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SENATE BILL 23-179

BY SENATOR(S) Moreno and Will, Buckner, Coleman, Cutter, Exum,

Gonzales, Hansen, Hinrichsen, Jaquez Lewis, Marchman, Mullica, Priola;

also REPRESENTATIVE(S) Hartsook and Daugherty, Amabile, Bird,

Boesenecker, Brown, deGruy Kennedy, Dickson, Gonzales-Gutierrez,

Hamrick, Jodeh, Lindsay, Marshall, Michaelson Jenet, Ricks, Weissman,

Willford, Young, McCluskie.

ONCERNING INSURANCE CARRIER REQUIREMENTS FOR HEALTH COVERAGE

PLANS

, AND, IN CONNECTION THEREWITH, MAKING AN

APPROPRIATION

Be it enacted by the General Assembly of the State of Colorado:

SECTION 1. Legislative declaration. (1) The general assembly

finds and declares that:

(a) Access to quality dental care is an essential component of every

Coloradan's health and well-being, as untreated dental issues contribute to

a number of serious medical conditions, including chronic obstructive

pulmonary disease, heart disease, stroke, and preterm labor or premature

birth, all of which drastically increase costs to individuals and to the state;

NOTE: This bill has been prepared for the signatures of the appropriate legislative

officers and the Governor. To determine whether the Governor has signed the bill

or taken other action on it, please consult the legislative status sheet, the legislative

history, or the Session Laws.

________

Capital letters or bold & italic numbers indicate new material added to existing law; dashes

through words or numbers indicate deletions from existing law and such material is not part of

the act.

(b) Meaningful insurance coverage is one of the most important

factors behind patients utilizing dental care services;

insurance carriers provides accountability for insurance plans and ensures

that patients get the most value for premiums paid;

(d) Patients should have visibility regarding how many of their

insurance premium dollars pay for health-care and dental services as

opposed to administrative, marketing, and operational costs;

(e) Medical loss ratio standards have been in place for health

insurance for more than 10 years;

(f) Dental plans in this state are not required to have equivalent

transparency and disclosure standards, known as dental loss ratios, in place;

(g) When patients and employers are comparing dental plans for

purchase, they should have access to information that shows how much

coverage is actually provided relative to what they pay in premiums for the

coverage;

(h) Bringing transparency to how much care the premiums are

actually paying for is an important step to drive efficiencies in care and

ensure value in patients' dental benefits; and

(i) As Colorado has long been a leader in policies that increase

transparency, value, accountability, and access to health care for consumers,

Colorado should continue to lead and provide protections for consumers in

accessing dental care coverage.

(2) In order to ensure dental care is accessible for all Coloradans, it

is critical that Colorado establish transparency and accountability for dental

plans.

SECTION 2. In Colorado Revised Statutes, 10-16-107, amend

(1)(a), (1)(f), (2)(a)(I) introductory portion, and (2)(b) as follows:

10-16-107. Rate filing regulation - benefits ratio - rules. (1) (a) A

carrier subject to part 2, 3, or

4, OR 5 of this article ARTICLE 16 shall not

PAGE 2-SENATE BILL 23-179

establish rates for any sickness, accident, or health insurance policy,

contract, certificate, or other evidence of coverage

OR DENTAL COVERAGE

PLAN

, AS DEFINED IN SECTION 10-16-165 (1)(a), issued or delivered to any

policyholder, enrollee, subscriber, or member in Colorado that are

excessive, inadequate, or unfairly discriminatory. To assure compliance

with the requirements of this section that rates are not excessive in relation

to benefits, the commissioner shall promulgate rules to require rate filings

and, as part of the rules, may require the submission of adequate

documentation and supporting information, including actuarial opinions or

certifications and set expected benefits ratios. The carrier shall submit

expected rate increases to the commissioner at least sixty days prior to the

proposed implementation of the rates. If the commissioner does not approve

or disapprove the rate filings within a sixty-day period, the carrier may

implement and reasonably rely upon the rates on the condition that the

commissioner may require correction of any deficiencies in the rate filing

upon later review if the rate the carrier charged is excessive, inadequate, or

unfairly discriminatory. A prospective rate adjustment is the sole remedy for

rate deficiencies pursuant to this subsection (1). If the commissioner finds

deficiencies in the rate filing after a sixty-day period, the commissioner

shall provide notice to the carrier, and the carrier shall correct the rate on a

prospective basis.

(f) Carriers shall file rate filings for insurance regulated under parts

1 to 4

5 of this article ARTICLE 16 electronically in a format made available

by the division, unless exempted by rule for an emergency situation as

determined by the commissioner. The division shall post on its website a

rate filing summary for insurance regulated under parts 1 to 4

5 of this

article

ARTICLE 16 in order to provide notice to the public.

(2) (a) (I) Rates for an individual health coverage plan issued or

delivered to any policyholder, enrollee, subscriber, or member in Colorado

by an insurer subject to part 2 of this article 16 or an entity subject to part

3, or

4, OR 5 of this article 16 shall not be excessive, inadequate, or unfairly

discriminatory to assure compliance with the requirements of this section

that rates are not excessive in relation to benefits. Rates are excessive if

they are likely to produce a long run profit that is unreasonably high for the

insurance provided or if expenses are unreasonably high in relation to

services rendered. In determining if rates are excessive, the commissioner

may consider:

PAGE 3-SENATE BILL 23-179

(b) Notwithstanding any other provision of this article ARTICLE 16,

a carrier subject to part 2, 3, or

4, OR 5 of this article ARTICLE 16 shall not

vary the premium rate for an individual health coverage plan due to the

gender of the individual policyholder, enrollee, subscriber, or member. Any

premium rate based on the gender of the individual policyholder, enrollee,

subscriber, or member is unfairly discriminatory and is not allowed.

SECTION 3. In Colorado Revised Statutes, add 10-16-165 as

follows:

10-16-165. Dental coverage plans - dental loss ratio - rules -

definitions. (1) A

S USED IN THIS SECTION, UNLESS THE CONTEXT

OTHERWISE REQUIRES

(a) "C

OMMUNITY BENEFIT EXPENDITURE" MEANS AN EXPENDITURE

FOR AN ACTIVITY OR PROGRAM

, OR TO AN ORGANIZATION, WHICH SEEKS TO

ACHIEVE THE OBJECTIVES OF IMPROVING ACCESS TO DENTAL SERVICES AND

ENHANCING DENTAL PUBLIC HEALTH

. THIS INCLUDES AN ACTIVITY THAT:

(I) I

S AVAILABLE BROADLY TO THE PUBLIC AND SERVES LOW-INCOME

CONSUMERS

;

(II) R

EDUCES GEOGRAPHIC, FINANCIAL, OR CULTURAL BARRIERS TO

ACCESSING DENTAL SERVICES

, AND IF THE ACTIVITY CEASED TO EXIST

WOULD RESULT IN ACCESS PROBLEMS

;

(III) A

DDRESSES ORAL HEALTH WORKFORCE SHORTAGES, SUCH AS

ADVANCING EDUCATION AND TRAINING OF ORAL HEALTH PROFESSIONALS

;

(IV) LEVERAGES OR ENHANCES DENTAL PUBLIC HEALTH ACTIVITIES.

(b) "D

ENTAL COVERAGE PLAN" MEANS A HEALTH COVERAGE PLAN

THAT INCLUDES COVERAGE FOR THE COSTS OF DENTAL CARE SERVICES

ENTAL COVERAGE PLAN" INCLUDES A PLAN ISSUED BY A PREPAID DENTAL

PLAN ORGANIZATION THAT HAS A CERTIFICATE OF AUTHORITY TO OPERATE

PURSUANT TO PART

5 OF THIS ARTICLE 16.

ENTAL LOSS RATIO" MEANS THE PERCENTAGE OF PREMIUM

DOLLARS COLLECTED EACH YEAR FOR A DENTAL COVERAGE PLAN THAT THE

PAGE 4-SENATE BILL 23-179

DENTAL COVERAGE PLAN INCURS ON DENTAL SERVICES PROVIDED TO AN

ENROLLEE

, SEPARATE FROM OVERHEAD AND ADMINISTRATIVE COSTS.

(II) T

HE DENTAL LOSS RATIO IS CALCULATED BY DIVIDING THE

NUMERATOR BY THE DENOMINATOR

, WHERE:

(A) T

HE NUMERATOR IS THE SUM OF THE AMOUNT INCURRED FOR

CLINICAL DENTAL SERVICES PROVIDED TO ENROLLEES

, THE AMOUNT

INCURRED ON ACTIVITIES THAT IMPROVE DENTAL CARE QUALITY

, AND THE

AMOUNT OF CLAIMS PAYMENTS IDENTIFIED THROUGH FRAUD REDUCTION

EFFORTS

; AND

(B) THE DENOMINATOR IS THE TOTAL AMOUNT OF PREMIUM

REVENUE

, EXCLUDING FEDERAL AND STATE TAXES, LICENSING AND

REGULATORY FEES PAID

, NONPROFIT COMMUNITY BENEFIT EXPENDITURES,

AND ANY OTHER PAYMENTS REQUIRED BY FEDERAL LAW.

(2) (a) T

HE COMMISSIONER SHALL DEFINE BY RULE:

(I) E

XPENDITURES FOR CLINICAL DENTAL SERVICES;

(II) A

CTIVITIES THAT IMPROVE DENTAL CARE QUALITY;

(III) O

VERHEAD AND ADMINISTRATIVE COST EXPENDITURES; AND

(IV) NONPROFIT COMMUNITY BENEFIT EXPENDITURES THAT ARE

ALIGNED WITH EXCLUSION PARAMETERS AND LIMITS OUTLINED IN

45 CFR

158.162;

EXCEPT THAT THE COMMISSIONER SHALL ENSURE THAT ONLY

EXPENDITURES THAT IMPROVE ACCESS TO DENTAL SERVICES OR ENHANCE

DENTAL HEALTH

, AND NO OVERHEAD OR ADMINISTRATIVE COSTS, ARE

REPORTED UNDER THIS SECTION

(b) T

HE DEFINITIONS PROMULGATED BY RULE PURSUANT TO THIS

SECTION MUST BE CONSISTENT WITH SIMILAR DEFINITIONS THAT ARE USED

FOR THE REPORTING OF MEDICAL LOSS RATIOS BY CARRIERS OFFERING

HEALTH BENEFIT PLANS IN THE STATE

. OVERHEAD AND ADMINISTRATIVE

COSTS MUST NOT BE INCLUDED IN THE NUMERATOR AS DESCRIBED IN

SUBSECTION

(1)(b)(II)(A) OF THIS SECTION.

(3) (a) O

N OR BEFORE JULY 31, 2024, AND ON OR BEFORE JULY 31

PAGE 5-SENATE BILL 23-179

EACH YEAR THEREAFTER, A CARRIER THAT ISSUES, SELLS, RENEWS, OR

OFFERS A DENTAL COVERAGE PLAN SHALL FILE A DENTAL LOSS RATIO FORM

ELECTRONICALLY WITH THE DIVISION FOR THE PRECEDING CALENDAR YEAR

IN WHICH DENTAL COVERAGE WAS PROVIDED BY THE DENTAL COVERAGE

PLAN

. THE COMMISSIONER MAY CREATE A NEW REPORTING FORM OR USE AN

EXISTING REPORTING FORM TO FACILITATE DATA COLLECTION

. THE

COMMISSIONER SHALL ENSURE THAT FIELDS ARE REPORTED CONSISTENTLY

BY CARRIERS

. THE FILING MUST:

(I) R

EPORT THE CALCULATED DENTAL LOSS RATIO ACCORDING TO

THE FORMULA IN SUBSECTION

(1)(b)(II) OF THIS SECTION;

(II) S

EPARATELY REPORT EACH DATA ELEMENT DESCRIBED IN

SUBSECTION

(1)(b) OF THIS SECTION;

(III) R

EPORT ADDITIONAL DATA THAT INCLUDES THE NUMBER OF

ENROLLEES

, THE PLAN COST-SHARING AND DEDUCTIBLE AMOUNTS, THE

ANNUAL MAXIMUM COVERAGE LIMIT

, AND THE NUMBER OF ENROLLEES WHO

MEET OR EXCEED THE ANNUAL COVERAGE LIMIT

;

(IV) R

EPORT DATA BY MARKET SEGMENT AND PRODUCT TYPE, AS

DEFINED BY RULE OF THE COMMISSIONER

; AND

(V) BE IN A FORM AND MANNER AS PRESCRIBED BY RULE OF THE

COMMISSIONER

(b) F

OR THE REPORT TO BE SUBMITTED ON OR BEFORE JULY 31, 2024,

A CARRIER SHALL ALSO SUBMIT THE INFORMATION REQUIRED IN SUBSECTION

(3)(a) OF THIS SECTION FOR THE PLAN YEARS 2021 THROUGH 2024.

F THE COMMISSIONER DEEMS THAT DATA VERIFICATION OF A

CARRIER

'S DENTAL LOSS RATIO FOR A DENTAL COVERAGE PLAN IS

NECESSARY

, THE COMMISSIONER SHALL GIVE THE CARRIER AT LEAST THIRTY

DAYS NOTIFICATION PRIOR TO BEGINNING THE VERIFICATION PROCESS WITH

THE CARRIER

(d) (I) B

Y JANUARY 1 OF THE YEAR AFTER THE DIVISION RECEIVES

THE DENTAL LOSS RATIO INFORMATION COLLECTED PURSUANT TO

SUBSECTION

(3)(a) OF THIS SECTION, THE DIVISION SHALL MAKE THE

INFORMATION

, INCLUDING THE AGGREGATE DENTAL LOSS RATIO AND THE

PAGE 6-SENATE BILL 23-179

DATA REPORTED PURSUANT TO SUBSECTIONS (3)(a)(II) AND (3)(a)(III) OF

THIS SECTION

, AVAILABLE TO THE PUBLIC IN A SEARCHABLE FORMAT ON A

PUBLIC WEBSITE THAT ALLOWS MEMBERS OF THE PUBLIC TO COMPARE

DENTAL LOSS RATIOS AMONG CARRIERS BY PLAN TYPE BY

(A) P

OSTING THE INFORMATION ON THE DIVISION'S WEBSITE; OR

(B) PROVIDING THE INFORMATION TO THE ADMINISTRATOR OF THE

ALL

-PAYER HEALTH CLAIMS DATABASE ESTABLISHED PURSUANT TO SECTION

25.5-1-204. IF THE DIVISION PROVIDES THE INFORMATION TO THE

ADMINISTRATOR

, THE ADMINISTRATOR SHALL MAKE THE INFORMATION

AVAILABLE TO THE PUBLIC IN A FORMAT DETERMINED BY THE DIVISION

(II) T

HE DIVISION SHALL REPORT THE DATA IN SUBSECTION (3)(a) OF

THIS SECTION

, AND, IF AVAILABLE, SUBSECTION (4)(a) OF THIS SECTION, TO

THE GENERAL ASSEMBLY DURING THE

"STATE MEASUREMENT FOR

ACCOUNTABLE, RESPONSIVE, AND TRANSPARENT (SMART) GOVERNMENT

ACT" HEARINGS HELD PURSUANT TO PART 2 OF ARTICLE 7 OF TITLE 2.

(4) (a) O

NCE THE DIVISION HAS COLLECTED THE DATA PURSUANT TO

SUBSECTION

(3) OF THIS SECTION FOR TWO CALENDAR YEARS, THE

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

UCH PROCESS SHALL INCLUDE:

(I) C

ALCULATING AN AVERAGE DENTAL LOSS RATIO FOR EACH

MARKET SEGMENT USING AGGREGATE DATA FOR A THREE

-YEAR PERIOD,

CONSISTING OF DATA FOR THE DENTAL LOSS RATIO REPORTING YEAR THAT

IS BEING REPORTED AND THE DATA FOR THE TWO PRIOR DENTAL LOSS RATIO

REPORTING YEARS

;

(II) I

DENTIFYING AS OUTLIERS THE DENTAL COVERAGE PLANS THAT

FALL OUTSIDE OF A SET NUMBER OF STANDARD DEVIATIONS FROM THE

AVERAGE DENTAL LOSS RATIO

, AS DETERMINED BY RULE OF THE

COMMISSIONER BASED ON REVIEW OF THE DATA AND CONSIDERATION OF THE

IMPACT OF NONPROFIT COMMUNITY BENEFIT EXPENDITURES ON ANY OUTLIER

CALCULATION

(b) T

HE COMMISSIONER MAY APPLY MORE RESTRICTIVE STANDARD

PAGE 7-SENATE BILL 23-179

DEVIATION METRICS OVER TIME TO PREVENT DECLINES IN THE AVERAGE

DENTAL LOSS RATIO IN A MARKET SEGMENT AND MAY ESTABLISH BY RULE

ADDITIONAL CRITERIA FOR USE IN IDENTIFYING OUTLIERS

(5) (a) T

HE COMMISSIONER MAY ENFORCE COMPLIANCE WITH THE

REPORTING REQUIREMENTS IN THIS SECTION AND IMPOSE A PENALTY OR

REMEDY AGAINST A PERSON WHO VIOLATES THIS SECTION

(b) T

HE COMMISSIONER MAY INVESTIGATE OR TAKE ENFORCEMENT

ACTIONS AGAINST CARRIERS THAT ARE DETERMINED TO BE OUTLIERS

PURSUANT TO SUBSECTION

(4) OF THIS SECTION AND RULES ADOPTED

PURSUANT TO SAID SUBSECTION

(4) AND IMPOSE A PENALTY OR REMEDY

AGAINST A PERSON WHO VIOLATES THIS SECTION

(6) T

HE COMMISSIONER MAY PROMULGATE RULES TO IMPLEMENT

THIS SECTION

SECTION 4. In Colorado Revised Statutes, 10-16-135, add (7) as

follows:

10-16-135. Health coverage plan information cards - rules -

standardization - contents. (7) T

HE COMMISSIONER SHALL ADOPT RULES

THAT REQUIRE EACH CARRIER THAT PROVIDES A DENTAL COVERAGE PLAN

AS DEFINED IN SECTION 10-16-165 (1)(a), TO ISSUE TO COVERED PERSONS TO

WHOM A DENTAL COVERAGE PLAN IDENTIFICATION CARD IS ISSUED A

STANDARDIZED WRITTEN OR VIRTUAL CARD CONTAINING PLAN

INFORMATION

. TO THE EXTENT POSSIBLE, THE RULES MUST INCORPORATE

AND NOT CONFLICT WITH THE REQUIREMENTS OF SECTION

10-16-124

REGARDING PRESCRIPTION INFORMATION CARDS. THE COMMISSIONER SHALL

ADOPT RULES BY

MARCH 31, 2024, THAT DESCRIBE THE FORMAT OF THE

STANDARDIZED CARD TO BE ISSUED BY CARRIERS

. THE RULES ESTABLISHING

THE FORMAT FOR THE CARD MUST INCLUDE A STANDARD SIZE

, MUST REQUIRE

THE CARD TO BE LEGIBLE AND PHOTOCOPIED

, AND MUST DELINEATE THE

INFORMATION TO BE CONTAINED ON THE CARD

, INCLUDING THE FOLLOWING,

AS APPLICABLE:

(a) T

HE COVERED PERSON'S NAME AND THE APPLICABLE PLAN

NUMBER

;

(b) C

ONTACT INFORMATION FOR THE CARRIER OR DENTAL COVERAGE

PAGE 8-SENATE BILL 23-179

PLAN ADMINISTRATOR; AND

REGULATED BY THE STATE OF

COLORADO.

SECTION 5. In Colorado Revised Statutes, 25.5-1-204, add (5)(j)

as follows:

25.5-1-204. Advisory committee to oversee the all-payer health

claims database - creation - members - duties - legislative declaration

- rules - report. (5) If sufficient funding is received, the executive director

shall direct the administrator to create the database and the administrator

shall:

(j) S

UBJECT TO AVAILABLE APPROPRIATIONS AND AT THE REQUEST

OF THE COMMISSIONER OF INSURANCE

, PUBLISH INFORMATION TO THE PUBLIC

CONCERNING DENTAL LOSS RATIO INFORMATION COLLECTED BY THE

DIVISION OF INSURANCE PURSUANT TO SECTION

10-16-165.

SECTION 6. Appropriation. For the 2023-24 state fiscal year,

$64,252 is appropriated to the department of regulatory agencies for use by

the division of insurance. This appropriation is from the division of

insurance cash fund created in section 10-1-103 (3), C.R.S. To implement

this act, the division may use this appropriation as follows:

(a) $56,637 for personal services, which amount is based on an

assumption that the division will require an additional 0.7 FTE; and

(b) $7,615 for operating expenses.

SECTION 7. Act subject to petition - effective date. This act

takes effect at 12:01 a.m. on the day following the expiration of the

ninety-day period after final adjournment of the general assembly; except

that, if a referendum petition is filed pursuant to section 1 (3) of article V

of the state constitution against this act or an item, section, or part of this act

within such period, then the act, item, section, or part will not take effect

unless approved by the people at the general election to be held in

PAGE 9-SENATE BILL 23-179

November 2024 and, in such case, will take effect on the date of the official

declaration of the vote thereon by the governor.

____________________________ ____________________________

Steve Fenberg Julie McCluskie

PRESIDENT OF SPEAKER OF THE HOUSE

THE SENATE OF REPRESENTATIVES

____________________________ ____________________________

Cindi L. Markwell Robin Jones

SECRETARY OF CHIEF CLERK OF THE HOUSE

THE SENATE OF REPRESENTATIVES

APPROVED________________________________________

(Date and Time)

_________________________________________

Jared S. Polis

GOVERNOR OF THE STATE OF COLORADO

PAGE 10-SENATE BILL 23-179