§ 10-16-413 — Prohibited practices

Colorado § 10-16-413

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

Text

(1) No health maintenance organization, or
representative thereof, may cause or knowingly permit the use of advertising which
is untrue or misleading, solicitation which is untrue or misleading, or any form of
evidence of coverage which is deceptive. For purposes of part 1 of this article and
this part 4:

(a) A statement or item of information is deemed to be untrue if it does not
conform to fact in any respect which is or may be significant to an enrollee of, or
person considering enrollment in, a health-care plan.

(b) A statement or item of information is deemed to be misleading, whether
or not it may be literally untrue, if, in the total context in which such statement is
made or such item of information is communicated, such statement or item of
information may be reasonably understood by a reasonable person not possessing
special knowledge regarding health-care coverage, as indicating any benefit or
advantage or the absence of any exclusion, limitation, or disadvantage of possible
significance to an enrollee of, or person considering enrollment in, a health-care
plan, if such benefit or advantage or absence of limitation, exclusion, or
disadvantage does not in fact exist.

(c) An evidence of coverage is deemed to be deceptive if the evidence of
coverage taken as a whole, and with consideration given to typography and format,
as well as language, shall be such as to cause a reasonable person, not possessing
special knowledge regarding health-care plans and evidences of coverage therefor,
to expect benefits, services, charges, or other advantages which the evidence of
coverage does not provide or which the health-care plan issuing such evidence of
coverage does not regularly make available for enrollees covered under such
evidence of coverage.

(2) Part 11 of article 3 of this title shall apply to health maintenance
organizations, health-care plans, and evidences of coverage except to the extent
that the commissioner determines that the nature of health maintenance
organizations, health-care plans, and evidences of coverage render such article
clearly inapplicable.

(3) An enrollee may not be canceled or nonrenewed on the basis of the
status of such enrollee's health.

(4) No health maintenance organization, unless licensed as an insurer, may
use in its name, contracts, or literature any of the words insurance, casualty,
surety, mutual, or any other words descriptive of the insurance, casualty, or
surety business and shall be distinguishable on the records of the secretary of state
from the name or description of any insurance or surety corporation doing business
in this state.

Legislative History

Source: L. 92: Entire article R&RE, p. 1705, � 1, effective July 1. L. 2000: (4) amended, p. 988, � 104, effective July 1.