On October 12, 2021, CMS approved the state’s proposed benchmark plan for policies beginning on or after January 1, 2023. The proposed plan added new services to the current benchmark plan, including an annual mental health wellness exam, gender-affirming care (those mental and physical health services that help align a transgender person’s body into alignment with their gender identity), and 15 new drugs that insurance companies must cover as alternatives to opioids.

Since small group plans issued in the state that cover employers with less than 100 employees must include these benefits, employers with such plans should be aware of these developments.

CMS Letter Approving Benchmark Plan »
Colorado Benchmark Plan for 2023 »

On September 21, 2021, the Division of Insurance adopted Emergency Regulation 21-E-12. This regulation creates a special enrollment period (SEP) in the state’s health insurance exchange for individuals or their dependents who lose either employer or government subsidies for COBRA premiums. This state regulation aligns with federal regulation that also creates an SEP in the federal marketplace under these circumstances. The triggering event is the last day of the period for which COBRA or state continuation coverage is paid for or subsidized, in whole or in part, by an employer or government entity.

Employers who subsidize the COBRA premiums for qualified beneficiaries, either through a severance agreement or ARPA subsidy, should be aware of this regulation.

Emergency Regulation 21-E-12 »

Commissioner Conway adopted emergency regulation 21-E-11, which became effective on July 22, 2021. This regulation applies to all carriers offering individual, small group, large group plans, student health plans and managed care plans subject to the state’s insurance laws. Those carriers must cover all FDA-authorized or approved vaccines for COVID-19 throughout the duration of the COVID-19 recovery, including all associated costs of administration, at no cost sharing. The requirement applies upon FDA authorization or approval and is not contingent on the issuance of a recommendation by the Center for Disease Control’s Advisory Committee on Immunization Practices.

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

Emergency Regulation 21-E-11 »

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 »

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 »

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 »

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 »

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 »

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 »

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 »