Beginning January 1, 2022, the bill requires a health insurance carrier (carrier) that offers an individual health benefit plan in this state to offer a Colorado option plan in the Colorado counties where the carrier offers the individual health benefit plan. The commissioner of insurance (commissioner) is required to develop and implement a Colorado option plan that must:
- Be offered to Colorado residents who purchase health insurance in the individual market;
- Implement a standardized plan that:
- Allows consumers to easily compare health benefit plans; and
- Provides first-dollar, predeductible coverage for certain services;
- Include the essential health benefits package;
- Provide different, specific levels of coverage;
- Include a hospital reimbursement rate formula;
- Require hospital participation;
- Require a minimum medical loss ratio of 85%; and
- Require carriers and pharmacy benefit management firms to pass rebate savings through to consumers and document the savings and pass-through in a form and manner determined by the commissioner.
The Colorado option advisory board (board) is created to advise and make recommendations to the commissioner on all aspects of the Colorado option plan.
The bill authorizes the commissioner to promulgate rules to develop, implement, and operate the Colorado option plan, including:
- Expanding the Colorado option plan to the small group market;
- Establishing a hospital reimbursement rate formula; and
- Requiring carriers to offer the Colorado option plan in specific counties.
If a hospital refuses to participate in the Colorado option plan, the department of public health and environment may issue a warning, impose fines, or suspend, revoke, or impose conditions on the hospital's license.
The commissioner, in consultation with the board, is required to evaluate the Colorado option plan beginning July 1, 2024, and each year thereafter.
(Note: This summary applies to this bill as introduced.)