First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 23-0471.01 Kristen Forrestal x4217
SENATE BILL 23-179
Senate Committees House Committees
Health & Human Services
A BILL FOR AN ACT
C
ONCERNING INSURANCE CARRIER REQUIREMENTS FOR HEALTH101
COVERAGE PLANS.102
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
.)
The bill requires a health insurance carrier (carrier) that issues,
sells, renews, or offers a dental coverage plan to file, beginning in 2024,
dental loss ratio forms with the division of insurance (division) for the
preceding calendar year in which dental coverage was provided.
The division is required to post dental loss ratio information on its
website or submit the information to the administrator of the all-payer
SENATE SPONSORSHIP
Moreno and Will,
HOUSE SPONSORSHIP
Hartsook and Daugherty,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. health claims database (APCD). If the information is submitted to the
APCD administrator, the administrator is directed to make the
information available to the public.
Once the division has collected dental loss ratio information for 2
years, the commissioner of insurance (commissioner) shall promulgate
rules that create a process to identify any carriers that significantly deviate
from average dental loss ratios and to investigate the causes of the
deviation.
Current law requires the commissioner to adopt rules requiring
every carrier providing a health benefit plan to issue to covered persons
to whom an identification card is issued a standardized, printed card
containing plan information. The bill amends this requirement to
encompass health coverage plans.
The bill also requires prepaid dental plans to file rates with the
division.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. Legislative declaration. (1) The general assembly2
finds and declares that:3
(a) Access to quality dental care is an essential component of4
every Coloradan's health and well-being, as untreated dental issues5
contribute to a number of serious medical conditions, including chronic6
obstructive pulmonary disease, heart disease, stroke, and preterm labor or7
premature birth, all of which drastically increase costs to individuals and8
to the state;9
(b) Meaningful insurance coverage is one of the most important10
factors behind patients utilizing dental care services;11
(c) The value that patients receive from their dental plans has12
eroded over time, particularly given the design of capped dental benefits13
that limit insurer risk and coverage of dental care services;14
(d) The average annual maximum coverage amounts among dental15
plans have not meaningfully increased in decades, and dental care16
coverage pays for far less than it once did;17
SB23-179-2- (e) Greater transparency on how premium dollars are spent by1
health insurance carriers provides accountability for insurance plans and2
ensures that patients get the most value for premiums paid;3
(f) Patients should have visibility regarding how many of their4
insurance premium dollars pay for health-care and dental services as5
opposed to administrative, marketing, and operational costs;6
(g) Medical loss ratio standards are already in place for health7
insurance, requiring health insurance carriers in Colorado to comply with8
transparency and disclosure standards;9
(h) The medical loss ratio standards for health insurance carriers,10
requiring at least eighty percent of patient premiums to be spent on direct11
patient care, have been working across all fifty states to increase12
transparency and accountability within medical insurance for more than13
ten years;14
(i) Dental plans in this state are not required to have equivalent15
transparency and disclosure standards, known as dental loss ratios, in16
place;17
(j) Momentum is growing across the country to implement dental18
loss ratios to ensure transparency and accountability for dental plans;19
(k) In the November 2022 election, voters in Massachusetts20
overwhelmingly supported a ballot initiative, with a decisive seventy-two21
percent supermajority vote, to require that dental plans spend at least22
eighty-three percent of patient premiums on direct patient care;23
(l) When patients and employers are comparing dental plans for24
purchase, they should have access to information that shows how much25
coverage is actually provided relative to what they pay in premiums for26
the coverage;27
SB23-179
-3- (m) Bringing transparency to how much care the premiums are1
actually paying for is an important step to drive efficiencies in care and2
ensure value in patients' dental benefits; and3
(n) As Colorado has long been a leader in policies that increase4
transparency, value, accountability, and access to health care for5
consumers, Colorado should continue to lead and provide protections for6
consumers in accessing dental care coverage.7
(2) In order to ensure dental care is accessible for all Coloradans,8
it is critical that Colorado establish transparency and accountability for9
dental plans by establishing standards for how premium dollars must be10
spent on patient care.11
SECTION 2. In Colorado Revised Statutes, 10-16-107, amend12
(1)(a), (1)(f), (2)(a)(I) introductory portion, and (2)(b), as follows:13
10-16-107. Rate filing regulation - benefits ratio - rules.14
(1) (a) A carrier subject to part 2, 3, or 4, OR 5 of this article ARTICLE 1615
shall not establish rates for any sickness, accident, or health insurance16
policy, contract, certificate, or other evidence of coverage
OR DENTAL17
COVERAGE PLAN, AS DEFINED IN SECTION 10-16-158 (1)(a), issued or18
delivered to any policyholder, enrollee, subscriber, or member in19
Colorado that are excessive, inadequate, or unfairly discriminatory. To20
assure compliance with the requirements of this section that rates are not21
excessive in relation to benefits, the commissioner shall promulgate rules22
to require rate filings and, as part of the rules, may require the submission23
of adequate documentation and supporting information, including24
actuarial opinions or certifications and set expected benefits ratios. The25
carrier shall submit expected rate increases to the commissioner at least26
sixty days prior to the proposed implementation of the rates. If the27
SB23-179
-4- commissioner does not approve or disapprove the rate filings within a1
sixty-day period, the carrier may implement and reasonably rely upon the2
rates on the condition that the commissioner may require correction of3
any deficiencies in the rate filing upon later review if the rate the carrier4
charged is excessive, inadequate, or unfairly discriminatory. A5
prospective rate adjustment is the sole remedy for rate deficiencies6
pursuant to this subsection (1). If the commissioner finds deficiencies in7
the rate filing after a sixty-day period, the commissioner shall provide8
notice to the carrier, and the carrier shall correct the rate on a prospective9
basis.10
(f) Carriers shall file rate filings for insurance regulated under11
parts 1 to 4 5 of this article ARTICLE 16 electronically in a format made12
available by the division, unless exempted by rule for an emergency13
situation as determined by the commissioner. The division shall post on14
its website a rate filing summary for insurance regulated under parts 1 to15
4 5 of this article ARTICLE 16 in order to provide notice to the public.16
(2) (a) (I) Rates for an individual health coverage plan issued or17
delivered to any policyholder, enrollee, subscriber, or member in18
Colorado by an insurer subject to part 2 of this article 16 or an entity19
subject to part 3, or 4, OR 5 of this article 16 shall not be excessive,20
inadequate, or unfairly discriminatory to assure compliance with the21
requirements of this section that rates are not excessive in relation to22
benefits. Rates are excessive if they are likely to produce a long run profit23
that is unreasonably high for the insurance provided or if expenses are24
unreasonably high in relation to services rendered. In determining if rates25
are excessive, the commissioner may consider:26
(b) Notwithstanding any other provision of this article ARTICLE 16,27
SB23-179
-5- a carrier subject to part 2, 3, or 4, OR 5 of this article ARTICLE 16 shall not1
vary the premium rate for an individual health coverage plan due to the2
gender of the individual policyholder, enrollee, subscriber, or member.3
Any premium rate based on the gender of the individual policyholder,4
enrollee, subscriber, or member is unfairly discriminatory and is not5
allowed.6
SECTION 3. In Colorado Revised Statutes, add 10-16-158 as7
follows:8
10-16-158. Dental coverage plans - dental loss ratio - rules -9
definitions. (1) A
S USED IN THIS SECTION, UNLESS THE CONTEXT10
OTHERWISE REQUIRES:11
(a) "D
ENTAL COVERAGE PLAN" MEANS A HEALTH COVERAGE PLAN12
THAT INCLUDES COVERAGE FOR THE COSTS OF DENTAL CARE SERVICES .13
"D
ENTAL COVERAGE PLAN " INCLUDES A PLAN ISSUED BY A PREPAID14
DENTAL PLAN ORGANIZATION THAT HAS A CERTIFICATE OF AUTHORITY TO15
OPERATE PURSUANT TO PART 5 OF THIS ARTICLE 16.16
(b) (I) "D
ENTAL LOSS RATIO" MEANS THE PERCENTAGE OF17
PREMIUM DOLLARS COLLECTED EACH YEAR FOR A DENTAL COVERAGE18
PLAN THAT THE DENTAL COVERAGE PLAN SPENDS ON DENTAL SERVICES19
PROVIDED TO AN ENROLLEE , SEPARATE FROM OVERHEAD AND20
ADMINISTRATIVE COSTS.21
(II) T
HE DENTAL LOSS RATIO IS CALCULATED BY DIVIDING THE22
NUMERATOR BY THE DENOMINATOR , WHERE:23
(A) T
HE NUMERATOR IS THE SUM OF THE AMOUNT EXPENDED FOR24
CLINICAL DENTAL SERVICES PROVIDED TO ENROLLEES , THE AMOUNT25
EXPENDED ON ACTIVITIES THAT IMPROVE DENTAL CARE QUALITY , AND THE26
AMOUNT OF CLAIMS PAYMENTS IDENTIFIED THROUGH FRAUD REDUCTION27
SB23-179
-6- EFFORTS; AND1
(B) T
HE DENOMINATOR IS THE TOTAL AMOUNT OF PREMIUM2
REVENUE, EXCLUDING FEDERAL AND STATE TAXES , LICENSING AND3
REGULATORY FEES PAID , AND ANY OTHER PAYMENTS REQUIRED BY4
FEDERAL LAW.5
(2) (a) T
HE COMMISSIONER SHALL DEFINE BY RULE :6
(I) E
XPENDITURES FOR CLINICAL DENTAL SERVICES ;7
(II) A
CTIVITIES THAT IMPROVE DENTAL CARE QUALITY ; AND8
(III) O
VERHEAD AND ADMINISTRATIVE COST EXPENDITURES .9
(b) T
HE DEFINITIONS PROMULGATED BY RULE PURSUANT TO THIS10
SECTION MUST BE CONSISTENT WITH SIMILAR DEFINITIONS THAT ARE USED11
FOR THE REPORTING OF MEDICAL LOSS RATIOS BY CARRIERS OFFERING12
HEALTH BENEFIT PLANS IN THE STATE. OVERHEAD AND ADMINISTRATIVE13
COSTS MUST NOT BE INCLUDED IN THE NUMERATOR AS DESCRIBED IN14
SUBSECTION (1)(b)(II)(A) OF THIS SECTION.15
(3) (a) O
N OR BEFORE JULY 31, 2024, AND ON OR BEFORE JULY 3116
EACH YEAR THEREAFTER , A CARRIER THAT ISSUES, SELLS, RENEWS, OR17
OFFERS A DENTAL COVERAGE PLAN SHALL FILE A DENTAL LOSS RATIO18
FORM ELECTRONICALLY WITH THE DIVISION FOR THE PRECEDING19
CALENDAR YEAR IN WHICH DENTAL COVERAGE WAS PROVIDED BY THE20
DENTAL COVERAGE PLAN . THE COMMISSIONER MAY CREATE A NEW21
REPORTING FORM OR USE AN EXISTING REPORTING FORM TO FACILITATE22
DATA COLLECTION. THE COMMISSIONER SHALL ENSURE THAT FIELDS ARE23
REPORTED CONSISTENTLY BY CARRIERS . THE FILING MUST:24
(I) R
EPORT THE CALCULATED DENTAL LOSS RATIO ACCORDING TO25
THE FORMULA IN SUBSECTION (1)(b)(II) OF THIS SECTION;26
(II) S
EPARATELY REPORT EACH DATA ELEMENT DESCRIBED IN27
SB23-179
-7- SUBSECTION (1)(b) OF THIS SECTION;1
(III) R
EPORT ADDITIONAL DATA THAT INCLUDES THE NUMBER OF2
ENROLLEES, THE PLAN DEDUCTIBLE AMOUNTS , THE ANNUAL MAXIMUM3
COVERAGE LIMIT, AND THE NUMBER OF ENROLLEES WHO MEET OR EXCEED4
THE ANNUAL COVERAGE LIMIT ;5
(IV) R
EPORT DATA BY MARKET SEGMENT AND PRODUCT TYPE , AS6
DEFINED BY RULE OF THE COMMISSIONER ; AND7
(V) B
E IN A FORM AND MANNER AS PRESCRIBED BY RULE OF THE8
COMMISSIONER.9
(b) F
OR THE REPORT TO BE SUBMITTED ON OR BEFORE JULY 31,10
2024,
A CARRIER SHALL ALSO SUBMIT THE INFORMATION REQUIRED IN11
SUBSECTION (3)(a) OF THIS SECTION FOR THE PLAN YEARS 2021 THROUGH12
2024.13
(c) I
F THE COMMISSIONER DEEMS THAT DATA VERIFICATION OF A14
CARRIER'S DENTAL LOSS RATIO FOR A DENTAL COVERAGE PLAN IS15
NECESSARY, THE COMMISSIONER SHALL GIVE THE CARRIER AT LEAST16
THIRTY DAYS NOTIFICATION PRIOR TO BEGINNING THE VERIFICATION17
PROCESS WITH THE CARRIER.18
(d) W
ITHIN ONE HUNDRED TWENTY DAYS AFTER THE DIVISION19
RECEIVES THE DENTAL LOSS RATIO INFORMATION COLLECTED PURSUANT20
TO SUBSECTION (3)(a) OF THIS SECTION, THE DIVISION SHALL MAKE THE21
INFORMATION, INCLUDING THE AGGREGATE DENTAL LOSS RATIO AND THE22
DATA REPORTED PURSUANT TO SUBSECTION (3)(a)(II) OF THIS SECTION,23
AVAILABLE TO THE PUBLIC IN A SEARCHABLE FORMAT ON A PUBLIC24
WEBSITE THAT ALLOWS MEMBERS OF THE PUBLIC TO COMPARE DENTAL25
LOSS RATIOS AMONG CARRIERS BY PLAN TYPE BY :26
(I) P
OSTING THE INFORMATION ON THE DIVISION 'S WEBSITE; OR27
SB23-179
-8- (II) PROVIDING THE INFORMATION TO THE ADMINISTRATOR OF THE1
ALL-PAYER HEALTH CLAIMS DATABASE ESTABLISHED PURSUANT TO2
SECTION 25.5-1-204. IF THE DIVISION PROVIDES THE INFORMATION TO THE3
ADMINISTRATOR, THE ADMINISTRATOR SHALL MAKE THE INFORMATION4
AVAILABLE TO THE PUBLIC IN A FORMAT DETERMINED BY THE DIVISION5
AND SHALL REPORT THE DATA TO THE GENERAL ASSEMBLY DURING THE6
"S
TATE MEASUREMENT FOR ACCOUNTABLE, RESPONSIVE, AND7
T
RANSPARENT (SMART) GOVERNMENT ACT" HEARINGS HELD PURSUANT8
TO PART 2 OF ARTICLE 7 OF TITLE 2.9
(4) (a) O
NCE THE DIVISION HAS COLLECTED THE DATA PURSUANT10
TO SUBSECTION (3) OF THIS SECTION FOR TWO CALENDAR YEARS , THE11
COMMISSIONER SHALL PROMULGATE RULES THAT CREATE A PROCESS TO12
IDENTIFY ANY CARRIERS THAT SIGNIFICANTLY DEVIATE FROM AVERAGE13
DENTAL LOSS RATIOS AND TO INVESTIGATE THE CAUSES OF THE14
DEVIATION. SUCH PROCESS SHALL INCLUDE:15
(I) C
ALCULATING AN AVERAGE DENTAL LOSS RATIO FOR EACH16
MARKET SEGMENT USING AGGREGATE DATA FOR A THREE -YEAR PERIOD,17
CONSISTING OF DATA FOR THE DENTAL LOSS RATIO REPORTING YEAR THAT18
IS BEING REPORTED AND THE DATA FOR THE TWO PRIOR DENTAL LOSS19
RATIO REPORTING YEARS;20
(II) I
DENTIFYING AS OUTLIERS THE DENTAL COVERAGE PLANS21
THAT FALL OUTSIDE OF A SET NUMBER OF STANDARD DEVIATIONS FROM22
THE AVERAGE DENTAL LOSS RATIO , AS DETERMINED BY RULE OF THE23
COMMISSIONER BASED ON REVIEW OF THE DATA .24
(b) T
HE COMMISSIONER MAY APPLY MORE RESTRICTIVE STANDARD25
DEVIATION METRICS OVER TIME TO PREVENT DECLINES IN THE AVERAGE26
DENTAL LOSS RATIO IN A MARKET SEGMENT AND MAY ESTABLISH BY RULE27
SB23-179
-9- ADDITIONAL CRITERIA FOR USE IN IDENTIFYING OUTLIERS .1
(5) (a) T
HE COMMISSIONER MAY ENFORCE COMPLIANCE WITH THE2
REPORTING REQUIREMENTS IN THIS SECTION AND IMPOSE A PENALTY OR3
REMEDY AGAINST A PERSON WHO VIOLATES THIS SECTION .4
(b) T
HE COMMISSIONER MAY INVESTIGATE OR TAKE ENFORCEMENT5
ACTIONS AGAINST CARRIERS THAT ARE DETERMINED TO BE OUTLIERS6
PURSUANT TO SUBSECTION (4) OF THIS SECTION AND RULES ADOPTED7
PURSUANT TO SAID SUBSECTION (4) AND IMPOSE A PENALTY OR REMEDY8
AGAINST A PERSON WHO VIOLATES THIS SECTION .9
(6) T
HE COMMISSIONER MAY PROMULGATE RULES TO IMPLEMENT10
THIS SECTION.11
SECTION 4. In Colorado Revised Statutes, 10-16-135, amend12
(1)(a) introductory portion, (1)(a)(III), (1)(a)(IV), and (1)(b) as follows:13
10-16-135. Health coverage plan information cards - rules -14
standardization - contents. (1) (a) The commissioner shall adopt rules15
requiring every carrier providing a health benefit
COVERAGE plan to issue16
to covered persons to whom a health benefit COVERAGE plan17
identification card is issued a standardized, printed card containing plan18
information. To the extent possible, the rules shall MUST incorporate and19
not conflict with the requirements of section 10-16-124 regarding20
prescription information cards. The commissioner shall adopt initial rules21
by October 31, 2008, that describe the format of a standardized, printed22
card to be issued by carriers to persons covered under a health benefit23
plan to whom health benefit plan identification cards are issued. The rules24
establishing THAT ESTABLISH the format for the printed card, shall WHICH25
RULES MUST include a standard size, shall require the card to be legible26
and photocopied, and shall delineate the information to be contained on27
SB23-179
-10- the card, including but not limited to, the following information, as1
applicable:2
(III) Contact information for the carrier or health benefit3
COVERAGE plan administrator; and4
(IV) An indication of whether the health benefit COVERAGE plan5
is regulated by the state.6
(b) The rules adopted pursuant to paragraph (a) of this subsection7
(1) shall SUBSECTION (1)(a) OF THIS SECTION MUST require all carriers to8
issue a standardized, printed card to a covered person to whom a health9
benefit COVERAGE plan identification card is issued upon the purchase or10
renewal of or enrollment in a plan on or after July 1, 2009. No later than11
July 1, 2010 THE EFFECTIVE DATE OF THIS SUBSECTION (1)(b), AS12
AMENDED. STARTING JULY 1, 2024, all carriers shall issue the13
standardized, printed card to covered persons to whom health benefit plan14
identification cards are issued CARDS.15
SECTION 5. In Colorado Revised Statutes, 25.5-1-204, add16
(5)(j) as follows:17
25.5-1-204. Advisory committee to oversee the all-payer health18
claims database - creation - members - duties - legislative declaration19
- rules - report. (5) If sufficient funding is received, the executive20
director shall direct the administrator to create the database and the21
administrator shall:22
(j) P
UBLISH INFORMATION TO THE PUBLIC CONCERNING DENTAL23
LOSS RATIO INFORMATION COLLECTED BY THE DIVISION OF INSURANCE24
PURSUANT TO SECTION 10-16-158.25
SECTION 6. Act subject to petition - effective date. This act26
takes effect at 12:01 a.m. on the day following the expiration of the27
SB23-179
-11- ninety-day period after final adjournment of the general assembly; except1
that, if a referendum petition is filed pursuant to section 1 (3) of article V2
of the state constitution against this act or an item, section, or part of this3
act within such period, then the act, item, section, or part will not take4
effect unless approved by the people at the general election to be held in5
November 2024 and, in such case, will take effect on the date of the6
official declaration of the vote thereon by the governor.7
SB23-179
-12-