S.B. 02-13 Health insurance - prompt payment of claims - uniform claims. Requires the commissioner of insurance, by July 1, 2002, to adopt the claim form adopted by the American dental association for use by all dental providers, the CMS-1500 and the CMS-1450 (Form UB92) as the claim forms to be used by all health care providers and carriers, and to adopt a uniform list of elements to be used on such forms. Requires all insurance carriers, by the effective date of the federal Health Insurance Portability and Accountability Act ("HIPAA") and related regulations pertaining to electronic filing of claims, to require the submission of electronic claim forms in the format required by HIPAA.
Deletes from the definition of "clean claim" the provision that information on the claim form must be in accordance with the carrier's published filing requirements. Specifies that a claim requiring additional information shall not be considered "clean".
Allows a policyholder, insured, or provider to submit a claim by U.S. mail, electronically, by fax, or by hand delivery. Requires a carrier to provide a mechanism to confirm receipt of a claim that is filed in a manner other than electronically and to list the claim on the mechanism as received. Allows the provider to resubmit a claim that is not listed by fax and presume it is received on the date of the fax. Presumes that claims sent electronically are received on the date of electronic verification of receipt by the carrier or carrier's clearinghouse.
Requires a carrier to request additional claim information, including medical information, in writing. Allows a carrier to deny a claim if a provider fails to provide additional information after receiving the request from the carrier.
Allows penalties that are not paid concurrently with the claim to be paid on a quarterly basis or when the aggregate exceeds $10.
Requires any third party to which a carrier has delegated the claims processing functions to comply with all the provisions with which the carrier must comply.
Specifies that the prompt pay provisions of the health care coverage statutes shall not apply to claims filed pursuant to the Workers' Compensation Act.
Requires a carrier to pay a participating institutional provider 85% of the contracted rate on the charges submitted and a nonparticipating institutional provider 60% of the amount due on the claim by the 45th day after the carrier receives the claim if a carrier decides to conduct an audit, and requires the audit to be completed within 90 days.
APPROVED by Governor April 19, 2002
EFFECTIVE April 19, 2002
S.B. 02-76 Insurance - insurance guaranty association - assessment. Increases from 1% to 2% the maximum amount a member insurer may be assessed in any year on any account, based on that member insurer's net direct written premiums for the preceding calendar year on the kinds of insurance in the account.
APPROVED by Governor March 22, 2002
EFFECTIVE March 22, 2002
S.B. 02-78 Life insurance - disability insurance - applications - genetic testing - consent requirement - privacy of test results. Applies consent and privacy conditions to the use of genetic information in connection with the issuance of life insurance and individual disability insurance. Directs the commissioner of insurance to prescribe the form in which consent shall be given. Prohibits the unauthorized release of the results of a genetic test, and allows a person aggrieved by such unauthorized release to sue for actual damages or $10,000 per violation, whichever is greater.
APPROVED by Governor June 1, 2002
EFFECTIVE June 1, 2002
S.B. 02-90 Motor vehicle insurance - continuation. Extends the automatic repeal date provision of the "Colorado Auto Accident Reparations Act" from July 1, 2002, to July 1, 2003.
APPROVED by Governor May 28, 2002
EFFECTIVE May 28, 2002
S.B. 02-107 Unfair practices - denial of coverage - nonprofessional participation in sports - skiing - snowboarding. For all policies issued or renewed on or after January 1, 2003, defines as an unfair method of competition and an unfair or deceptive act or practice in the business of insurance the denial of health care coverage to any individual, or the exclusion of medical benefits under health care coverage to any covered individual, based solely on that individual's casual or nonprofessional participation in skiing or snowboarding.
APPROVED by Governor March 22, 2002
EFFECTIVE March 22, 2002
S.B. 02-146 Medicare supplement insurance - premiums - refund in case of cancellation. Requires insurers to refund prepaid premiums for Medicare supplement insurance policies after 30 days of coverage at a prorated amount. Such refund is based on the subsequent full months of coverage being cancelled when the policyholder or certificate holder provides 30 days' notice of cancellation to the insurer.
APPROVED by Governor April 18, 2002
EFFECTIVE January 1, 2003
S.B. 02-188 Health insurance - uniform prescription drug cards. Requires all health benefit plans with prescription drug benefits to issue to the named insured, upon issuance of a health benefit plan and when there is a change of coverage to the insured, a prescription card containing uniform information. Exempts from this requirement the children's basic health plan and health maintenance organizations that supply benefits to plan subscribers through an in-house drug or pharmacy outlet.
APPROVED by Governor June 7, 2002
EFFECTIVE January 1, 2003
H.B. 02-1003 Health insurance - small employer groups - health maintenance organizations - excess loss insurance minimum - direct contracting for Medicaid - disease management - encouragement of nursing education - public-private partnership for education and information concerning the nursing shortage - health care systems interim committee - Medicaid waivers - statewide pilot program for state employee benefits. Clarifies the definition of "small employer" to address instances when only one employee is enrolled in the group health benefit plan for the small employer. Requires the commissioner of the division of insurance (commissioner) to promulgate a rule concerning the documentation that may be required by a small employer carrier to substantiate that a business group of one meets the requirement of working at least 24 hours per week. Requires the commissioner to promulgate a rule concerning geographic areas that may be considered case characteristics.
Modifies the statutory authority of the commissioner for rules governing the design of the standard and basic health benefit plan that must be offered by a small employer carrier. Allows the basic health benefit plan to be:
Clarifies when an individual health benefit plan may be considered creditable coverage for the purpose of minimum participation requirements for small employer group health benefit coverage. Allows a health benefit plan issued to a business group of one to exclude, deny coverage for, or limit benefits for losses incurred for preexisting conditions up to 12 months after the date of enrollment of the individual in such plan. Excludes short-term limited duration health benefit policies from being considered an individual health benefit plan for the purposes of eligibility for small group health insurance.
Allows a health maintenance organization to offer coverage outside of its service area. Requires disclosure to consumers concerning service area. Allows for balance billing in certain circumstances. Provides an exemption for person who are so severely disabled that reasonable travel would be a hardship. Changes the standard for seeking covered emergency care for enrollees within an HMO to a prudent lay person standard. Allows an HMO to use deductible amounts as a cost-sharing mechanism in addition to copayments.
Increases the amount of excess loss coverage of a self-insured employer from $10,000 to $15,000 per person enrolled in the health benefit plan on and after January 1, 2003.
Requires that advance practice nurses who work in a rural area and who are not practicing under the supervision of a physician, not be discriminated against when establishing reimbursement rates for covered services that could be provided by an advance practice nurse or a physician.
Requires a carrier that discontinues coverage from a market segment, but not from the Colorado market in general, to continue coverage through the first renewal period after the 6-month notice period not to exceed 12 months. Allows a health insurance carrier to cross state lines to comply with existing requirements for network adequacy. Restricts which out-of-state health care providers may contract with a carrier.
Allows the department of health care policy and financing (the department) to contract directly with health care providers for the purposes of Medicaid. Sets out criteria for such direct contracting. Allows the department of create and implement disease management programs for Medicaid recipients to address over- and under-utilization or the inappropriate use of services or prescription drugs. Allows the department to apply for waivers to the federal government for the Medicaid program to enhance flexibility and cost-effectiveness of the Medicaid program.
Encourages the consortium work force investment board and the department of labor and employment to inform eligible individuals of the educational opportunities in practical nursing. Creates a public and private partnership for education and information concerning the nursing shortage. Requires the commission on higher education to evaluate and implement 2-year educational programs for professional registered nurses.
Creates an interim committee to evaluate health care systems. Sets out the composition of the interim committee, required number of meetings, and areas of evaluation by the interim committee.
Allows the director of the department of personnel to develop and implement a statewide pilot program concerning health benefits for state employees.
Makes certain sections related to short-term limited duration health benefit policies of this act contingent upon the enactment of House Bill 02-1136.
APPROVED by Governor June 7,
2002
PORTIONS EFFECTIVE June
7, 2002; January 1, 2003
NOTE: Final action by the General Assembly was not taken on House Bill 02-1136 and the bill is deemed lost.
H.B. 02-1005 Prohibited policy changes - failure to comply with child support order. Prohibits an insurer from cancelling, failing to renew, refusing to write, reclassifying an insured under, reducing coverage under, or increasing a premium on an insurance policy because the applicant for insurance, the insured, or any resident of the household of the applicant or the insured, has had his or her driver's license suspended for failing to comply with a child support order.
APPROVED by Governor March 13, 2002
EFFECTIVE August 7, 2002
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi
of this digest.
H.B. 02-1013 Small employer group health insurance - definitions - preexisting conditions. Clarifies that a small employer that enrolls only one employee in a group health benefit plan must provide documentation to the small employer carrier that the small employer employed at least 2 or more individuals in the period covered by its 2 most recent quarterly employment and tax statements so as not to be considered a business group of one.
Requires the commissioner of insurance to promulgate a rule concerning what documentation satisfies the requirement that a business group of one has worked 24 hours per week.
Allows a health benefit plan issued to a business group of one to exclude, deny coverage for, or limit benefits for losses incurred for preexisting conditions up to 12 months after the date of enrollment of the individual in such plan.
APPROVED by Governor June 7, 2002
EFFECTIVE January 1, 2003
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi
of this digest.
H.B. 02-1050 Motor vehicle insurance - no-fault - personal injury protection - premiums - required disclosures. Requires an auto insurance carrier to provide a statement of the cost savings if the insured opts for managed care. Clarifies that the cost savings may be expressed either as a dollar savings on the personal injury protection policy term premium or as a percentage of the premium. Requires an auto insurance carrier to add to the managed care disclosure form an acknowledgment, in capitalized or underlined type, that the managed care provision is optional coverage and that the insured understands that the discount for the managed care option only applies to the personal injury protection portion of the insured's premium. Removes other typeface requirements for the managed care disclosure form.
APPROVED by Governor April 19, 2002
EFFECTIVE January 1, 2003
H.B. 02-1121 Motor vehicle insurance - no-fault - disclosure of terms to insureds - when required. Authorizes an insurer to provide the required explanations of all available motor vehicle insurance coverages upon or after the issuance of the binder.
APPROVED by Governor March 26, 2002
EFFECTIVE August 7, 2002
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi
of this digest.
H.B. 02-1158 Life and health insurance protection association - succession to rights of insolvent insurer - conditions - payment of premiums due. Specifies that, with respect to covered insurance policies of a member insurer for which the life and health insurance protection association (association) has become responsible, the association may elect to succeed to the rights of the insolvent member insurer under a reinsurance contract if the association pays unpaid premiums due with respect to policies covered by the association both before and after the date of the order of liquidation.
APPROVED by Governor March 26, 2002
EFFECTIVE March 26, 2002
H.B. 02-1164 Health insurance - small group coverage - plan options. Makes legislative findings. Increases the types of health insurance products to be offered by a small employer carrier to small employer groups. Choices include a high-deductible plan that may be a traditional indemnity plan, a preferred provider plan, a health maintenance organization plan, or a point of service plan. Allows these additional high-deductible plans to be offered in conjunction with a medical savings account. Requires a small employer carrier to provide disclosure concerning the deductible amount and the policies related to copayments, deductibles, and cost-sharing arrangements.
APPROVED by Governor April 19, 2002
EFFECTIVE January 1, 2003
H.B. 02-1220 Mandated coverage - hearing aids - children - appropriation. Declares that hearing loss may contribute to the impairment of early language development in children. Mandates that insurance providers cover hearing aids for minor children when medically appropriate. Includes a new hearing aid every 5 years, or when needed, and services and supplies for such hearing aid in such mandated coverage. Requires that such coverage shall be provided with the same annual deductible or copayment established for all other covered benefits within the insured's policy.
Authorizes the carrier to require that services be provided by an appropriate experienced audiologist who is affiliated with the carrier prior to covering the hearing aids. Subjects such coverage to utilization review.
Appropriates $1,728 to the department of health care policy and financing, indigent care program, children's basic health premiums, for implementation of this act.
VETOED by Governor May 24, 2002
H.B. 02-1305 Motor vehicle insurance - personal injury protection - criminal abuse. Adds automobile personal injury protection insurance to the list of types of insurance subject to the criminal prohibition on abuse of health insurance.
APPROVED by Governor April 25, 2002
EFFECTIVE April 25, 2002
H.B. 02-1353 Managed care plans - adjustments to health care claims. Requires that adjustments to health care claims be made within 12 months after the date of the original explanation of benefits except in the case of adjustments to claims paid under a risk assumption or risk sharing agreement, which must be made within 6 months after the last date of service. Requires adjustments to claims related to coordination of benefits with federally funded health plans to be made within 36 months after the date of service. Prohibits retroactive adjustment of claims based on eligibility for coverage if the health care provider (provider) received eligibility verification within 2 business days prior to delivery of service.
Allows a health coverage carrier (carrier) to report to a provider that eligibility for health care coverage is contingent upon payment of a premium. If a carrier makes such a report, requires the carrier to provide an electronic or written mechanism that verifies coverage or to institute a policy prohibiting adjustments to claims unless the carrier can prove that the enrollee never appeared as eligible for coverage to the provider on any verification mechanism. Requires each carrier to provide one or more mechanisms by which a provider can determine if a person is covered by such carrier.
Allows a provider to collect payment from the enrollee if the enrollee's coverage is terminated for non-payment of a premium. Allows a carrier to require an enrollee to reimburse the carrier for claims paid if the enrollee is ineligible for coverage on the date of service or if the enrollee has committed fraud or material misrepresentation. Prohibits the retroactive adjustment of a claim based on eligibility if the provision of benefits occurs within a statutorily required grace period.
Requires any adjustment by a carrier to recover an overpayment to include a written explanation of the adjustment and an explanation of the dispute resolution process or appeals procedure. Requires the explanation to be provided to the provider and the enrollee as applicable. For claims adjusted due to coordination of benefits, upon request of the provider, requires the carrier to provide an explanation as to who is responsible for payment of the claim.
Requires every contract between a carrier and a policyholder to contain a provision explaining the policyholder's requirement to pay premiums through the date of notification to the carrier that an individual on the policy will no longer be covered or the date of cancellation of a group policy.
Exempts fraudulent insurance claims from the requirements of this act. Clarifies that the provisions of this act regarding retroactive adjustment of a claim apply only to managed care plans.
APPROVED by Governor May 30, 2002
EFFECTIVE January 1, 2003
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi
of this digest.
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