance program
C.R.S. § 10-16-1106— Accounting
C.R.S. § 10-16-1107— Funding for reinsurance program
C.R.S. § 10-16-1109— State innovation waiver
C.R.S. § 10-16-1110— Repeal of part
C.R.S. § 10-16-1201— Short title
C.R.S. § 10-16-1202— Legislative declaration
C.R.S. § 10-16-1203— Definitions
C.R.S. § 10-16-1204— Health insurance affordability enterprise
C.R.S. § 10-16-1205— Health insurance affordability fee
C.R.S. § 10-16-1206— Health insurance affordability cash fund
C.R.S. § 10-16-1207— Health insurance affordability board
C.R.S. § 10-16-1208— Limitation on authority
C.R.S. § 10-16-1301— Short title
C.R.S. § 10-16-1302— Legislative declaration
C.R.S. § 10-16-1303— Definitions
C.R.S. § 10-16-1304— Standardized health benefit plan
C.R.S. § 10-16-1305— Standardized health benefit plan
C.R.S. § 10-16-1305.5— Rate filings
C.R.S. § 10-16-1306— Failure to meet premium rate requirements
C.R.S. § 10-16-1307— Advisory board
C.R.S. § 10-16-1308— Federal waiver
C.R.S. § 10-16-1309— Standardized plan
C.R.S. § 10-16-1310— Reports required
C.R.S. § 10-16-1311— State measurement for accountable, responsive, and transparent (SMART) government act report
C.R.S. § 10-16-1312— Rules
C.R.S. § 10-16-1313— Severability
C.R.S. § 10-16-1401— Definitions
C.R.S. § 10-16-1402— Colorado prescription drug affordability review board
C.R.S. § 10-16-1403— Colorado prescription drug affordability review board
C.R.S. § 10-16-1404— Colorado prescription drug affordability review board meetings
C.R.S. § 10-16-1405— Colorado prescription drug affordability review board
C.R.S. § 10-16-1406— Colorado prescription drug affordability review board
C.R.S. § 10-16-1407— Colorado prescription drug affordability review board
C.R.S. § 10-16-1408— Colorado prescription drug affordability review board
C.R.S. § 10-16-1409— Colorado prescription drug affordability advisory council
C.R.S. § 10-16-1410— Use of savings
C.R.S. § 10-16-1411— Unlawful acts
C.R.S. § 10-16-1412— Notice of withdrawal of prescription drugs with upper payment limits required
C.R.S. § 10-16-1413— Optional participating plans
C.R.S. § 10-16-1414— Reports
C.R.S. § 10-16-1415— Exemption
C.R.S. § 10-16-1416— Repeal of part
C.R.S. § 10-16-1501— Short title
C.R.S. § 10-16-1502— Legislative declaration
C.R.S. § 10-16-1503— Definitions
C.R.S. § 10-16-1504— Applicability
C.R.S. § 10-16-1505— Prohibition on 340B discrimination
C.R.S. § 10-16-1506— Enforcement