Insurance - Digest of Bills

Digest of Bills - 2008

INSURANCE

S.B. 08-11 Automobile insurance - medical payments coverage required - option to reject coverage - scope of coverage - providers eligible for payment - priority of payments to trauma care providers - reserve requirement - subrogation prohibited - exemptions from medical payments coverage - appropriation. Requires automobile insurance policies issued, delivered, or renewed in the state on or after January 1, 2009, to contain coverage for medical payments with benefits of $5,000 for bodily injury, sickness, or disease arising from the ownership, maintenance, or use of a motor vehicle. Allows the named insured under an automobile insurance policy to reject medical payments coverage, in which case the insurer is required to maintain proof of such coverage rejection for at least 3 years after the date of the rejection. Protects an insurance agent or insurer that obtains a rejection of medical payments coverage from liability to any person thereafter seeking medical payments coverage under the policy.

Establishes a presumption that $5,000 in medical payments coverage is contained in an automobile insurance policy if the insurer fails to offer the coverage to the insured or fails to maintain proof of rejection of the coverage. Preserves the ability of an insured to purchase medical payments coverage in excess of $5,000.

Specifies that medical payments coverage benefits are payable to persons providing medically necessary and accident-related trauma care or medical care to a person injured in an automobile accident. Includes the following as "providers" to whom medical payments benefits are payable:

● Licensed ambulances;

● Licensed air ambulances;

● Trauma physicians, which include trauma surgeons, orthopedic surgeons, neurosurgeons, intensive care unit physicians, anesthesiologists, or other physicians providing trauma care to an injured person;

● Trauma centers, which include the emergency department in a licensed or certified hospital or a health care facility that is designated by the department of public health and environment as a level I, II, III, IV, or V facility or as a regional pediatric trauma center; and

● Licensed health care providers, which include licensed or certified hospitals, health care facilities, or dispensaries, persons licensed or certified to practice medicine, osteopathy, chiropractic, nursing, physical therapy, podiatry, dentistry, pharmacy, acupuncture, or optometry, and occupational therapists.

Requires an insurer, upon receipt of notice of an accident for which medical payments coverage may be claimed, to reserve $5,000 of the medical payments coverage for the payment of trauma care providers that provided trauma care to the injured person in the following priority, as applicable:

● Payment is to be made first to licensed ambulances and licensed air ambulances that provide trauma care at the scene of or immediately after the accident, including transport to or from a trauma center;

● Payment is to be made next to trauma physicians who provide trauma care to stabilize or provide the first episode of care to the injured person;

● Payment is to be made next to level IV or V trauma centers that provide trauma care to stabilize or provide the first episode of care to the injured person;

● Payment is to be made next to level I, II, or III trauma centers or a regional pediatric trauma center that provide trauma care to stabilize or provide the first episode of care to the injured person.

Obligates insurers to maintain the reserve for 30 days to pay claims made by trauma care providers submitted during that 30-day period. After the 30-day period, requires the insurer to use any remaining amount of the reserve for the payment of claims made by all providers that provided trauma care or medical care to the injured person. During the 30-day period, suspends the prompt payment of claims requirements, but only to the extent the medical payments coverage benefits not held in reserve are insufficient to pay a claim submitted by a provider during that period.

Precludes the ability of an insurer to recover from the person at fault for the automobile accident any amount of medical payments coverage benefits paid under an automobile policy and the ability of the insurer to bring a direct cause of action against the alleged at-fault party for recovery of benefits paid under medical payments coverage.

Exempts self-insurers, motorcycles, motorscooters, motorbicycles, motorized bicycles, toy vehicles, snowmobiles, and any vehicle designed primarily for use off the road or on rails from the requirements of the act. Defines terms.

Appropriates $10,848 and 0.2 FTE to the division of insurance from the division of insurance cash fund for the implementation of the act.

APPROVED by Governor June 5, 2008
EFFECTIVE January 1, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 08-57 Health insurance - mandatory coverage provisions - hearing aids for children - appropriation. Finds that providing hearing aids to hearing-impaired children will improve the language development of such children. Declares that providing hearing aids to such children will reduce the costs borne by the state in connection with providing special education and other costs associated with such hearing loss.

Requires insurance providers to cover hearing aids for minor children when medically appropriate. Requires the coverage to include a new hearing aid not more frequently than every 5 years, a new hearing aid when alterations to the existing hearing aid cannot meet the needs of the child, and services and supplies such as the initial assessment, fitting, adjustments, and auditory training. Requires that coverage be provided with the same annual deductible or copayment established for all other covered benefits within the insured's policy.

Appropriates $19,000 to the department of health care policy and financing, indigent care program, for children's basic health plan premium costs from the children's basic health plan trust for the implementation of the act. Specifies the department is expected to receive an additional $35,300 in federal funds for the implementation of the act.

APPROVED by Governor June 3, 2008
EFFECTIVE January 1, 2009

S.B. 08-110 Commissioner of insurance - authority to adopt rules - frequency of automobile insurance premium payments - small group health benefit plans. Allows the commissioner of insurance (commissioner) to adopt rules establishing monthly premium payments, in addition to quarterly, semiannual, and annual premium payments, for insureds under an automobile insurance policy.

Allows the commissioner to amend the rules implementing the basic and standard health benefit plans offered in the small group market as often as necessary.

Deletes an error in an internal statutory citation.

APPROVED by Governor April 10, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

S.B. 08-135 Health benefit plans - standardized cards - electronic access to coverage and benefit information - work group - rules - appropriations. Requires the commissioner of insurance (commissioner) to adopt, by October 31, 2008, initial rules requiring every health insurance carrier providing a health benefit plan in the state to issue, to covered persons to whom a health benefit plan identification card is issued, a standardized, printed card containing plan information. Specifies that the rules establishing the card format are to include a standard size for the cards, are to require the card to be legible and capable of photocopying, and are to delineate the information to be contained on the card, including at least the following information, as applicable:

● The covered person's name and applicable plan number;

● Copayment and deductible amounts for the most commonly used health care services;

● Contact information for the carrier or plan administrator; and

● An indication of whether the plan is regulated by the state.

Requires carriers to issue the standardized cards upon the purchase or renewal of or enrollment in a plan on or after July 1, 2009, and, by July 1, 2010, to issue standardized cards to all covered persons to whom identification cards are issued.

Requires the commissioner, in consultation with the director of the division of registrations in the department of regulatory agencies and the executive director of the department of public health and environment, to establish a work group consisting of representatives from the divisions of insurance and registrations in the department of regulatory agencies; the departments of public health and environment, personnel, and health care policy and financing; the governor's office of information technology; carriers; health care providers; private businesses; consumers; and other appropriate stakeholders. Charges the work group with making recommendations regarding the following:

● Standards for technology and tools through which information concerning health benefit plans may be electronically recognized, exchanged, or transmitted between carriers and providers;

● Specific information that such technology and tools should be able to electronically exchange or transmit;

● Simplifying eligibility and coverage verification through electronic data interchange using swipe card or other appropriate technology;

● Eligibility notification, preauthorization, or service notification and retroactive denial through electronic data interchange using swipe card or other appropriate technology;

● How to incorporate uniform prescription drug information cards as part of the technology and tools for electronically recognizing, exchanging, or transmitting information between carriers and providers;

● Whether standardized, printed cards are necessary once electronic data interchange technology and tools are fully implemented and, if so, what information needs to be included on printed cards;

● When such technology could be implemented for medicaid; and

● Creation of a pilot program for initial use of the recommended technology and tools, if the work group so chooses.

Requires the work group to report its recommendations within 6 months after its first meeting and allows for an extension of time of up to an additional 6 months if the work group is unable to timely complete its tasks. Requires the commissioner, upon receipt of the work group's recommendations, to adopt rules to implement the standardized technology to be used by carriers, providers, and covered persons no later than 2 years after the effective date of the rules. Allows a 6-month extension for full implementation if the work group finds that carriers cannot meet the original deadline. Requires the commissioner to update the rules, as necessary, to reflect the most current technology available.

Requires hospitals and physicians to use the standardized cards and technology to access information about coverage available to covered persons and children's basic health plan enrollees to whom health care services are provided. Allows carriers and providers located in rural areas of the state to apply for an extension of any of the deadlines established in the act if meeting the deadline imposes a financial hardship on the rural carrier or provider.

Appropriates $12,928 to the department of regulatory agencies, for allocation to the division of insurance, for the implementation of this act.

APPROVED by Governor June 3, 2008
EFFECTIVE June 3, 2008

S.B. 08-203 Blue ribbon commission for health care reform - repeal. Repeals the blue ribbon commission for health care reform, created in Senate Bill 06-208, on July 1, 2008. Specifies that any moneys remaining in the health care reform cash fund on June 30, 2008, shall be transferred to the general fund, and abolishes the cash fund effective July 1, 2008.

APPROVED by Governor May 14, 2008
EFFECTIVE May 14, 2008

S.B. 08-207 Insurance producers - licenses - applications - collection of statistical data. Requires an application for an insurance producer examination to request demographic information from each applicant and to specify that an applicant does not have to provide information concerning gender, native language, or race or ethnicity. Directs the commissioner of insurance to annually prepare and publish a report regarding the demographic information gathered from the application.

APPROVED by Governor May 28, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1043 Consumer insurance council - creation - advisory body to commissioner of insurance. Codifies the existing consumer insurance council within the division of insurance to operate as an advisory body to the commissioner of insurance concerning matters of interest to the public. Authorizes the commissioner to appoint up to 15 members to the council to serve 2-year terms. Requires the members to be representatives of consumers. Authorizes the council to meet no more than 8 times per year, with regular meetings held at the office of the division. Allows the chair of the council and the commissioner to remove a person from the council who has 3 or more unexcused absences. Requires the council to elect a chair and a vice-chair to serve one-year terms. Repeals the council in 2018.

APPROVED by Governor March 24, 2008
EFFECTIVE July 1, 2008

H.B. 08-1060 Health insurance - participating provider determinations - advanced practice nurses. Beginning in 2009, requires carriers that provide health benefit plans to use objective and reasonable criteria, and to consider the provider-to-covered-person ratio for the covered benefits that may be provided by an advanced practice nurse, when evaluating an application for status as a participating provider submitted by an advanced practice nurse. Specifies that the carrier is to make the determination on the advanced practice nurse's participating provider application, and notify the applicant of its determination, within the same period in which the carrier makes a participating provider determination for physicians. When an application is denied, requires the carrier to notify the advanced practice nurse of the reason for the denial. When an application is approved, requires the carrier to include the advanced practice nurse in the provider directory for the health benefit plan.

APPROVED by Governor March 20, 2008
EFFECTIVE January 1, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1087 Denial of health insurance benefits - first-level appeal - dental care. Allows the first-level appeal in the case of dental care to be evaluated by a dentist, who must consult with an appropriate clinical peer, unless the reviewing dentist is a clinical peer. Allows a licensed dentist familiar with standards of care in Colorado to sign a written denial of request for covered benefits for dental care.

APPROVED by Governor March 18, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1131 Mergers of insurers - procedures for approval by commissioner - investigation - report. Requires the commissioner of insurance (commissioner) to conduct an independent investigation to determine the impact on competition when a proposed merger involves a domestic entity or a domestic insurer. Requires the investigation to include an analysis of the probable effects on consumers and on suppliers of services. Requires the commissioner to issue a public report on his or her findings within a certain period after the filing of the insurers' statements regarding the proposed merger. Specifies that all data and reports pertaining to the proposed merger and collected or used by the commissioner in his or her investigation and analysis shall be made available to the public, and sets forth the procedures and time frames for such independent investigation and for public hearings. Specifies that, if the procedures set forth in the act are not followed, an aggrieved party may seek remedies.

APPROVED by Governor April 25, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1213 Insurance producers - continuation of licensing by division of insurance - crop hail lines of authority - registration of similar names - cooling-off period after license revocation or surrender. Continues the functions of the division of insurance (division) relating to the licensing of insurance producers until July 1, 2019. Allows insurance producers to obtain new crop hail lines of authority. Eliminates the requirement that the commissioner of insurance reject the registration of any insurance producer whose name is similar to that of another registered insurance producer. Precludes an insurance producer whose license has been revoked or surrendered to avoid discipline from applying for a new license for 2 years after the revocation or surrender.

APPROVED by Governor March 26, 2008
EFFECTIVE March 26, 2008

H.B. 08-1228 Unfair business practice in the business of insurance - financial responsibility - restitution. Authorizes the commissioner of insurance to collect restitution from insurance producers and insurance companies for wrongful acts. Requires an insurer to be financially responsible for the unfair business practices of an insurance producer authorized to sell a product or plan of the insurer, if the insurer knew or should have known about the unfair business practices.

APPROVED by Governor April 21, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1309 CoverColorado program - funding - assessments on carriers - task force. Continues the assessments imposed upon health insurance carriers to fund the CoverColorado program (program) and removes the repeal of the assessment. Creates the CoverColorado long-term funding task force to develop and submit a plan to the general assembly by March 31, 2009, regarding funding for the program for the next 10 years. In developing the funding plan, requires the task force to consider at least the following:

● The anticipated enrollment growth;

● The long-term viability of current funding structure;

● Increasing the premium tax credit for donations to the program;

● Revising the methodology, administration, and collection of the assessment imposed on carriers; and

● Reducing program claims costs by modifying benefit designs, implementing a provider fee schedule, imposing an enrollment limit, or other cost-containment measures.

APPROVED by Governor May 1, 2008
EFFECTIVE May 1, 2008

H.B. 08-1334 Group sickness and accident insurance - emergency service providers authorized to contract for coverage of bona fide volunteers. Authorizes emergency service providers to enter into group health insurance contracts with carriers for the purpose of providing insurance to bona fide volunteers who are active and in good standing. Allows the governing body of each emergency service provider the discretion to negotiate the details related to the procurement and administration of the insurance contracts. Specifies that bona fide volunteers and emergency service providers fall within the purview of existing group sickness and accident insurance law.

APPROVED by Governor April 21, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1385 Consumer guide to health insurance web site - financial disclosure by insurance producers - appropriation. Finds that providing reliable cost and quality information about health care insurance empowers consumer choice. Requires the commissioner of insurance to maintain a web site that displays a consumer guide on insurance information provided to the division of insurance by health insurance carriers. Creates an exception for information that is proprietary pursuant to Colorado open records laws. Requires insurance producers to disclose financial information to consumers.

Appropriates $8,774 to the division of insurance from the division of insurance cash fund for the implementation of the act.

APPROVED by Governor June 3, 2008
EFFECTIVE January 1, 2009
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1389 Health insurance - approval of insurance rate increases prior to implementation - penalties for false reporting - report of cost and financial information required - consumers' choice award - appropriation. Requires each insurance carrier to file with the commissioner of insurance (commissioner) a detailed description of its rating and renewal practices for health insurance. Makes all such information public when filed, unless it is determined to be confidential.

Requires each carrier to file annually with the commissioner the number of lives insured in the previous year. Requires requested rate filing increases for health insurance to be submitted to the commissioner at least 60 days prior to the proposed implementation date. Allows the rates to be implemented if the commissioner does not approve or disapprove the rates within a 60-day period. Allows the commissioner to disapprove the rates upon later review. Requires the commissioner to disapprove the rates for health insurance if certain conditions apply.

Prohibits persons from knowingly withholding information that will affect rates or premiums charged or from giving false or misleading information. Creates penalties for violations.

Requires each carrier to report specific cost and financial information to the commissioner annually. Directs the commissioner to aggregate the data submitted, publish it on the division of insurance's web site, and report annually to the general assembly on the costs of health care and financial information on carriers.

Allows the consumer insurance council to issue an annual consumers' choice award.

Applies the act to insurance rates that take effect on or after January 1, 2009.

Appropriates $309,985 and 4.5 FTE to the department of regulatory agencies for allocation to the division of insurance from the division of insurance cash fund.

APPROVED by Governor June 5, 2008
PORTIONS EFFECTIVE June 5, 2008
PORTIONS EFFECTIVE July 1, 2008

H.B. 08-1390 CoverColorado program - funding allocation - required carrier assessments - supplemental transfers from unclaimed property trust fund - long-term funding plan. Allows the board of directors (board) of the CoverColorado program (program) to establish the period of service of the carrier selected to administer the program.

Establishes the following percentages of total funding for the program from the various sources of funding for the program:

● 25% from the unclaimed property trust fund;

● Up to 25% from special fees assessed against insurers; and

● 50% from premiums, grants, donations, and other available funds.

If, in a given calendar year, the program enrollment or claims expenses exceed projected enrollment or claims expenses by more than 115% and the program's losses exceed projected losses, requires the board to report the amount of excess losses to the state treasurer, who is to make a supplemental transmittal from the unclaimed property trust fund to cover the excess losses of the program.

Effective January 1, 2009, requires, rather than allows, the program to assess special fees against insurers, and allows the board to determine the amount of the special fees so as to provide the necessary percentage of total funding for the program. Eliminates the repeal of the assessments.

Repeals the funding structure for the CoverColorado program on July 1, 2017, and requires the state auditor, prior to the repeal, to review and evaluate the efficacy of the funding structure and submit a report and recommendations to the general assembly by January 1, 2017, regarding the funding structure.

Establishes the CoverColorado long-term funding task force to develop and submit a plan to the general assembly by March 31, 2009, for funding the program in the future.

APPROVED by Governor May 27, 2008
EFFECTIVE July 1, 2008

H.B. 08-1407 Insurance carriers - penalties imposed by commissioner of insurance - unreasonable delay or denial of insurance claim - cause of action created - remedies - appropriation. Increases the penalties that the commissioner of insurance may impose for the violation of any law, rule, or order of the commissioner. Prohibits an insurer from unreasonably delaying or denying a claim for payment of benefits by a claimant. Creates a cause of action for a claimant who is unreasonably denied insurance benefits. Allows a claimant to recover reasonable attorney fees, court costs, and 2 times the amount of the covered benefit. Exempts workers' compensation, life, and title insurance. If an insurer denies a health insurance claim pursuant to the prompt pay laws and the denial is determined to be unreasonable, requires a penalty to be paid to the insured.

Decreases the appropriation to the department of health care policy and financing, division of medical services premiums, for medical services premiums by $277,780.

APPROVED by Governor June 4, 2008
EFFECTIVE August 5, 2008
NOTE: This act was passed without a safety clause. For further explanation concerning the effective date, see page vi of this digest.

H.B. 08-1410 Health insurance - mandated coverage - colorectal cancer screening - consideration by commission on mandated health insurance benefits. Requires most health insurance plans to cover colorectal cancer screening. Specifies that the mandated coverage is not subject to policy deductibles, but that copayments and coinsurance may apply. Limits cost sharing to 10% of the cost of the screening for health maintenance organizations that directly provide health care services to their enrollees. Exempts small group basic health plans other than the high-deductible plan from the requirements of the act. Specifies that the substantive portions of the act take effect only if the commission on mandated health insurance benefits either twice fails to reach a quorum to consider the mandated coverage or concludes that the benefits of the mandated coverage outweigh its harms.

States that certain provisions of the act shall take effect only if the commission on mandated health insurance benefits twice fails to reach a quorum to consider the mandated health insurance coverage established by section 10-16-104 (18) or concludes that the benefits of the mandated health insurance coverage established by section 10-16-104 (18) outweigh its harms.

APPROVED by Governor June 3, 2008
EFFECTIVE June 3, 2008