§ 10-16-103.4 — Essential health benefits - requirements - rules

Colorado § 10-16-103.4

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

Text

(1) Carriers
offering individual or small group health benefit plans in this state shall ensure that
the coverage includes the essential health benefits package. This subsection (1)
does not apply to grandfathered health benefit plans.

(2) Except as provided in subsection (3) of this section, carriers subject to
subsection (1) of this section shall offer health benefit plans that provide at least
one of the following levels of coverage:

(a) Bronze level. A health benefit plan in the bronze level provides a level of
coverage designed to provide benefits actuarially equivalent to sixty percent of the
full actuarial value of the benefits provided under the plan.

(b) Silver level. A health benefit plan in the silver level provides a level of
coverage designed to provide benefits actuarially equivalent to seventy percent of
the full actuarial value of the benefits provided under the plan.

(c) Gold level. A health benefit plan in the gold level provides a level of
coverage designed to provide benefits actuarially equivalent to eighty percent of
the full actuarial value of the benefits provided under the plan.

(d) Platinum level. A health benefit plan in the platinum level provides a
level of coverage designed to provide benefits actuarially equivalent to ninety
percent of the full actuarial value of the benefits provided under the plan.

(3) A carrier that offers an individual health benefit plan that does not
provide a bronze, silver, gold, or platinum level of coverage, as described in
subsection (2) of this section, meets the requirements of this section with respect
to any policy year if the plan is a catastrophic plan, as defined in section 10-16-102
(10).

(4) If a carrier subject to subsection (1) of this section offers an individual
health benefit plan in any level of coverage specified in subsection (2) of this
section, the carrier shall also offer coverage in that level as child-only coverage.

(5) A carrier subject to subsection (1) of this section shall ensure that the
annual cost-sharing and annual deductible limitations imposed under the health
benefit plan it offers do not exceed the limitations under federal law.

(6) Exclusion. This section does not apply to stand-alone dental plans
offered separately or in conjunction with a health benefit plan.

(7) The commissioner may adopt rules as necessary for the implementation
and administration of this section and to ensure consistent requirements for
pediatric dental benefits under this section regardless of the method by which a
health benefit plan is purchased.

Legislative History

Source: L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 919, � 2, effective May 13. L. 2014: (7) amended, (HB 14-1053), ch. 7, p. 89, � 1, effective February 19.