Statutes, codes, and regulations
Colorado Administrative Code
Department 700 - Department of Regulatory AgenciesDivision 702 - Division of InsuranceRule 3 CCR 702-4 - LIFE, ACCIDENT AND HEALTHSection 3 CCR 702-4 Series 4-2 - LIFE, ACCIDENT AND HEALTH, Series 4-2 Accident and Health (General)
Regulation Regulation 4-2-78 - CONCERNING COST SHARING REDUCTION ENHANCEMENTS
Section 3 CCR 702-4-2-78-4 - Definitions

3 Colo. Code Regs. § 702-4-2-78-4

Download
PDF
Current through Register Vol. 47, No. 24, December 25, 2024
Section 3 CCR 702-4-2-78-4 - Definitions
A. "87% Cost Sharing Reduction Enhancement" or "87% CSR Enhancement" means, for the purpose of this regulation, an increase in silver plans' actuarial value from 87% to 94% for eligible enrollees.
B. "Actuarial value" and "AV" means, for the purpose of this regulation, the percentage of total average costs for covered benefits that a health benefit plan will cover, with calculations based on the provision of essential health benefits to a standard population.
C. "Benefit year" shall have the same meaning as found at § 10-16-1103(2), C.R.S.
D. "Carrier" shall have the same meaning as found at § 10-16-102(8), C.R.S.
E. "Cost Sharing Reduction Enhancement" or "CSR Enhancement" means, for the purpose of this regulation, an increase in silver plans' actuarial value from 87% to 94% for eligible enrollees.
F. "CSR Load" means, for the purpose of this regulation, the load in the silver plan premiums necessary to cover the cost of providing cost-sharing reductions in the on-exchange silver health benefit plans.
G. "CSR variant" means, for purposes of this regulation, a cost-sharing reduction plan variation defined in 45 C.F.R. § 156.420(a).
H. "Eligible enrollee" means, for the purpose of this regulation, an individual enrolled in a CSR variant plan whose household income is from 150% to 200% of the Federal Poverty Level.
I. "Exchange" shall have the same meaning as found at § 10-16-102(26), C.R.S.
J. "Federal Actuarial Value Calculator" or "Federal AV Calculator" means, for the purpose of this regulation, the AV Calculator required pursuant to 45 C.F.R. § 156.135(a).
K. "Federal Poverty Level" or "Federal Poverty Line" shall have the same meaning as found at § 10-16-1203(4), C.R.S.
L. "Health benefit plan" shall have the same meaning as found at § 10-16-102(32), C.R.S.
M. "Induced Demand Factor" shall mean the anticipated induced demand associated with the plan's cost sharing (metal) level.
N. "Metal AV Adjustment Factor" means, for the purpose of this regulation, the differences in Metal AV values as produced by the Federal AV Calculator, and the actuarial values used by carriers in pricing.
O. "Plans and Benefits Template" or "PBT" means, for the purpose of this regulation, the Plans & Benefits Template created by the Centers for Medicare & Medicaid Services.
P. "Rate" means, for the purpose of this regulation, the value in the carrier's Rates Table Template available in SERFF corresponding to the enrollee's age, geographic rating area, and tobacco status.
Q. "Rate filing" means, for the purpose of this regulation, a carrier's electronic submission to the Division in accordance with Colorado Insurance Regulation 4-2-39.
R. "Rates Table Template" means, for the purposes of this regulation, the Rates Tables Template created by the Centers for Medicare and Medicaid Services.
S. "Standard silver plan" shall have the same meaning as found at § 10-16-103.4(2)(b), C.R.S.
T. "URRT" means, for the purpose of this regulation, the Unified Rate Review Template created by the Centers for Medicare & Medicaid Services.

3 CCR 702-4-2-78-4

37 CR 11, June 10, 2014, effective 7/1/2014
37 CR 12, June 25, 2014, effective 7/15/2014
Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/2014
37 CR 23, December 10, 2014, effective 1/1/2015
38 CR 03, February 10, 2015, effective 3/15/2015
38 CR 06, March 25, 2015, effective 4/30/2015
38 CR 09, May 10, 2015, effective 6/1/2015
38 CR 13, July 10, 2015, effective 7/30/2015
38 CR 19, October 10, 2015, effective 11/1/2015
38 CR 21, November 10, 2015, effective 1/1/2016
38 CR 23, December 10, 2015, effective 1/1/2016
39 CR 01, January 10, 2016, effective 2/1/2016
39 CR 05, March 10, 2016, effective 4/1/2016
39 CR 08, April 25, 2016, effective 5/15/2016
39 CR 19, October 10, 2016, effective 11/1/2016
39 CR 20, October 25, 2016, effective 1/1/2017
39 CR 22, November 25, 2016, effective 1/1/2017
39 CR 23, December 10, 2016, effective 1/1/2017
39 CR 23, December 25, 2016, effective 1/1/2017
40 CR 03, February 10, 2017, effective 3/15/2017
40 CR 09, May 10, 2017, effective 6/1/2017
40 CR 15, August 10, 2017, effective 9/1/2017
40 CR 17, September 10, 2017, effective 10/1/2017
40 CR 21, November 10, 2017, effective 12/1/2017
41 CR 04, February 25, 2018, effective 4/1/2018
41 CR 05, March 10, 2018, effective 6/1/2018
41 CR 08, April 25, 2018, effective 6/1/2018
41 CR 09, May 10, 2018, effective 6/1/2018
41 CR 11, June 10, 2018, effective 7/1/2018
41 CR 15, August 10, 2018, effective 9/1/2018
41 CR 17, September 10, 2018, effective 10/1/2018
41 CR 18, September 25, 2018, effective 10/15/2018
41 CR 21, November 10, 2018, effective 12/1/2018
41 CR 23, December 10, 2018, effective 1/1/2019
42 CR 01, January 10, 2019, effective 2/1/2019
41 CR 19, October 10, 2018, effective 3/1/2019
42 CR 03, February 10, 2019, effective 4/1/2019
42 CR 04, February 25, 2019, effective 4/1/2019
42 CR 06, March 25, 2019, effective 6/1/2019
42 CR 08, April 10, 2019, effective 6/1/2019
42 CR 15, August 10, 2019, effective 9/1/2019
42 CR 17, September 10, 2019, effective 10/1/2019
43 CR 02, January 25, 2020, effective 12/20/2019
43 CR 02, January 25, 2020, effective 12/23/2019
42 CR 23, December 10, 2019, effective 1/1/2020
43 CR 01, January 10, 2020, effective 2/1/2020
42 CR 24, December 25, 2019, effective 2/2/2020
43 CR 06, March 25, 2020, effective 4/15/2020
43 CR 10, May 25, 2020, effective 8/1/2020
43 CR 14, July 25, 2020, effective 8/15/2020
43 CR 17, September 10, 2020, effective 10/1/2020
43 CR 18, September 25, 2020, effective 11/1/2020
43 CR 22, November 25, 2020, effective 12/15/2020
43 CR 24, December 25, 2020, effective 1/15/2021
44 CR 03, February 10, 2021, effective 3/15/2021
44 CR 08, April 25, 2021, effective 5/15/2021
44 CR 09, May 10, 2021, effective 6/1/2021
44 CR 10, May 25, 2021, effective 6/14/2021
44 CR 10, May 25, 2021, effective 6/15/2021
44 CR 13, July 10, 2021, effective 8/1/2021
44 CR 15, August 10, 2021, effective 9/1/2021
44 CR 19, October 10, 2021, effective 11/1/2021
44 CR 21, November 10, 2021, effective 12/1/2021
44 CR 23, December 10, 2021, effective 12/30/2021
44 CR 21, November 10, 2021, effective 1/1/2022
44 CR 23, December 10, 2021, effective 1/15/2022
44 CR 24, December 25, 2021, effective 1/15/2022
45 CR 03, February 10, 2022, effective 3/2/2022
45 CR 08, April 25, 2022, effective 5/30/2022
45 CR 09, May 10, 2022, effective 5/30/2022
45 CR 10, May 25, 2022, effective 6/14/2022
45 CR 11, June 10, 2022, effective 6/30/2022
45 CR 11, June 10, 2022, effective 7/15/2022
45 CR 19, October 10, 2022, effective 11/1/2022
45 CR 20, October 25, 2022, effective 11/14/2022
45 CR 21, November 10, 2022, effective 11/30/2022
45 CR 24, December 25, 2022, effective 1/14/2023
46 CR 01, January 10, 2023, effective 2/14/2023
46 CR 06, March 25, 2023, effective 2/15/2023
46 CR 03, February 10, 2022, effective 3/2/2023
46 CR 04, February 25, 2023, effective 3/17/2023
46 CR 05, March 10, 2023, effective 4/15/2023
46 CR 09, May 10, 2023, effective 5/30/2023
46 CR 09, May 10, 2023, effective 6/1/2023
46 CR 10, May 25, 2023, effective 6/15/2023
46 CR 11, June 10, 2023, effective 6/30/2023
46 CR 16, August 25, 2023, effective 9/14/2023
47 CR 19, October 10, 2024, effective 10/30/2024