S.B. 97-41 Health insurance - Colorado uninsurable health insurance plan. Updates definitions applicable to the Colorado uninsurable health insurance plan to conform such provisions with existing law applicable to health care coverage. Adds definitions necessary for new funding mechanisms provided in this act.
Revises provisions related to the members of the board of directors of the plan and the powers and duties of the board. Makes the Denver district court the venue for legal actions affecting the plan. Clarifies the board's procedures for selecting the administering carrier for the plan. Clarifies the establishment of premiums for coverage offered through the plan.
Expands the powers of the board to include the establishment of procedures and standards for the subsidization of premiums and other plan expenses of qualified insureds and the development of a list of medical conditions for which plan eligibility will be granted without the need for prior application to an insurance carrier. Repeals preexisting condition limitations for any eligible individual with qualifying previous coverage.
Provides that continued funding for the plan shall be from current sources and penalties, fines, and excise taxes collected by the commissioner of insurance and currently credited to the general fund of the state. Establishes the Colorado uninsurable health insurance plan cash fund for the deposit of such additional revenues. Deletes the repeal of the business associations unclaimed moneys fund and the deposit of moneys therefrom to the Colorado uninsurable health insurance plan cash fund.
APPROVED by
Governor May 1, 1997
EFFECTIVE July 1, 1997
S.B. 97-54 Health insurance - federal "Health Insurance Portability and Accountability Act of 1996". Brings Colorado's health insurance laws into compliance with the requirements of the federal "Health Insurance Portability and Accountability Act of 1996". Declares that the intent of this act is solely to make Colorado law consistent with federal law in order to retain state jurisdiction over health insurance plans, avoid dual state and federal regulation, reduce public confusion about health insurance rights and responsibilities, and preserve Colorado health insurance requirements that exceed federal law. Declares that nothing in this act shall prevent or prohibit the governor from giving the required notice to the federal government that Colorado is implementing an acceptable alternative mechanism to section 2741 of the federal act, but that no such notice may take place without specific statutory authorization from the general assembly. Specifies that nothing in this act shall be construed to authorize implementation of the National Association of Insurance Commissioners' model acts on individual availability or portability.
Cross references identical definitions contained in both the "Small Employer Health Insurance Availability Program Act" and the "Colorado Health Care Coverage Act". Makes these definitions consistent with the federal law.
Makes Colorado's health insurance laws with respect to renewability of policies consistent with the requirements of federal law. Sets forth the circumstances under which an insurer may refuse to renew coverage.
Pursuant to federal law, requires small employer carriers to offer all of their small employer health insurance policies to all employers of 2 to 50 employees rather than only the basic and standard health benefit plans currently required by Colorado law. Makes this requirement inapplicable to such health benefit plans made available in the small employer group market only through certain types of bona fide associations.
Requires carriers offering individual health insurance coverage to offer and accept for enrollment every eligible individual applying for coverage except for coverage offered only through bona fide associations and conversion policies.
Prohibits health insurers from charging higher premiums to similarly situated covered individuals on the basis of health status-related factors. Makes Colorado's limitations on preexisting condition exclusions in health benefit plans consistent with federal law.
Clarifies that contributions to a medical savings account may only be excluded from federal taxable income for purposes of Colorado income tax if the individual has not already deducted such contributions on federal income tax returns.
APPROVED by
Governor May 1, 1997
EFFECTIVE May 1, 1997
S.B. 97-61 Reporting requirements - form of financial statements - application of NAIC guidelines - requests for phase-in. In connection with the existing requirement that insurers and certain health care providers follow all applicable instructions, procedures, and guidelines promulgated by the National Association of Insurance Commissioners (NAIC) when filing annual financial statements with the insurance commissioner, provides relief from the initial application of such instructions, procedures, or guidelines if the result would be to reduce a company's total capital and surplus by 10% or more or would cause the company's capital and surplus to fall to or below a threshold level, known as the "company action level," set by the commissioner.
Allows a company to request relief from a new NAIC instruction, procedure, or guideline in the form of a phase-in of its effectiveness over a period of up to 3 years. Requires the commissioner to provide notice and an opportunity for a hearing before denying any such request.
APPROVED by
Governor March 24, 1997
EFFECTIVE March 24,
1997
S.B. 97-72 Domestic abuse discrimination - prohibited. Identifies practices that discriminate against victims of domestic abuse that are unfair methods of competition and unfair or deceptive acts or practices in the business of insurance. Requires an insurer, upon the written request of an insured or an applicant, to demonstrate that an act taken that adversely affects a victim of domestic abuse is not solely based on a victim's domestic abuse status but instead is based on underwriting criteria related to the condition, property, or claim history of the insured or the applicant and upon sound underwriting and actuarial principles. Grants immunity to insurers for actions taken in compliance with the act.
APPROVED by
Governor March 24, 1997
EFFECTIVE January 1,
1998
S.B. 97-104 Insurance companies - regulation by insurance commissioner - market conduct examinations - confidentiality of information - appropriation. Creates a market conduct examinations program under which the commissioner of insurance will consider complaint analyses, underwriting and claims practices, pricing, product solicitation, policy form compliance, and market share analyses in addition to the other sources of information currently considered. Includes advisory organizations and rating organizations within the definition of a "company" subject to examination.
Requires companies that are examined to make documents available for examination at the division offices and to pay the costs associated with the examination. Requires examinations to be conducted by the insurance commissioner or the commissioner's assistants unless good cause is shown to hire contract examiners. Provides that working papers, claim files, and other documents involved in an ongoing informal investigation are to be given confidential treatment. Increases certain fees to pay for examinations.
Appropriates $503,262 and 7.0 FTE to the department of regulatory agencies for the implementation of the act. Of this amount, $100,831 and 1.4 FTE is further appropriated to the department of law and $17,182 and 0.1 FTE is further appropriated to the department of personnel, division of administrative hearings, for legal and administrative law judge services related to the implementation of the act.
APPROVED by
Governor June 3, 1997
EFFECTIVE June 3, 1997
S.B. 97-108 Division of insurance - sunset review - continuation until July 1, 2002 - appropriation. Continues the division of insurance until July 1, 2002.
Expands the range of misconduct for which the commissioner may assess monetary penalties, authorizing penalties of up to $1,000 per occurrence (limited to a maximum aggregate penalty of $10,000) for violations of any insurance statute or rule or order adopted pursuant to the insurance statutes. In cases of willful violation, authorizes a penalty of up to $10,000 per occurrence, not to exceed an aggregate penalty of $150,000 in any 6-month period. Allows appeal of such penalty to be made to the court of appeals.
Allows the reduction of coverage of motor vehicle insurance policies if the reduction is part of a general reduction filed with, instead of approved by, the commissioner.
Changes the administration of self-insurance authorization from the department of revenue to the division of insurance.
Appropriates $245,401 and .6 FTE to the department of regulatory agencies, division of insurance, for the implementation of the act. Of this amount, $204,984 and 2.8 FTE is further appropriated to the department of law for the provision of legal services relating to the implementation of the act.
APPROVED by
Governor May 27, 1997
EFFECTIVE July 1, 1997
S.B. 97-109 Insurance companies - financial examinations. Reinstates the requirement that self-insured employers report closed-claim data. Eliminates the current requirement that managed care plans file premiums or charges, in addition to rates, with the commissioner of insurance. Changes the financial examination cycle for health maintenance organizations from at least once every 3 years to once every 5 years. When auditing a company's tax statement, grants the commissioner authority to examine any books or records bearing on the company's tax statement. For purposes of litigation involving unauthorized foreign or alien insurers, if the insurer is listed on the commissioner's nonadmitted insurers list, allows the insurer to show to the judge and the commissioner that sufficient assets exist to pay any final judgment instead of depositing cash or filing a bond with the clerk of the court.
APPROVED by
Governor April 24, 1997
EFFECTIVE April 24,
1997
S.B. 97-224 Automobile insurance - income sensitive motor vehicle coverage - continuation. Continues until July 1, 2002, the availability to persons with qualifying incomes of income sensitive motor vehicle insurance policies that provide $25,000 medical protection and $5,000 wage loss protection. Lowers the required savings that the insurer must demonstrate from a minimum of 20% to 15% of the personal injury protection coverage premium during the first year an insurer offers income sensitive motor vehicle insurance policies.
APPROVED by
Governor May 16, 1997
EFFECTIVE May 16,
1997
H.B. 97-1104 Health insurance - treatment of intractable pain. Requires an insurance carrier offering a health care plan or managed health care plan to disclose whether the plan provides coverage for the treatment of intractable pain. If the carrier does offer treatment for intractable pain, requires that the plan provide access to such treatment either by a primary care physician with demonstrated interest and documented experience in pain management or by allowing direct access or referral to a pain management specialist participating in and available under the plan. Provides that, if the plan is silent on whether it covers treatment for intractable pain, then the plan shall be presumed to offer coverage for the treatment of intractable pain. Authorizes the commissioner of insurance to promulgate rules regarding the referral of insured persons to pain management specialists. Defines "intractable pain".
APPROVED by
Governor April 24, 1997
EFFECTIVE April 24,
1997
H.B. 97-1122 Managed care plans - consumer protection standards - enforcement by commissioner of insurance. Enacts the "Consumer Protection Standards Act for the Operation of Managed Care Plans". Defines the terms "network" and "participating provider" for purposes of the "Colorado Health Care Coverage Act".
Sets forth standards for the adequacy of managed care networks. Requires health insurance carriers to maintain access plans for health care services offered through managed care plans. Sets forth the requirements for such access plans. Provides for the confidentiality of any proprietary parts of access plans. Establishes occurrences when a managed care plan may not penalize or deny or restrict benefits to a covered person.
Sets forth requirements for health insurance carriers and health care providers participating in managed care plans. Requires contracts between such parties to hold persons covered under managed care plans harmless for the cost of covered care. Requires such agreements to provide for contingencies in the event of insurance carrier insolvency or cessation of operations. Requires the development of provider selection standards. Prohibits certain conduct with respect to provider selection. Requires certain terms with respect to termination of a contract between a carrier and a provider of health care services under a managed care plan. Requires that each managed care plan allow covered persons to continue receiving care for 60 days after a participating provider is terminated by the plan without cause and the covered person did not receive proper notice.
Establishes standards for contracts between persons authorized by health care providers to negotiate provider contracts and health insurance carriers. Requires contracts between such intermediaries and health insurance carriers to be consistent with other standards in this act.
Authorizes the commissioner of insurance to enforce the provisions of this act. Makes violation of this act an unfair method of competition and unfair or deceptive act or practice under the unfair insurance practices laws. Prohibits the commissioner from arbitrating, mediating, or settling disputes between a managed care plan and a provider concerning the provider's inclusion in or termination from the plan.
Applies to all managed care plans that are issued, renewed, extended, or modified on or after January 1, 1998, except worker's compensation and automobile insurance contracts.
APPROVED by
Governor June 3, 1997
EFFECTIVE July 1, 1997
H.B. 97-1131 Health insurance - denial of coverage based on recreational activities. Makes it an act of unfair discrimination and an unfair claim settlement practice for a health insurer to deny coverage to an individual solely because of the individual's casual or nonprofessional participation in certain lawful recreational activities including motorcycling, snowmobiling, and off-highway vehicle riding.
APPROVED by
Governor March 24, 1997
EFFECTIVE October 1,
1997
H.B. 97-1144 Health insurance - small employer geographic location case characteristics. Authorizes the commissioner of insurance to establish one or more separate geographic location categories for certain counties that are not part of a primary metropolitan statistical area or a metropolitan statistical area for purposes of certain health insurance premium rating determinations.
APPROVED by
Governor March 24, 1997
EFFECTIVE March 24,
1997
H.B. 97-1161 Health coverage plans - procedure for denial of benefits. Specifies that a health coverage plan shall not deny a request for reimbursement for or coverage of medical treatment on the grounds that treatment is not necessary, appropriate, efficient, or effective unless the denial is made in accordance with this statutory provision. Requires such plans to notify the policy holder in writing of the reasons for denial. Requires the commissioner of insurance to promulgate rules for the content of and deadline for such notification.
Requires all such denials to include an explanation of the specific medical basis for the denial and to advise the covered person of the right to appeal the decision. Requires such denials to be signed by a licensed physician familiar with the Colorado standard of care. Grants the covered person's health care provider the ability to communicate with the physician involved in the decision. Requires a health coverage plan to disclose its standards for denial of treatment. Specifies that this statutory provision does not preclude the right of an individual to seek other legal remedy.
APPROVED by
Governor June 3, 1997
EFFECTIVE July 1, 1997
H.B. 97-1175 Financial institutions - sale of insurance. Prescribes certain standards related to the sale of insurance by financial institutions. Forbids "tying" arrangements and misleading advertising. Requires disclosure by the financial institution that the insurance products are not deposits, not insured or guaranteed, may involve investment risk, and that the product may be purchased from an agent of the consumer's choice. Forbids discrimination against nonaffiliated agents. To the extent practicable, requires a separate location within the financial institution for sale of insurance. Forbids sales of insurance by unlicensed employees of financial institutions.
Allows the banking board and the commissioner of insurance to adopt rules relating to the sale of insurance by banks, industrial banks, and trust companies. Allows the financial services board and the commissioner of insurance to adopt rules relating to the sale of insurance by savings and loan associations and credit unions.
APPROVED by
Governor April 24, 1997
EFFECTIVE April 24,
1997
H.B. 97-1192 Health insurance - mandatory coverage - biologically based mental illness. Effective January 1, 1998, requires health care policies to provide coverage for the treatment of biologically based mental illness that is no less extensive than the coverage provided for any other physical illness. Defines "biologically based mental illness" to include schizophrenia, schizoaffective disorder, bipolar affective disorder, major depressive disorder, specific obsessive-compulsive disorder, and panic disorder. Specifies that these benefits are not required to the extent that such benefits duplicate other mandated mental illness coverages currently required under Colorado law.
APPROVED by
Governor April 1, 1997
EFFECTIVE January 1,
1998
H.B. 97-1275 Insurers' rehabilitation and liquidation - priority of distribution. Specifies that an annuity issued in connection with funding a structured settlement of liability is a class 2 claim for purposes of distributions of assets of life insurers upon liquidation.
Defines an "insurer's estate" to mean general assets of the insurer less any assets held in separate accounts that are not chargeable with liabilities arising out of any other business of the insurer. Provides that every claim under a separate account contract not chargeable with liabilities arising out of any other business of the insurer shall be satisfied out of the assets in the separate account equal to the reserves and other contract liabilities maintained in the account for such contract.
To the extent that such amounts are insufficient to discharge such a claim due to fraud, error, or malfeasance on the part of the insurer, the unsatisfied claim shall be treated as a class 2 claim against the insurer.
APPROVED by
Governor April 19, 1997
EFFECTIVE August 6,
1997
NOTE: This act was
passed without a safety clause. It shall take effect at 12:01 a.m. on the day following the
expiration of the ninety-day period after final adjournment of the general assembly that is
allowed for submitting a
referendum petition pursuant to article V, section 1 (3) of the state constitution; except that,
if a referendum petition is
filed against this act or an item, section, or part of this act within such period, then the act,
item, section, or part, if
approved by the people, shall take effect on the date of the official declaration of the vote
thereon by proclamation of
the governor.
H.B. 97-1311 Health benefit plans - description form. Requires the commissioner of insurance to develop a Colorado health benefit plan description form, by rule, by November 15, 1997. Requires the form to include information of general interest to purchasers of health plans and to facilitate comparison of different health benefit plans. Requires insurance carriers to provide such description form on request or as part of marketing materials provided to potential health insurance purchasers.
APPROVED by
Governor June 3, 1997
EFFECTIVE June 3, 1997
H.B. 97-1316 Fraud investigations by the attorney general - appropriation. Allows the commissioner of insurance to refer suspected insurance fraud to the attorney general. Requires the notice of insurance fraud penalties statement to be printed on insurance policies or applications for insurance. Increases the maximum fine for making a false insurance entry from $500 to $5000. Increases the maximum fine for testifying falsely in an insurance investigation from $500 to $5000. Grants the attorney general concurrent jurisdiction with the district attorneys to investigate and prosecute insurance fraud. Imposes a $120 fee on each entity regulated by the division of insurance to fund the costs of attorney general investigations and prosecutions.
Makes it an unfair method of competition to:
Makes an appropriation from the division of insurance cash fund to the department of regulatory agencies, division of insurance, of $174,846. Further appropriates such amount and 2.5 FTE to the department of law to implement this act.
APPROVED by
Governor May 27, 1997
EFFECTIVE August 6,
1997
NOTE: This act was
passed without a safety clause. It shall take effect at 12:01 a.m. on the day following the
expiration of the ninety-day period after final adjournment of the general assembly that is
allowed for submitting a
referendum petition pursuant to article V, section 1 (3) of the state constitution; except that,
if a referendum petition is
filed against this act or an item, section, or part of this act within such period, then the act,
item, section, or part, if
approved by the people, shall take effect on the date of the official declaration of the vote
thereon by proclamation of
the governor.
H.B. 97-1323 Health insurance - small group coverage - exemptions - business groups of one. Repeals an existing prohibition on interruptions in coverage and changes in plan design or benefits since January 1, 1996, for insurers that issued individual health insurance policies for self-employed individuals or other "business groups of one" before January 1, 1996, and do not wish to be regulated under provisions applicable to small group carriers. Adopts detailed requirements for continuation of the exemption, including parity of rate increases upon renewal among a carrier's entire book of individual health benefit plans sold to business groups of one, disclosure by the carrier to the purchaser in advance of specified differences between available health insurance options, and certification by the carrier's representative of certain facts pertaining to the marketing and sale of the plan.
APPROVED by
Governor May 21, 1997
EFFECTIVE May 21,
1997
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