3 Colo. Code Regs. § 702-4-6-8-3
Current through Register Vol. 47, No. 16, August 25, 2024
Section 3 CCR 702-4-6-8-3 - ApplicabilityA. This regulation applies to any health benefit plan, whether provided on a group, group association, or individual basis, which: 1. Meets one or more of the conditions set forth in § 10-16-105.2(1)(a)(I) through (IV), C.R.S., except as provided in § 10-16-105.2(1)(d) and (1.5), C.R.S., and subsection 3.J. of this regulation; and2. Provides coverage to the employees of a Colorado small employer, without regard to whether the policy or certificate was issued in this state, except as provided in § 10-3-903(2)(h), C.R.S.B. A carrier that provides individual or group health insurance coverage to one or more of the employees of a small employer shall be considered a small employer carrier subject to the provisions of this regulation if it meets any of the conditions found in § 10-16-105.2(1)(a)(I) through (IV), C.R.S., except as provided in § 10-16-105.2(1)(d) and (1.5), C.R.S.C. The provisions of this regulation shall apply to a health benefit plan provided to a small employer or to the employees of a small employer without regard to whether the health benefit plan is offered under or provided through a group policy or trust arrangement of any size or is sponsored by an association, health care coverage cooperative or discretionary group, except as provided in §§ 10-16-105.2(1)(b) and 10-16-214(5), C.R.S.D. If a small employer is issued a health benefit plan subject to the small group health insurance laws of Colorado, the provisions of this regulation and statutes concerning small group health insurance shall continue to apply to the health benefit plan in the event that the small employer subsequently employs more than one hundred (100) eligible employees. A carrier providing coverage to such an employer shall, within sixty (60) calendar days of becoming aware that the employer no longer meets the definition of a small employer, but no later than the anniversary date of the employer's health benefit plan, notify the employer that the small employer health insurance provisions of Colorado law shall cease to apply to the employer if such employer fails to renew its current health benefit plan or elects to enroll in a different health benefit plan.E. If a small employer is issued a health benefit plan subject to the small group health insurance laws of Colorado, and subsequently employs more than one hundred employees and the employer opts to renew the small group health benefit plan, the carrier that issues the small group health benefit plan shall offer the employer the same small group health benefit plan or, if the same plan is no longer being offered to any small employer, a similar small group health benefit plan that the carrier offers to other small employersF. If a health benefit plan is issued to an employer with more than one hundred (100) eligible employees that is not a small employer but subsequently the employer becomes a small employer (e.g., due to the loss or change of work status of one or more employees), the provisions of this regulation and statutes concerning small group health insurance shall not apply to the health benefit plan. The carrier providing a health benefit plan to such an employer shall not become a small employer carrier solely because the carrier continues to provide coverage under the health benefit plan to the employer. A carrier providing coverage to such an employer shall, within sixty (60) days of becoming aware that the employer has one hundred (100) or fewer eligible employees, notify the employer of the options and protections that may be available to the employer under the small group health insurance laws of Colorado, including the employer's option to purchase a small employer health benefit plan from any small employer carrier.G. Employees in more than one state.1. If the primary business location of the small employer is in this state, then the provisions of this regulation and statutes concerning small group health insurance shall apply to the health benefit plan issued to such a small employer, except as provided under § 10-3-903(2)(h), C.R.S.2. If a health benefit plan is subject to the small group health insurance laws of Colorado, this regulation and relevant statutes shall apply to all individuals covered under the health benefit plan.H. A carrier that is not operating as a small employer carrier in this state shall not become subject to Colorado's small group health insurance laws solely because a small employer that was issued a health benefit plan in another state, by that carrier, moves to this state. I. A plan marketed to individual employees through an employer, or at an employer's place of business, is subject to this regulation and all applicable small group laws unless a carrier can demonstrate that the circumstances of the sale, marketing, and continuation of such plan coverage meet the conditions established in § 10-16-105.2(1)(a) or (d), C.R.S., and as further defined in subsection 3.J. of this regulation.J. A health benefit plan which meets the criteria listed in section 3.A. of this regulation shall be subject to small group requirements even if that health benefit plan covers a single person. Examples include, but are not limited to: 1. A health benefit plan that covers the sole eligible employee of a small employer;2. A health benefit plan that covers just one employee because the other employees of a small employer, who have coverage under another health benefit plan, have waived off the plan; or3. A health benefit plan that covers the only employer-determined eligible employee of a small employer.K. Pursuant to the authority granted to the Colorado Division of Insurance (Division) under § 10-16-105.2(1)(a)(IV), C.R.S., this regulation shall not apply to health benefit plans marketed by producers through an employer or at an employer's place of business to individual employees if all of the following conditions are met both at the time of marketing and sale, and continuously during the period of coverage: 1. No portion of the premium or benefit is paid by or on behalf of a small employer, except as permitted in § 10-16-105.2 (1.5), C.R.S.;2. No person covered by the health benefit plan is reimbursed, whether through wage adjustments or otherwise, by or on behalf of a small employer for any portion of premium, except as permitted in § 10-16-105.2 (1.5), C.R.S.;3. The health benefit plan is not treated by the employer or anyone covered by the plan who meets the definition of an eligible employee or dependent of an eligible employee as part of a plan or program for the purposes of Section 106, 125, or 162 of the federal Internal Revenue Code of 1986, as amended, except as permitted in § 10-16-105.2(1)(d), C.R.S.;4. If the health benefit plan is marketed to an employer's ineligible employees through an employer or at a place of business, this marketing occurs only with the written permission or at the written request of the employer;5. There is an employer-sponsored health benefit plan already in place at the place of business where the health benefit plan is being marketed;6. No billings, premium collections or other correspondence regarding the health benefit plan are sent to the place of business or otherwise involve the employer; and7. The employee being marketed and/or sold the health benefit plan meets one or more of the following criteria: a. The employee will be terminating employment within thirty-one (31) days;b. The employee is a seasonal employee with an employment contract that is shorter than the waiting period for coverage or is not eligible for coverage under his/her employer's health benefit plan;c. The employee is a temporary or substitute employee;d. The employee is not a full time employee as defined by this regulation;e. The employee has a dependent who was covered under the employee's employer-sponsored health benefit plan but that dependent is no longer eligible for such coverage, in which case an individual health benefit plan for such dependent may be marketed to the employee at the workplace;f. The employee is a late enrollee who is completely excluded from his/her employer's health benefit plan for a year; org. The employee is in a waiting period for coverage under an employer-sponsored health benefit plan and all the following conditions are met: (1) The individual health benefit plan marketed to such an employee is a short-term health benefit plan that can be rewritten by the short-term carrier or any other carrier for a combined total of no more than twelve (12) months; and(2) The producer selling such a plan gives the employee an explanation of the employee's continuation rights under his/her prior employer's plan, if any.L. Nothing in subsection J. above shall prohibit a small group carrier that provides coverage to a small employer group from offering individual health benefit plans to dependents of the eligible employees; however, the small employer carrier must also offer the group coverage to all of the dependents. Such group coverage could specify different levels of coverage for eligible employees and dependents.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 6/30/2023