3 Colo. Code Regs. § 702-4-2-64-9
Current through Register Vol. 48, No. 1, January 10, 2025
Section 3 CCR 702-4-2-64-9 - [Effective 1/30/2025] Annual Filings to the CommissionerA. As part of their annual health benefit plan filings, carriers shall provide the financial requirements and quantitative treatment limitation annual compliance documents, as detailed in this section.B. Timing and Format of Filings 1. Carriers offering plans in the non-grandfathered individual and small group markets shall submit fully completed "Financial Requirements Attestation" and "Financial Requirements and Quantitative Treatment Limitation Classification" documents by the date designated by the Division for annual filings. Carriers are required to use the template provided in SERFF to complete the "Financial Requirements Attestation" and "Financial Requirements and Quantitative Treatment Limitation Classification" submissions.2. Carriers offering plans in the non-grandfathered large group, student health policy, and short-term limited duration policy lines of business shall submit fully completed the "Financial Requirements Attestation" and "Financial Requirements and Quantitative Treatment Limitation Classifications" documents no later than March 1 of each year and prior to the submission of any rates, as applicable, for an upcoming plan year.3. Carriers shall submit the completed "Financial Requirements Attestation" and "Quantitative Treatment Limitation Classifications" in SERFF as an "Annual MHPAEA Compliance Statement" filing. This filing shall be submitted separately from any rate, form, annual certification, binder or network adequacy filing.4. Carriers shall use "On Approval" for the "Implementation Date" in SERFF.5. Carriers shall use "File and Use" for the "Requested Filing Mode" in SERFF.6. Carriers shall provide a filing description, including the plan year the filing will support.C. Attestations Carriers shall attest that all plans meet the requirements of § 10-16-104 (5.5), C.R.S., and Colorado Insurance Regulation 4-2-64, in that all benefits associated with behavioral, mental health and substance use disorder meet all of the requirements of Colorado and federal law. Carriers must also attest to the following:
1. The plan meets the requirements of Section 6 of this regulation concerning financial requirements and quantitative treatment limitations.2. The plan meets the requirements of Section 7 of this regulation concerning non-quantitative treatment limitations;3. The coverage for autism spectrum disorders may not be subject to copayments, coinsurance, or deductibles that are less favorable than those applied to physical illness for the following services: a. Evaluation and assessment services;b. Habilitative benefits, including occupational therapy, physical therapy and speech therapy;c. Rehabilitative benefits, including occupational therapy, physical therapy and speech therapy;d. Pharmacy care and medication, if covered by the health benefit plan;f. Psychological care, including family counseling; and4. The expected claim payments utilize a reasonable and credible method to determine the estimated claim payments associated with the medical/surgical benefits that are subject to a financial requirement or quantitative treatment limitation. The method utilized must conform to the Actuarial Standards of Practice.5. The attestation shall be signed by an actuary and the president, vice president, assistant vice president, corporate secretary, assistant corporate secretary, chief executive officer, chief financial officer, chief operating officer, general counsel or other person, with documentation showing that the person has been appointed a company officer by the board of directors.D. Quantitative Treatment Limitation Classifications:1. Carriers shall provide Quantitative Treatment Limitation Classifications for the following plans: a. For individual and small group plans, carriers shall provide the required calculations for plans identified by the Division, which are chosen upon submission of reasonable modifications filings. The Division may increase the number of plans reviewed upon binder submissions. Carriers shall be notified of such via SERFF.b. For large group, student health policies and short-term limited duration policies, carriers shall provide the required calculations for the top ten (10) plan designs or top twenty percent (20%) of plan designs by premium volume, whichever is greater provided.2. Carriers shall provide the classification of all benefits, except emergency room and prescription drugs, provided by the plan as: inpatient, in-network; inpatient, out-of-network; outpatient, in-network; or outpatient, out-of-network. If the carrier sub-classifies the outpatient benefits, the carrier shall specify which of the outpatient benefits is considered an "Office Visit" or is included in the "All Other Outpatient Items and Services" category. Carriers shall not subclassify outpatient benefits using any other classes other than "Office Visits" and "All Other Outpatient Items and Services."3. Carriers shall provide the copay or coinsurance amount that applies to each of the benefits. Carriers shall also identify whether the deductible, if any, applies to the benefit.4. Carriers shall provide the expected claims payments for all medical/surgical benefits provided by the plan.5. Carriers shall not include expected claim payments for any behavioral, mental health, or substance use disorder benefits in the Quantitative Treatment Limitation Classification, including applied behavioral analysis therapy for autism spectrum disorders.6. If the carrier utilizes multiple in-network tiers, the carrier shall supply two (2) versions of the "Quantitative Treatment Limitation Classifications" worksheet, identifying the template to which the tier applies.E. The signatures required by this Section 9 must be an original or valid electronic signature of the person signing. Signature stamps, photocopies or a signature on behalf of the authorized signer are not acceptable. Electronic signatures shall be in compliance with § 24-71.3-101 et seq., C.R.S., and applicable regulations.37 CR 11, June 10, 2014, effective 7/1/201437 CR 12, June 25, 2014, effective 7/15/2014Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/201437 CR 23, December 10, 2014, effective 1/1/201538 CR 03, February 10, 2015, effective 3/15/201538 CR 06, March 25, 2015, effective 4/30/201538 CR 09, May 10, 2015, effective 6/1/201538 CR 13, July 10, 2015, effective 7/30/201538 CR 19, October 10, 2015, effective 11/1/201538 CR 21, November 10, 2015, effective 1/1/201638 CR 23, December 10, 2015, effective 1/1/201639 CR 01, January 10, 2016, effective 2/1/201639 CR 05, March 10, 2016, effective 4/1/201639 CR 08, April 25, 2016, effective 5/15/201639 CR 19, October 10, 2016, effective 11/1/201639 CR 20, October 25, 2016, effective 1/1/201739 CR 22, November 25, 2016, effective 1/1/201739 CR 23, December 10, 2016, effective 1/1/201739 CR 23, December 25, 2016, effective 1/1/201740 CR 03, February 10, 2017, effective 3/15/201740 CR 09, May 10, 2017, effective 6/1/201740 CR 15, August 10, 2017, effective 9/1/201740 CR 17, September 10, 2017, effective 10/1/201740 CR 21, November 10, 2017, effective 12/1/201741 CR 04, February 25, 2018, effective 4/1/201841 CR 05, March 10, 2018, effective 6/1/201841 CR 08, April 25, 2018, effective 6/1/201841 CR 09, May 10, 2018, effective 6/1/201841 CR 11, June 10, 2018, effective 7/1/201841 CR 15, August 10, 2018, effective 9/1/201841 CR 17, September 10, 2018, effective 10/1/201841 CR 18, September 25, 2018, effective 10/15/201841 CR 21, November 10, 2018, effective 12/1/201841 CR 23, December 10, 2018, effective 1/1/201942 CR 01, January 10, 2019, effective 2/1/201941 CR 19, October 10, 2018, effective 3/1/201942 CR 03, February 10, 2019, effective 4/1/201942 CR 04, February 25, 2019, effective 4/1/201942 CR 06, March 25, 2019, effective 6/1/201942 CR 08, April 10, 2019, effective 6/1/201942 CR 15, August 10, 2019, effective 9/1/201942 CR 17, September 10, 2019, effective 10/1/201943 CR 02, January 25, 2020, effective 12/20/201943 CR 02, January 25, 2020, effective 12/23/201942 CR 23, December 10, 2019, effective 1/1/202043 CR 01, January 10, 2020, effective 2/1/202042 CR 24, December 25, 2019, effective 2/2/202043 CR 06, March 25, 2020, effective 4/15/202043 CR 10, May 25, 2020, effective 8/1/202043 CR 14, July 25, 2020, effective 8/15/202043 CR 17, September 10, 2020, effective 10/1/202043 CR 18, September 25, 2020, effective 11/1/202043 CR 22, November 25, 2020, effective 12/15/202043 CR 24, December 25, 2020, effective 1/15/202144 CR 03, February 10, 2021, effective 3/15/202144 CR 08, April 25, 2021, effective 5/15/202144 CR 09, May 10, 2021, effective 6/1/202144 CR 10, May 25, 2021, effective 6/14/202144 CR 10, May 25, 2021, effective 6/15/202144 CR 13, July 10, 2021, effective 8/1/202144 CR 15, August 10, 2021, effective 9/1/202144 CR 19, October 10, 2021, effective 11/1/202144 CR 21, November 10, 2021, effective 12/1/202144 CR 23, December 10, 2021, effective 12/30/202144 CR 21, November 10, 2021, effective 1/1/202244 CR 23, December 10, 2021, effective 1/15/202244 CR 24, December 25, 2021, effective 1/15/202245 CR 03, February 10, 2022, effective 3/2/202245 CR 08, April 25, 2022, effective 5/30/202245 CR 09, May 10, 2022, effective 5/30/202245 CR 10, May 25, 2022, effective 6/14/202245 CR 11, June 10, 2022, effective 6/30/202245 CR 11, June 10, 2022, effective 7/15/202245 CR 19, October 10, 2022, effective 11/1/202245 CR 20, October 25, 2022, effective 11/14/202245 CR 21, November 10, 2022, effective 11/30/202245 CR 24, December 25, 2022, effective 1/14/202346 CR 01, January 10, 2023, effective 2/14/202346 CR 06, March 25, 2023, effective 2/15/202346 CR 03, February 10, 2022, effective 3/2/202346 CR 04, February 25, 2023, effective 3/17/202346 CR 05, March 10, 2023, effective 4/15/202346 CR 09, May 10, 2023, effective 5/30/202346 CR 09, May 10, 2023, effective 6/1/202346 CR 10, May 25, 2023, effective 6/15/202346 CR 11, June 10, 2023, effective 6/30/202348 CR 01, January 10, 2025, effective 1/30/2025