First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
REVISED
This Version Includes All Amendments Adopted
on Second Reading in the Second House
LLS NO. 23-0471.01 Kristen Forrestal x4217
SENATE BILL 23-179
Senate Committees House Committees
Health & Human Services Public & Behavioral Health & Human Services
Appropriations Appropriations
A BILL FOR AN ACT
C
ONCERNING INSURANCE CARRIER REQUIREMENTS FOR HEALTH101
COVERAGE PLANS, AND, IN CONNECTION THEREWITH , MAKING
102
AN APPROPRIATION.103
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
HOUSE
2nd Reading Unamended
May 3, 2023
SENATE
3rd Reading Unamended
April 14, 2023
SENATE
Amended 2nd Reading
April 13, 2023
SENATE SPONSORSHIP
Moreno and Will, Buckner, Coleman, Cutter, Exum, Gonzales, Hansen, Hinrichsen,
Jaquez Lewis, Marchman, Mullica, Priola
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. website or submit the information to the administrator of the all-payer
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
12
(c) Greater transparency on how premium dollars are spent by13
health insurance carriers provides accountability for insurance plans and14
ensures that patients get the most value for premiums paid;15
(d) Patients should have visibility regarding how many of their16
179-2- insurance premium dollars pay for health-care and dental services as1
opposed to administrative, marketing, and operational costs;2
(e) Medical loss ratio standards have been in place for health3
insurance for more than 10 years;4
(f) Dental plans in this state are not required to have equivalent5
transparency and disclosure standards, known as dental loss ratios, in6
place;7
8
(g) When patients and employers are comparing dental plans for9
purchase, they should have access to information that shows how much10
coverage is actually provided relative to what they pay in premiums for11
the coverage;12
(h) Bringing transparency to how much care the premiums are13
actually paying for is an important step to drive efficiencies in care and14
ensure value in patients' dental benefits; and15
(i) As Colorado has long been a leader in policies that increase16
transparency, value, accountability, and access to health care for17
consumers, Colorado should continue to lead and provide protections for18
consumers in accessing dental care coverage.19
(2) In order to ensure dental care is accessible for all Coloradans,20
it is critical that Colorado establish transparency and accountability for21
dental plans.22
SECTION 2. In Colorado Revised Statutes, 10-16-107, amend23
(1)(a), (1)(f), (2)(a)(I) introductory portion, and (2)(b), as follows:24
10-16-107. Rate filing regulation - benefits ratio - rules.25
(1) (a) A carrier subject to part 2, 3, or 4, OR 5 of this article ARTICLE 1626
shall not establish rates for any sickness, accident, or health insurance27
179
-3- policy, contract, certificate, or other evidence of coverage OR DENTAL1
COVERAGE PLAN, AS DEFINED IN SECTION 10-16-158 (1)(a), issued or2
delivered to any policyholder, enrollee, subscriber, or member in3
Colorado that are excessive, inadequate, or unfairly discriminatory. To4
assure compliance with the requirements of this section that rates are not5
excessive in relation to benefits, the commissioner shall promulgate rules6
to require rate filings and, as part of the rules, may require the submission7
of adequate documentation and supporting information, including8
actuarial opinions or certifications and set expected benefits ratios. The9
carrier shall submit expected rate increases to the commissioner at least10
sixty days prior to the proposed implementation of the rates. If the11
commissioner does not approve or disapprove the rate filings within a12
sixty-day period, the carrier may implement and reasonably rely upon the13
rates on the condition that the commissioner may require correction of14
any deficiencies in the rate filing upon later review if the rate the carrier15
charged is excessive, inadequate, or unfairly discriminatory. A16
prospective rate adjustment is the sole remedy for rate deficiencies17
pursuant to this subsection (1). If the commissioner finds deficiencies in18
the rate filing after a sixty-day period, the commissioner shall provide19
notice to the carrier, and the carrier shall correct the rate on a prospective20
basis.21
(f) Carriers shall file rate filings for insurance regulated under22
parts 1 to 4 5 of this article ARTICLE 16 electronically in a format made23
available by the division, unless exempted by rule for an emergency24
situation as determined by the commissioner. The division shall post on25
its website a rate filing summary for insurance regulated under parts 1 to26
4 5 of this article ARTICLE 16 in order to provide notice to the public.27
179
-4- (2) (a) (I) Rates for an individual health coverage plan issued or1
delivered to any policyholder, enrollee, subscriber, or member in2
Colorado by an insurer subject to part 2 of this article 16 or an entity3
subject to part 3, or 4, OR 5 of this article 16 shall not be excessive,4
inadequate, or unfairly discriminatory to assure compliance with the5
requirements of this section that rates are not excessive in relation to6
benefits. Rates are excessive if they are likely to produce a long run profit7
that is unreasonably high for the insurance provided or if expenses are8
unreasonably high in relation to services rendered. In determining if rates9
are excessive, the commissioner may consider:10
(b) Notwithstanding any other provision of this article ARTICLE 16,11
a carrier subject to part 2, 3, or 4, OR 5 of this article ARTICLE 16 shall not12
vary the premium rate for an individual health coverage plan due to the13
gender of the individual policyholder, enrollee, subscriber, or member.14
Any premium rate based on the gender of the individual policyholder,15
enrollee, subscriber, or member is unfairly discriminatory and is not16
allowed.17
SECTION 3. In Colorado Revised Statutes, add 10-16-158 as18
follows:19
10-16-158. Dental coverage plans - dental loss ratio - rules -20
definitions. (1) A
S USED IN THIS SECTION, UNLESS THE CONTEXT21
OTHERWISE REQUIRES:22
(a) "C
OMMUNITY BENEFIT EXPENDITURE " MEANS AN EXPENDITURE
23
FOR AN ACTIVITY OR PROGRAM , OR TO AN ORGANIZATION, WHICH SEEKS24
TO ACHIEVE THE OBJECTIVES OF IMPROVING ACCESS TO DENTAL SERVICES25
AND ENHANCING DENTAL PUBLIC HEALTH . THIS INCLUDES AN ACTIVITY26
THAT:27
179
-5- (I) IS AVAILABLE BROADLY TO THE PUBLIC AND SERVES1
LOW-INCOME CONSUMERS;2
(II) R
EDUCES GEOGRAPHIC, FINANCIAL, OR CULTURAL BARRIERS
3
TO ACCESSING DENTAL SERVICES, AND IF THE ACTIVITY CEASED TO EXIST4
WOULD RESULT IN ACCESS PROBLEMS ;5
(III) A
DDRESSES ORAL HEALTH WORKFORCE SHORTAGES , SUCH AS
6
ADVANCING EDUCATION AND TRAINING OF ORAL HEALTH PROFESSI ONALS ;7
OR8
(IV) L
EVERAGES OR ENHANCES DENTAL PUBLIC HEALTH
9
ACTIVITIES.10
(b) "DENTAL COVERAGE PLAN" MEANS A HEALTH COVERAGE PLAN11
THAT INCLUDES COVERAGE FOR THE COSTS OF DENTAL CARE SERVICES .12
"D
ENTAL COVERAGE PLAN " INCLUDES A PLAN ISSUED BY A PREPAID13
DENTAL PLAN ORGANIZATION THAT HAS A CERTIFICATE OF AUTHORITY TO14
OPERATE PURSUANT TO PART 5 OF THIS ARTICLE 16.15
(c)
(I) "DENTAL LOSS RATIO" MEANS THE PERCENTAGE OF16
PREMIUM DOLLARS COLLECTED EACH YEAR FOR A DENTAL COVERAGE17
PLAN THAT THE DENTAL COVERAGE PLAN INCURS ON DENTAL SERVICES18
PROVIDED TO AN ENROLLEE , SEPARATE FROM OVERHEAD AND19
ADMINISTRATIVE COSTS.20
(II) T
HE DENTAL LOSS RATIO IS CALCULATED BY DIVIDING THE21
NUMERATOR BY THE DENOMINATOR , WHERE:22
(A) T
HE NUMERATOR IS THE SUM OF THE AMOUNT INCURRED
FOR23
CLINICAL DENTAL SERVICES PROVIDED TO ENROLLEES , THE AMOUNT24
INCURRED ON ACTIVITIES THAT IMPROVE DENTAL CARE QUALITY , AND THE25
AMOUNT OF CLAIMS PAYMENTS IDENTIFIED THROUGH FRAUD REDUCTION26
EFFORTS; AND27
179
-6- (B) THE DENOMINATOR IS THE TOTAL AMOUNT OF PREMIUM1
REVENUE, EXCLUDING FEDERAL AND STATE TAXES , LICENSING AND2
REGULATORY FEES PAID, NONPROFIT COMMUNITY BENEFIT EXPENDITURES ,3
AND ANY OTHER PAYMENTS REQUIRED BY FEDERAL LAW .4
(2) (a) T
HE COMMISSIONER SHALL DEFINE BY RULE :5
(I) E
XPENDITURES FOR CLINICAL DENTAL SERVICES ;6
(II) A
CTIVITIES THAT IMPROVE DENTAL CARE QUALITY ;
7
(III) O
VERHEAD AND ADMINISTRATIVE COST EXPENDITURES ; AND
8
(IV) N
ONPROFIT COMMUNITY BENEFIT EXPENDITURES THAT ARE
9
ALIGNED WITH EXCLUSION PARAMETERS AND LIMITS OUTLINED IN 45 CFR10
158.162;
EXCEPT THAT THE COMMISSIONER SHALL ENSURE THAT ONLY
11
EXPENDITURES THAT IMPROVE ACCESS TO DENTAL SERVICES OR ENHANCE12
DENTAL HEALTH, AND NO OVERHEAD OR ADMINISTRATIVE COSTS , ARE13
REPORTED UNDER THIS SECTION.14
(b) T
HE DEFINITIONS PROMULGATED BY RULE PURSUANT TO THIS15
SECTION MUST BE CONSISTENT WITH SIMILAR DEFINITIONS THAT ARE USED16
FOR THE REPORTING OF MEDICAL LOSS RATIOS BY CARRIERS OFFERING17
HEALTH BENEFIT PLANS IN THE STATE. OVERHEAD AND ADMINISTRATIVE18
COSTS MUST NOT BE INCLUDED IN THE NUMERATOR AS DESCRIBED IN19
SUBSECTION (1)(b)(II)(A) OF THIS SECTION.20
(3) (a) O
N OR BEFORE JULY 31, 2024, AND ON OR BEFORE JULY 3121
EACH YEAR THEREAFTER , A CARRIER THAT ISSUES, SELLS, RENEWS, OR22
OFFERS A DENTAL COVERAGE PLAN SHALL FILE A DENTAL LOSS RATIO23
FORM ELECTRONICALLY WITH THE DIVISION FOR THE PRECEDING24
CALENDAR YEAR IN WHICH DENTAL COVERAGE WAS PROVIDED BY THE25
DENTAL COVERAGE PLAN . THE COMMISSIONER MAY CREATE A NEW26
REPORTING FORM OR USE AN EXISTING REPORTING FORM TO FACILITATE27
179
-7- DATA COLLECTION. THE COMMISSIONER SHALL ENSURE THAT FIELDS ARE1
REPORTED CONSISTENTLY BY CARRIERS . THE FILING MUST:2
(I) R
EPORT THE CALCULATED DENTAL LOSS RATIO ACCORDING TO3
THE FORMULA IN SUBSECTION (1)(b)(II) OF THIS SECTION;4
(II) S
EPARATELY REPORT EACH DATA ELEMENT DESCRIBED IN5
SUBSECTION (1)(b) OF THIS SECTION;6
(III) R
EPORT ADDITIONAL DATA THAT INCLUDES THE NUMBER OF7
ENROLLEES, THE PLAN COST-SHARING AND
DEDUCTIBLE AMOUNTS, THE8
ANNUAL MAXIMUM COVERAGE LIMIT , AND THE NUMBER OF ENROLLEES9
WHO MEET OR EXCEED THE ANNUAL COVERAGE LIMIT ;10
(IV) R
EPORT DATA BY MARKET SEGMENT AND PRODUCT TYPE , AS11
DEFINED BY RULE OF THE COMMISSIONER ; AND12
(V) B
E IN A FORM AND MANNER AS PRESCRIBED BY RULE OF THE13
COMMISSIONER.14
(b) F
OR THE REPORT TO BE SUBMITTED ON OR BEFORE JULY 31,15
2024,
A CARRIER SHALL ALSO SUBMIT THE INFORMATION REQUIRED IN16
SUBSECTION (3)(a) OF THIS SECTION FOR THE PLAN YEARS 2021 THROUGH17
2024.18
(c) I
F THE COMMISSIONER DEEMS THAT DATA VERIFICATION OF A19
CARRIER'S DENTAL LOSS RATIO FOR A DENTAL COVERAGE PLAN IS20
NECESSARY, THE COMMISSIONER SHALL GIVE THE CARRIER AT LEAST21
THIRTY DAYS NOTIFICATION PRIOR TO BEGINNING THE VERIFICATION22
PROCESS WITH THE CARRIER.23
(d) (I)
BY JANUARY 1 OF THE YEAR AFTER THE DIVISION RECEIVES24
THE DENTAL LOSS RATIO INFORMATION COLLECTED PURSUANT TO25
SUBSECTION (3)(a) OF THIS SECTION, THE DIVISION SHALL MAKE THE26
INFORMATION, INCLUDING THE AGGREGATE DENTAL LOSS RATIO AND THE27
179
-8- DATA REPORTED PURSUANT TO SUBSECTIONS (3)(a)(II) AND (3)(a)(III) OF1
THIS SECTION, AVAILABLE TO THE PUBLIC IN A SEARCHABLE FORMAT ON2
A PUBLIC WEBSITE THAT ALLOWS MEMBERS OF THE PUBLIC TO COMPARE3
DENTAL LOSS RATIOS AMONG CARRIERS BY PLAN TYPE BY :4
(A) POSTING THE INFORMATION ON THE DIVISION 'S WEBSITE; OR5
(B) PROVIDING THE INFORMATION TO THE ADMINISTRATOR OF THE6
ALL-PAYER HEALTH CLAIMS DATABASE ESTABLISHED PURSUANT TO7
SECTION 25.5-1-204. IF THE DIVISION PROVIDES THE INFORMATION TO THE8
ADMINISTRATOR, THE ADMINISTRATOR SHALL MAKE THE INFORMATION9
AVAILABLE TO THE PUBLIC IN A FORMAT DETERMINED BY THE DIVISION .10
(II) T
HE DIVISION
SHALL REPORT THE DATA IN SUBSECTION (3)(a)11
OF THIS SECTION, AND, IF AVAILABLE, SUBSECTION (4)(a) OF THIS SECTION,12
TO THE GENERAL ASSEMBLY DURING THE "STATE MEASUREMENT FOR13
A
CCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART)14
G
OVERNMENT ACT" HEARINGS HELD PURSUANT TO PART 2 OF ARTICLE 715
OF TITLE 2.16
(4) (a) O
NCE THE DIVISION HAS COLLECTED THE DATA PURSUANT17
TO SUBSECTION (3) OF THIS SECTION FOR TWO CALENDAR YEARS , THE18
COMMISSIONER SHALL PROMULGATE RULES THAT CREATE A PROCESS TO19
IDENTIFY ANY CARRIERS THAT SIGNIFICANTLY DEVIATE FROM AVERAGE20
DENTAL LOSS RATIOS AND TO INVESTIGATE THE CAUSES OF THE21
DEVIATION. SUCH PROCESS SHALL INCLUDE:22
(I) C
ALCULATING AN AVERAGE DENTAL LOSS RATIO FOR EACH23
MARKET SEGMENT USING AGGREGATE DATA FOR A THREE -YEAR PERIOD,24
CONSISTING OF DATA FOR THE DENTAL LOSS RATIO REPORTING YEAR THAT25
IS BEING REPORTED AND THE DATA FOR THE TWO PRIOR DENTAL LOSS26
RATIO REPORTING YEARS;27
179
-9- (II) IDENTIFYING AS OUTLIERS THE DENTAL COVERAGE PLANS1
THAT FALL OUTSIDE OF A SET NUMBER OF STANDARD DEVIATIONS FROM2
THE AVERAGE DENTAL LOSS RATIO , AS DETERMINED BY RULE OF THE3
COMMISSIONER BASED ON REVIEW OF THE DATA AND CONSIDERATION OF4
THE IMPACT OF NONPROFIT COMMUNITY BENEFIT EXPENDITURES ON ANY5
OUTLIER CALCULATION.6
(b) T
HE COMMISSIONER MAY APPLY MORE RESTRICTIVE STANDARD7
DEVIATION METRICS OVER TIME TO PREVENT DECLINES IN THE AVERAGE8
DENTAL LOSS RATIO IN A MARKET SEGMENT AND MAY ESTABLISH BY RULE9
ADDITIONAL CRITERIA FOR USE IN IDENTIFYING OUTLIERS .10
(5) (a) T
HE COMMISSIONER MAY ENFORCE COMPLIANCE WITH THE11
REPORTING REQUIREMENTS IN THIS SECTION AND IMPOSE A PENALTY OR12
REMEDY AGAINST A PERSON WHO VIOLATES THIS SECTION .13
(b) T
HE COMMISSIONER MAY INVESTIGATE OR TAKE ENFORCEMENT14
ACTIONS AGAINST CARRIERS THAT ARE DETERMINED TO BE OUTLIERS15
PURSUANT TO SUBSECTION (4) OF THIS SECTION AND RULES ADOPTED16
PURSUANT TO SAID SUBSECTION (4) AND IMPOSE A PENALTY OR REMEDY17
AGAINST A PERSON WHO VIOLATES THIS SECTION .18
(6) T
HE COMMISSIONER MAY PROMULGATE RULES TO IMPLEMENT19
THIS SECTION.20
SECTION 4. In Colorado Revised Statutes, 10-16-135, add21
(7) as follows:22
10-16-135. Health coverage plan information cards - rules -23
standardization - contents. (7) T
HE COMMISSIONER SHALL ADOPT RULES
24
THAT REQUIRE EACH CARRIER THAT PROVIDES A DENTAL COVERAGE PLAN ,25
AS DEFINED IN SECTION 10-16-158 (1)(a), TO ISSUE TO COVERED PERSONS26
TO WHOM A DENTAL COVERAGE PLAN IDENTIFICATION CARD IS ISSUED A27
179
-10- STANDARDIZED WRI TTEN OR VIRTUAL CARD CONTAINING PLAN1
INFORMATION. TO THE EXTENT POSSIBLE, THE RULES MUST INCORPORATE2
AND NOT CONFLICT WITH THE REQUIREMENTS OF SECTION 10-16-1243
REGARDING PRESCRIPTION INFORMATION CARDS . THE COMMISSIONER4
SHALL ADOPT RULES BY MARCH 31, 2024, THAT DESCRIBE THE FORMAT OF5
THE STANDARDIZED CARD TO BE ISSUED BY CARRIERS . THE RULES6
ESTABLISHING THE FORMAT FOR THE CARD MUST INCLUDE A STANDARD7
SIZE, MUST REQUIRE THE CARD TO BE LEGIBLE AND PHOTOCOPIED , AND8
MUST DELINEATE THE INFORMATION TO BE CONTAINED ON THE CARD ,9
INCLUDING THE FOLLOWING, AS APPLICABLE:10
(a) T
HE COVERED PERSON'S NAME AND THE APPLICABLE PLAN
11
NUMBER;12
(b) C
ONTACT INFORMATION FOR THE CARRIER OR DENTAL
13
COVERAGE PLAN ADMINISTRATOR ; AND14
(c) A
N INDICATION OF WHETHER THE DENTAL COVERAGE PLAN IS
15
REGULATED BY THE STATE OF COLORADO.16
SECTION 5. In Colorado Revised Statutes, 25.5-1-204, add17
(5)(j) as follows:18
25.5-1-204. Advisory committee to oversee the all-payer health19
claims database - creation - members - duties - legislative declaration20
- rules - report. (5) If sufficient funding is received, the executive21
director shall direct the administrator to create the database and the22
administrator shall:23
(j) S
UBJECT TO AVAILABLE APPROPRIATIONS AND AT THE REQUEST
24
OF THE COMMISSIONER OF INSURANCE , PUBLISH INFORMATION TO THE25
PUBLIC CONCERNING DENTAL LOSS RATIO INFORMATION COLLECTED BY26
THE DIVISION OF INSURANCE PURSUANT TO SECTION 10-16-158.27
179
-11- SECTION 6. Appropriation. For the 2023-24 state fiscal year,1
$64,252 is appropriated to the department of regulatory agencies for use2
by the division of insurance. This appropriation is from the division of3
insurance cash fund created in section 10-1-103 (3), C.R.S. To implement4
this act, the division may use this appropriation as follows: 5
(a) $56,637 for personal services, which amount is based on an6
assumption that the division will require an additional 0.7 FTE; and7
(b) $7,615 for operating expenses.8
SECTION 7. Act subject to petition - effective date. This act9
takes effect at 12:01 a.m. on the day following the expiration of the10
ninety-day period after final adjournment of the general assembly; except11
that, if a referendum petition is filed pursuant to section 1 (3) of article V12
of the state constitution against this act or an item, section, or part of this13
act within such period, then the act, item, section, or part will not take14
effect unless approved by the people at the general election to be held in15
November 2024 and, in such case, will take effect on the date of the16
official declaration of the vote thereon by the governor.17
179
-12-