§ 10-16-1002 — Definitions

Colorado § 10-16-1002

• Jurisdiction: Colorado
• Title 10: Insurance
• Art.: Health-care Coverage

Text

As used in this part 10, unless the context otherwise
requires:

(1) Repealed.

(2) Cooperative or health-care coverage cooperative means a health-care
coverage cooperative created pursuant to this part 10 as an entity that provides to
its members health coverage and health-care purchasing services, including but
not limited to detailed information on comparative prices, usage, outcomes, quality,
and member satisfaction with provider networks. Cooperative does not include a
cooperative association organized without capital stock in accordance with article
55 of title 7, C.R.S., that is subject to articles 121 to 137 of title 7, C.R.S., and that
had filed articles of incorporation with the secretary of state on or before March 15,
1991.

(3) Health information has the same meaning as medical information, as
set forth in section 18-4-412 (2)(b), C.R.S. Health information also includes
information that relates to the past, present, or future physical or mental health of
the member and its eligible employees and to payment for the provision of health
care to the member and its eligible employees.

(4) Licensed provider network shall have the same meaning as in section 6-18-301.5 (1), C.R.S.

(5) Managed care has the same meaning as managed care plan, as
defined in section 10-16-102 (43).

(6) (a) Member means any public or private employer that has employees
covered for health benefits through a cooperative.

(b) If, pursuant to section 10-16-1009 (3)(l), a cooperative provides coverage
to individuals and allows individuals to join the cooperative, member may also
include an individual who is covered by a plan purchased through a cooperative and
any dependent of the individual, including a dependent child who is under twenty-six years of age.

(6.5) Member class means the class of member based on whether the
member would qualify for coverage in the individual market, the small employer
fully insured market, the large employer fully insured market, or the employer self-insured market.

(7) Person with financial interest in the cooperative's business means one
of the following or an immediate family member of one of the following:

(a) A health-care provider who is contracting or attempting to contract,
directly or indirectly, with the cooperative;

(b) An individual who is an employee or member of the board of directors of,
has a substantial ownership interest in, or derives substantial income from an entity
or person that is contracting or attempting to contract, directly or indirectly, with
the cooperative; or

(c) An employee of an association, law firm, or other institution or
organization that represents the interests of one or more entities or persons that
are contracting or attempting to contract, directly or indirectly, with the
cooperative.

(8) Provider network means a group of health-care providers formed to
provide health-care services to individuals.

(9) Purchaser means an individual, an organization, or a governmental
entity that makes health benefit purchasing decisions on behalf of a group of
individuals.

(9.5) Self-insured means not insured under a plan underwritten by a
carrier.

(10) Utilization management means programs designed to assure
appropriate utilization of health services relative to established standards or norms.

(11) Repealed.

Legislative History

Source: L. 2004: Entire part added, p. 993, � 14, effective August 4. L. 2013: (5) amended, (HB 13-1266), ch. 217, p. 989, � 52, effective May 13. L. 2019: (1) and (11) repealed, (5) and (6)(b) amended, and (6.5) added, (SB 19-004), ch. 205, p. 2190, � 3, effective August 2. L. 2025: (9.5) added, (SB 25-275), ch. 377, p. 2038, � 46, effective August 6.