Second Regular Session
Seventy-third General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted in the House of Introduction
LLS NO. 22-0288.01 Christy Chase x2008
HOUSE BILL 22-1269
House Committees Senate Committees
Health & Insurance
Appropriations
A BILL FOR AN ACT
C
ONCERNING REQUIREMENTS IMPOSED ON
PERSONS NOT AUTHORIZED101
TO TRANSACT INSURANCE BUSINESS IN THIS STATE WHO ARE102
OFFERING COVERAGE OF HEALTH -CARE COSTS FOR COLORADO103
RESIDENTS, AND, IN CONNECTION THEREWITH, MAKING AN104
APPROPRIATION.105
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov
.)
Starting October 1, 2022, and by each March 1 thereafter, the bill
requires any person that is not authorized to engage in the business of
HOUSE
3rd Reading Unamended
April 22, 2022
HOUSE
Amended 2nd Reading
April 21, 2022
HOUSE SPONSORSHIP
Lontine, Amabile, Bernett, Boesenecker, Caraveo, Hooton, Jodeh, Kipp, Lindsay,
McCormick, Michaelson Jenet, Sirota, Titone, Woodrow
SENATE SPONSORSHIP
Hansen,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute. insurance in this state but that offers or intends to offer a plan or
arrangement to facilitate payment of or to cover health-care costs or
services for Colorado residents to annually submit to the commissioner
of insurance (commissioner) specified information and a certification that
the information is accurate and complies with the requirements of the bill.
The submission must include information about the operation of the plan
or arrangement in the immediately preceding calendar year, including:
! The number of participants in the plan or arrangement;
! The total amount of fees, dues, or other payments collected
from participants and the percentage of fees, dues, or other
payments that the person retained;
! The total amount of payments made to providers or to
reimburse participants for health-care services provided or
received;
! The estimated number of participants the person anticipates
in the next calendar year;
! The counties in which the person offers or intends to offer
a plan or arrangement and any other states in which the
person offers a plan or arrangement;
! A list of third parties associated with, or offering or
enrolling participants in a plan or arrangement on behalf of,
the person and a detailed accounting of commissions or
other remuneration paid to a third party for services
provided in promoting or administering the plan or
arrangement;
! The person's reserve balance; and
! Contact information for an individual serving as the
person's contact person in this state, a list of the person's
officers and directors, and the person's organizational chart.
Within 45 days after receipt, the commissioner is to determine
whether a submission by a person is complete. Each year, the
commissioner is to compile a report summarizing the information
submitted by persons, post the report on the division of insurance website,
and submit the report to specified legislative committees. The
commissioner is authorized to adopt rules to implement the bill and to
issue an emergency cease-and-desist order against a person that fails to
comply with the requirements of the bill.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 10-16-107.4 as2
follows:3
10-16-107.4. Health-care sharing plan or arrangement -4
1269-2- required reporting and certification - noncompliance - information1
posted on division website - rules. (1) A PERSON NOT AUTHORIZED2
BY THE COMMISSIONER PURSUANT TO ARTICLE 3 OF THIS TITLE 10 TO3
OFFER INSURANCE IN THIS STATE THAT OFFERS OR INTENDS TO OFFER A4
PLAN OR ARRANGEMENT TO FACILITATE PAYMENT OR REIMBURSEMENT OF5
HEALTH-CARE COSTS OR SERVICES FOR RESIDENTS OF THIS STATE ,6
REGARDLESS OF WHETHER THE PERSON IS DOMICILED IN THIS STATE OR7
ANOTHER STATE, SHALL SUBMIT TO THE COMMISSIONER BY OCTOBER 1,8
2022,
AND BY MARCH 1 EACH YEAR THEREAFTER:9
(a) T
HE FOLLOWING INFORMATION :10
(I) T
HE TOTAL NUMBER OF INDIVIDUALS AND HOUSEHOLDS THAT11
PARTICIPATED IN THE PLAN OR ARRANGEMENT IN THIS STATE IN THE12
IMMEDIATELY PRECEDING CALENDAR YEAR ;13
(II) T
HE TOTAL NUMBER OF EMPLOYER GROUPS THAT14
PARTICIPATED IN THE PLAN OR ARRANGEMENT IN THIS STATE IN THE15
IMMEDIATELY PRECEDING CALENDAR YEAR , SPECIFYING THE TOTAL16
NUMBER OF PARTICIPATING INDIVIDUALS IN EACH PARTICIPATING17
EMPLOYER GROUP;18
(III) IF THE PERSON OFFERS A PLAN OR ARRANGEMENT IN OTHER19
STATES, THE TOTAL NUMBER OF PARTICIPANTS IN THE PLAN OR20
ARRANGEMENT NATIONALLY ;21
(IV) ANY CONTRACTS THE PERSON HAS ENTERED INTO WITH22
PROVIDERS IN THIS STATE THAT PROVIDE HEALTH-CARE SERVICES TO PLAN23
OR ARRANGEMENT PARTICIPANTS ;24
(V) THE TOTAL AMOUNT OF FEES , DUES, OR OTHER PAYMENTS25
COLLECTED BY THE PERSON IN THE IMMEDIATELY PRECEDING CALENDAR26
YEAR FROM INDIVIDUALS , EMPLOYER GROUPS , OR OTHERS WHO27
1269
-3- PARTICIPATED IN THE PLAN OR ARRANGEMENT IN THIS STATE , SPECIFYING1
THE PERCENTAGE OF FEES, DUES, OR OTHER PAYMENTS RETAINED BY THE2
PERSON FOR ADMINISTRATIVE EXPENSES ;3
(VI) THE TOTAL DOLLAR AMOUNT OF REQUESTS FOR4
REIMBURSEMENT OF HEALTH-CARE COSTS OR SERVICES SUBMITTED IN THIS5
STATE IN THE IMMEDIATELY PRECEDING CALENDAR YEAR BY6
PARTICIPANTS IN THE PLAN OR ARRANGEMENT OR PROVIDERS THAT7
PROVIDED HEALTH-CARE SERVICES TO PLAN OR ARRANGEMENT8
PARTICIPANTS;9
(VII) THE TOTAL DOLLAR AMOUNT OF REQUESTS FOR10
REIMBURSEMENT OF HEALTH-CARE COSTS OR SERVICES THAT WERE11
SUBMITTED IN THIS STATE AND WERE DETERMINED TO QUALIFY FOR12
REIMBURSEMENT UNDER THE PLAN OR ARRANGEMENT IN THE13
IMMEDIATELY PRECEDING CALENDAR YEAR ;14
(VIII) THE TOTAL AMOUNT OF PAYMENTS MADE TO PROVIDERS IN15
THIS STATE IN THE IMMEDIATELY PRECEDING CALENDAR YEAR FOR16
HEALTH-CARE SERVICES PROVIDED TO OR RECEIVED BY A PLAN OR17
ARRANGEMENT PARTICIPANT ;18
(IX) THE TOTAL AMOUNT OF REIMBURSEMENTS MADE TO PLAN OR19
ARRANGEMENT PARTICIPANTS IN THIS STATE IN THE IMMEDIATELY20
PRECEDING CALENDAR YEAR FOR HEALTH -CARE SERVICES PROVIDED TO OR21
RECEIVED BY A PLAN OR ARRANGEMENT PARTICIPANT ;22
(X) THE TOTAL NUMBER OF REQUESTS FOR REIMBURSEMENT OF23
HEALTH-CARE COSTS OR SERVICES SUBMITTED IN THIS STATE IN THE24
IMMEDIATELY PRECEDING CALENDAR YEAR THAT WERE DENIED ,25
EXPRESSED AS A PERCENTAGE OF TOTAL REIMBURSEMENT REQUESTS26
SUBMITTED IN THAT CALENDAR YEAR, AND THE TOTAL NUMBER OF27
1269
-4- REIMBURSEMENT REQUEST DENIALS THAT WERE APPEALED ;1
(XI) THE TOTAL AMOUNT OF HEALTH-CARE EXPENSES SUBMITTED2
IN THIS STATE BY PLAN OR ARRANGEMENT PARTICIPANTS OR PROVIDERS3
IN THE IMMEDIATELY PRECEDING CALENDAR YEAR THAT QUALIFY FOR4
REIMBURSEMENT PURSUANT TO THE PLAN OR ARRANGEMENT CRITERIA5
BUT THAT, AS OF THE END OF THAT CALENDAR YEAR , HAVE NOT BEEN6
REIMBURSED, EXCLUDING ANY AM OUNTS THAT THE PLAN OR7
ARRANGEMENT PARTICIPANTS INCURRING THE HEALTH-CARE COSTS MUST8
PAY BEFORE RECEIVING REIMBURSEMENT UNDER THE PLAN OR9
ARRANGEMENT;10
(XII) THE ESTIMATED NUMBER OF PLAN OR ARRANGEMENT11
PARTICIPANTS THE PERSON IS ANTICIPATING IN THIS STATE IN THE NEXT12
CALENDAR YEAR, SPECIFYING THE ESTIMATED NUMBER OF INDIVIDUALS ,13
HOUSEHOLDS, EMPLOYER GROUPS, AND EMPLOYEES;14
(XIII) THE SPECIFIC COUNTIES IN THIS STATE IN WHICH THE15
PERSON:16
(A) O
FFERED A PLAN OR ARRANGEMENT IN THE IMMEDIATELY17
PRECEDING CALENDAR YEAR ; AND18
(B) I
NTENDS TO OFFER A PLAN OR ARRANGEMENT IN THE NEXT19
CALENDAR YEAR;20
(XIV) OTHER STATES IN WHICH THE PERSON OFFERS A PLAN OR21
ARRANGEMENT;22
(XV) A LIST OF ANY THIRD PARTIES, OTHER THAN A PRODUCER,23
THAT ARE ASSOCIATED WITH OR ASSIST THE PERSON IN OFFERING OR24
ENROLLING PARTICIPANTS IN THIS STATE IN THE PLAN OR ARRANGEMENT ,25
COPIES OF ANY TRAINING MATERIALS PROVIDED TO A THIRD PARTY , 26
AND A DETAILED ACCOUNTING OF ANY COMMISSIONS OR OTHER FEES OR27
1269
-5- REMUNERATION PAID TO A THIRD PARTY IN THE IMMEDIATELY PRECEDING1
CALENDAR YEAR FOR:2
(A) M
ARKETING, PROMOTING, OR ENROLLING PARTICIPANTS IN A3
PLAN OR ARRANGEMENT OFFERED BY THE PERSON IN THIS STATE ; OR4
(B) O
PERATING, MANAGING, OR ADMINISTERING A PLAN OR5
ARRANGEMENT OFFERED BY THE PERSON IN THIS STATE ;6
(XVI) THE TOTAL NUMBER OF PRODUCERS THAT ARE ASSOCIATED7
WITH OR ASSIST THE PERSON IN OFFERING OR ENROLLING PARTICIPANTS IN8
THIS STATE IN THE PLAN OR ARRANGEMENT , THE TOTAL NUMBER OF9
PARTICIPANTS ENROLLED IN THE PLAN OR ARRANGEMENT THROUGH A10
PRODUCER, COPIES OF ANY TRAINING MATERIALS PROVIDED TO A11
PRODUCER, AND A DETAILED ACCOUNTING OF ANY COMMISSIONS OR12
OTHER FEES OR REMUNERATION PAID TO A PRODUCER IN THE13
IMMEDIATELY PRECEDING CALENDAR YEAR FOR MARKETING , PROMOTING,14
OR ENROLLING PARTICIPANTS IN A PLAN OR ARRANGEMENT OFFERED BY15
THE PERSON IN THIS STATE;16
(XVII) COPIES OF ANY CONSUMER -FACING AND MARKETING17
MATERIALS USED IN THIS STATE IN PROMOTING THE PERSON 'S PLAN OR18
ARRANGEMENT, INCLUDING PLAN OR ARRANGEMENT AND BENEFIT19
DESCRIPTIONS AND OTHER MATERIALS THAT EXPLAIN THE PLAN OR20
ARRANGEMENT;21
(XVIII) THE NAME, MAILING ADDRESS, E-MAIL ADDRESS, AND22
TELEPHONE NUMBER OF AN INDIVIDUAL SERVING AS A CONTACT PERSON23
FOR THE PERSON IN THIS STATE;24
(XIX) A LIST OF ANY PARENT COMPANIES , SUBSIDIARIES, AND25
OTHER NAMES THAT THE PERSON HAS OPERATED UNDER AT ANY TIME26
WITHIN THE IMMEDIATELY PRECEDING FIVE CALENDAR YEARS ; AND27
1269
-6- (XX) AN ORGANIZATIONAL CHART FOR THE PERSON AND A LIST OF1
THE OFFICERS AND DIRECTORS OF THE PERSON ;2
3
(b) A
CERTIFICATION BY AN OFFICER OF THE PERSON THAT, TO THE4
BEST OF THE PERSON'S GOOD-FAITH KNOWLEDGE AND BELIEF , THE5
INFORMATION SUBMITTED IS A CCURATE AND SATISFIES THE6
REQUIREMENTS OF THIS SUBSECTION (1).7
(2) (a) I
F THE PERSON SUBJECT TO THE REQUIREMENTS OF8
SUBSECTION (1) OF THIS SECTION FAILS TO SUBMIT THE INFORMATION OR9
CERTIFICATION REQUIRED BY SAID SUBSECTION , THE SUBMISSION IS10
INCOMPLETE. THE COMMISSIONER SHALL MAKE A DETERMINATION OF11
COMPLETENESS NO LATER THAN FORTY -FIVE DAYS AFTER THE SUBMISSION.12
I
F THE COMMISSIONER HAS NOT INFORMED THE PERSON OF ANY13
DEFICIENCIES IN THE SUBMISSION WITHIN FORTY -FIVE DAYS AFTER14
RECEIVING THE SUBMISSION, THE SUBMISSION IS CONSIDERED COMPLETE .15
(b) (I) IF THE COMMISSIONER DETERMINES THAT A PERSON FAILS16
TO COMPLY WITH THE REQUIREMENTS OF SUBSECTION (1) OF THIS SECTION,17
THE COMMISSIONER SHALL:18
(A) NOTIFY THE PERSON THAT THE SUBMISSION IS INCOMPLETE19
AND ENUMERATE IN THE NOTIFICATION EACH DEFICIENCY FOUND IN THE20
PERSON'S SUBMISSION; AND21
(B) ALLOW THE PERSON THIRTY DAYS AFTER NOTICE OF THE22
INCOMPLETE SUBMISSION TO REMEDY THE DEFICIENCY FOUND IN THE23
SUBMISSION.24
(II) IF THE PERSON DOES NOT REMEDY THE DEFICIENCY WITHIN THE25
THIRTY-DAY PERIOD, THE COMMISSIONER MAY LEVY A FINE NOT TO26
EXCEED FIVE THOUSAND DOLLARS PER DAY .27
1269
-7- (III) IF THE PERSON DOES NOT REMEDY THE DEFICIENCY OR1
DEFICIENCIES WITHIN THIRTY DAYS AFTER THE INITIAL FINE IS LEVIED, THE2
COMMISSIONER MAY ISSUE A CEASE-AND-DESIST ORDER IN ACCORDANCE3
WITH SECTION 10-3-904.5.4
(3) O
N OR BEFORE APRIL 1, 2023, AND ON OR BEFORE EACH5
O
CTOBER 1 THEREAFTER, THE COMMISSIONER SHALL:6
(a) P
REPARE A WRITTEN REPORT SUMMARIZING THE INFORMATION7
SUBMITTED BY PERSONS PURSUANT TO SUBSECTION (1) OF THIS SECTION;8
AND9
(b) P
OST ON THE DIVISION'S WEBSITE THE REPORT AND
ACCURATE10
AND EVIDENCE-BASED INFORMATION ABOUT THE PERSONS WHO11
SUBMITTED INFORMATION PURSUANT TO SUBSECTION (1) OF THIS SECTION,12
INCLUDING HOW CONSUMERS MAY FILE COMPLAINTS .13
(4) T
HE COMMISSIONER MAY ADOPT RULES AS NECESSARY TO14
IMPLEMENT THIS SECTION.15 (5) THIS SECTION DOES NOT APPLY TO:16
(a) DIRECT PRIMARY CARE AGREEMENTS AS DEFINED IN ARTICLE17
23 OF TITLE 6; OR18
(b) OTHER CONSUMER PAYMENT ARRANGEMENTS IDENTIFIED BY19
THE COMMISSIONER BY RULE, INCLUDING CONSUMER PAYMENT PLANS20
OFFERED DIRECTLY BY A PROVIDER TO A PATIENT OR THE PARTY21
RESPONSIBLE FOR PAYMENT ON BEHALF OF THE PATIENT .22
SECTION 2. In Colorado Revised Statutes, 10-3-904.5, amend23
(1)(a) as follows:24
10-3-904.5. Emergency cease-and-desist orders - issuance.25
(1) The commissioner may issue an emergency cease-and-desist order ex26
parte if:27
1269
-8- (a) The commissioner believes that:1
(I) An unauthorized person is engaging in the business of2
insurance in violation of the provisions of section 10-3-105 or 10-3-9033
or is in violation of a rule promulgated by the commissioner; and OR4
(II) A PERSON IS FAILING TO REMEDY OR HAS NOT REMEDIED A 5
DEFICIENCY OR DEFICIENCIES IN THE SUBMISSION REQUIRED PURSUANT TO6
SECTION 10-16-107.4 (1) WITHIN THE THIRTY DAYS AFTER THE7
COMMISSIONER LEVIES AN INITIAL FINE PURSUANT TO SECTION8
10-16-107.4 (2)(b)(II); AND9
SECTION 3. Appropriation. (1) For the 2022-23 state fiscal10
year, $84,568 is appropriated to the department of regulatory agencies.11
This appropriation is from the division of insurance cash fund created in12
section 10-1-103 (3), C.R.S. To implement this act, the department may13
use this appropriation as follows:14
(a) $39,097 for use by the division of insurance for personal15
services, which amount is based on an assumption that the division will16
require an additional 0.5 FTE;17
(b) $6,875 for use by the division of insurance for operating18
expenses;19
(c) $19,714 for the purchase of legal services; and20
(d) $18,882 for the purchase of information technology services.21
(2) For the 2022-23 state fiscal year, $19,714 is appropriated to22
the department of law. This appropriation is from reappropriated funds23
received from the department of regulatory agencies under subsection24
(1)(c) of this section and is based on an assumption that the department25
of law will require an additional 0.1 FTE. To implement this act, the26
department of law may use this appropriation to provide legal services for27
1269
-9- the department of regulatory agencies.1
(3) For the 2022-23 state fiscal year, $18,882 is appropriated to2
the office of the governor for use by the office of information technology.3
This appropriation is from reappropriated funds received from the4
department of regulatory agencies under subsection (1)(d) of this section.5
To implement this act, the office may use this appropriation to provide6
information technology services for the department of regulatory7
agencies.8
SECTION 4. Applicability. This act applies to conduct occurring9
on or after the effective date of this act.10
SECTION 5. Safety clause. The general assembly hereby finds,11
determines, and declares that this act is necessary for the immediate12
preservation of the public peace, health, or safety.13
1269
-10-