§ 10-16-105.2 — Small employer health insurance availability program

Colorado § 10-16-105.2

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

Text

(1) (a)
Except as provided in paragraphs (b) and (d) of this subsection (1), this article
applies to any health benefit plan that provides coverage to the employees of a
small employer in this state if any of the following conditions are met:

(I) Any portion of the premium or benefit is paid by or on behalf of a small
employer;

(II) An eligible employee or dependent is reimbursed, whether through wage
adjustments or otherwise, by or on behalf of a small employer for any portion of the
premium;

(III) The health benefit plan is treated by the employer or any of the eligible
employees or dependents as part of a plan or program for the purposes of section
106, 125, or 162 of the federal Internal Revenue Code of 1986, as amended, except
as provided in paragraph (d) of this subsection (1); or

(IV) The plan is marketed to individual employees through an employer or at
a place of business, except as otherwise allowed by rule. The division of insurance
shall promulgate a rule to allow, with the permission of or at the request of the
employer:

(A) Agents to market health benefit plans through an employer or at an
employer's place of business to such employer's ineligible employees;

(B) Small employer carriers to market individual health benefit plans through
an employer or at an employer's place of business to such employer's ineligible
employees and to dependents of eligible employees when the carrier has group
coverage in place with the employer.

(b) The provisions of this article shall not apply to a multiple employer health
trust, as set forth in section 10-3-903.5 (7)(b), or a multiple employer welfare
arrangement, as set forth in section 10-3-903.5 (7)(c).

(c) Repealed.

(d) A plan shall not be subject to the small group provisions of this article if
the premium for the plan is paid for through a section 125 plan or program of the
federal Internal Revenue Code of 1986, as amended, the employer makes no
contribution to the section 125 plan or program, the employer does not have in
place an employer-sponsored health benefit plan, and the employer does not pay
for any portion of the premium or benefit paid.

(1.5) Notwithstanding any other provision of law, a small employer that does
not have, and has not had in the previous twelve months, a small group health
benefit plan providing coverage to its employees under this article may reimburse
an employee, whether through wage adjustments or health reimbursement
arrangements, for any portion of the premium for a health coverage plan.

(2) (a) Except as provided in paragraph (b) of this subsection (2), carriers that
are affiliated companies or that are eligible to file a consolidated tax return shall be
treated as one carrier and any restrictions or limitations imposed by this article
shall apply as if all health benefit plans delivered or issued for delivery to small
employers in this state by such affiliated carriers were issued by one carrier.

(b) An affiliated carrier that is a health maintenance organization having a
certificate of authority under this article may be considered to be a separate carrier
for purposes of this subsection (2).

(c) Part 7 of article 3 of this title applies if a small employer carrier cedes or
assumes all of the insurance obligation or risk with respect to one or more health
benefit plans delivered or issued for delivery to small employers in this state.

(3) and (4) Repealed.

Legislative History

Source: L. 2004: Entire section added, p. 986, � 6, effective August 4; (1)(c)(I)(A) amended, p. 1214, � 109, effective August 4. L. 2011: (1.5) added, (SB 11-019), ch. 78, p. 214, � 1, effective March 29. L. 2013: IP(1)(a) amended and (1)(c), (3), and (4) repealed, (HB 13-1266), ch. 217, p. 933, � 8, effective May 13. L. 2014: (2)(c) amended, (HB 14-1315), ch. 295, p. 1218, � 8, effective January 1, 2015.