NFP
Skip to Content

Compliance Corner

State Updates

State Insurance Exchange Special Enrollment Period Extended

April 13, 2021

In response to the extension of the special enrollment period (SEP) in the federal marketplace exchange, the state’s health insurance marketplace (Connect for Health Colorado) has extended its special open enrollment period to August 15, 2021.

While the creation of the SEP will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the SEP. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace. Unless future legislation or guidance indicates otherwise, applicable large employers are still required to offer full-time employees minimum value coverage satisfying one of the affordability safe harbors.

Connect for Health Colorado Press Release »

Emergency Regulation Requires Coverage of COVID-19 Treatment without Cost Sharing

March 30, 2021

Effective March 23, 2021, the Division of Insurance issued Emergency Regulation 21-E-06, which requires carriers regulated by the state to provide persons covered by their healthcare policies with COVID-19 treatments and vaccinations with no cost sharing. It also requires these carriers to pay out-of-network providers that provide emergency services to the participants in their plans in accordance with Colorado law.

This emergency regulation replaces Emergency Regulation 21-E-03, which was discussed in the March 2, 2021, edition of Compliance Corner.

Employers with health plans regulated by the state should be aware of this development.

Emergency Regulation 21-E-06 »

Emergency COVID-19 Regulation Extended

March 02, 2021

Effective February 24, 2021, the Division of Insurance adopted Emergency Regulation 21-E-03. This emergency regulation is an extension of regulation 20-E-17, which requires carriers to provide covered people with treatment related to COVID-19 and access to COVID-19 vaccines without cost sharing. This emergency regulation also ensures that out-of-network providers rendering emergency services for emergency medical conditions, including but not limited to COVID-19, are appropriately compensated for per regulation without delay. The regulation is in effect for 120 days or during any period in which a disaster declaration is in effect in the state of Colorado due to the presence of COVID-19, whichever is shorter.

Employers with plans regulated by the state should be aware of this emergency regulation.

Emergency Regulation 21-E-03 »

Emergency Regulation Establishes SEP for State Exchange

March 02, 2021

Effective February 5, 2021, the Division of Insurance adopted Emergency Regulation 21-E-02. This emergency regulation establishes a SEP for the state’s health insurance exchange, Connect for Health Colorado. The SEP begins on February 8, 2021, and extends through May 15, 2021.

While the creation of the SEP will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the SEP. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace.

Emergency Regulation 21-E-02 »

Marketplace Special Enrollment Period

February 02, 2021

On January 28, 2021, the Division of Insurance announced that the state will open its marketplace for enrollment. The announcement was made in conjunction with the federal government announcement that it would open the federal marketplace, as reported elsewhere in this edition of Compliance Corner.

The standard open enrollment period for the state marketplace ended on January 15, 2021. The marketplace will be reopened from February 8 through May 15, 2021, to enroll more state residents who do not have health insurance through their employers.

While this change will affect individuals that will enroll on the marketplace, employers should be mindful of this extension in case there are employees who seek to drop coverage under their plans to take advantage of the marketplace’s special open enrollment period. Specifically, the permissible qualifying event for a revocation due to enrollment in a qualified plan will allow an employee to drop their employer’s plan mid-year if they intend to enroll in the marketplace.

State announcement »

Utilization Review Regulations Adopted

January 20, 2021

On January 14, 2021, the Division of Insurance adopted amended Regulation 4-2-17. This regulation requires carriers to adopt and implement reasonable standards for the prompt investigation of claims arising from health coverage plans; promptly provide a reasonable explanation of the basis in the health coverage plan in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; and refrain from denying a claim without conducting a reasonable investigation based upon all available information.

The amendments allow dentists to evaluate first level reviews involving dental care and consult with an appropriate clinical peer or peers, and other non-substantive changes. The amendments are effective March 15, 2021.

Employers with plans regulated by the state should be aware of these amendments.

Regulation 4-2-17 »

Emergency COVID-19 Regulation Adopted

January 20, 2021

On December 23, 2020, the Division of Insurance adopted Emergency Regulation 20-E-17. This emergency regulation requires carriers to provide covered persons with treatment related to COVID-19 and access to COVID-19 vaccines without cost sharing. This emergency regulation also ensures that out-of-network providers rendering emergency services for emergency medical conditions, including but not limited to COVID-19, are appropriately compensated per regulation without delay. The regulation is in effect for 120 days or during any period in which a disaster declaration is in effect in the state of Colorado due to the presence of COVID-19, whichever is shorter.

Employers with plans regulated by the state should be aware of this emergency regulation.

Emergency Regulation 20-E-17 »

Telehealth Services Required during COVID-19 Crisis

December 22, 2020

On December 15, 2020, the Division of Insurance issued Emergency regulation 20-E-16. It extends coverage and reimbursement for telehealth services during the ongoing public health emergency, by requiring carriers to reimburse providers for the provision of telehealth services. The regulation requires insurers to reimburse providers for telehealth service at rates that are at least the same as those paid for the in-person equivalent and prohibits carriers from imposing limits on technologies to telehealth, and from imposing more certification and training requirements. The regulation also prohibits carriers from requiring providers to provide documentation beyond what is needed for the same service or procedure if performed in-person.

The rule is primarily directed at insurers. However, employers should also be aware of these developments.

Emergency Regulation 20-E-16 »

New Regulations Aim to Make Plans More Affordable

December 08, 2020

On December 3, 2020, the Division of Insurance announced that it adopted Regulation 4-2-72, which establishes standards for carriers that issue health plans to employers that cover over 10,000 lives. The division intends to use these standards to make health insurance more affordable by setting targets for carriers to increase utilization of primary care by the proportion of total medical expenditures in Colorado allocated to primary care by one percentage point annually in calendar years 2022 and 2023, compared to each carrier’s baseline primary care spending (the baseline is calculated as the proportion of total medical expenditures allocated to primary care for the calendar year 2021). The new regulations also require that carriers target 25% of the expenditure to be made through prospective payments by the end of calendar year 2023.

In addition, the regulations require that carriers target 50% of a carrier’s total medical expenditures in Colorado to be made through alternative payment models (APMs) by the end of calendar year 2022. The regulations define APMs to mean “health care payment methods that use financial incentives to promote greater value – including higher quality care at lower costs – for patients, purchasers, and providers. Unlike traditional fee for service payments, APMs utilize cost and quality control strategies that benefit consumers by increasing the value of care delivered and, ultimately, the affordability of care.” The regulations mandate that carriers target 10% of the expenditure to occur through prospective payments by the end of calendar year 2022.

Employers with plans issued by state-regulated carriers should be aware of these new standards and requirements.

Regulation 4-2-72 »

Voters Pass Statewide Family and Medical Leave Statute

November 10, 2020

On November 3, 2020, voters passed Proposition 118, an initiated state statute (that is, a statute passed directly by the voters, rather than through the legislature) which establishes a family and medical leave program that provides up to 16 weeks of paid leave.

Starting on January 1, 2023, each employer in the state must remit a payroll tax for each employee in an amount equal to 0.9% of the employee’s wage to a state fund established to pay for the leave taken by employees under this law. Although the employer is responsible for remitting the tax, the cost of the tax is split 50/50 between the employer and employee. After the first two years, this tax may be increased or adjusted up to a cap of 1.2% of the employee’s wage.

Starting on January 1, 2024, employees who have earned at least $2,500 at their jobs can take family and medical leave under this law. The law ensures that employees who take this leave receive insurance benefits as well as up to $1,100 per week in wages. The pay is tied to the state average weekly wage, so it may increase or decrease year to year. In addition, the employee can take up to 12 weeks of paid leave (plus an extra four weeks for pregnancy and childbirth complications). This leave can be taken intermittently if such leave is already provided for by the employer.

The employee can take this leave for any of the following reasons:

  • Caring for their own serious health condition
  • Caring for a new child during the first year after the birth or adoption or for foster care of a new child
  • Caring for a family member with a serious health condition
  • When a family member is on active duty military service or is called for active-duty military service
  • When the individual or the individual’s family member is a victim of domestic violence, stalking or sexual assault

Finally, employers cannot retaliate against employees who request or take this leave. If the employee has worked for the employer for at least 180 days, then the employee is entitled to return to the same or similar position after the leave is taken.

Colorado employers should be aware of this new law.

Proposition 118 »


Page 1
Back to top