DEPARTMENT OF REGULATORY AGENCIES
Division of Insurance
3 CCR 702-4
life, accident and health
Emergency Regulation 08-E-2
MANDATORY COVERAGE OF MENTAL ILLNESSES PURSUANT TO §10-16-104 (5) AND (5.5), C.R.S.
Section 1	Authority
Section 2	Scope and Purpose
Section 3	Applicability
Section 4	Definitions
Section 5	Rules
Section 6	Severability
Section 7	Enforcement
Section 8	Effective Date
Section 9	History
Section 1	Authority
This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 10-1-109 and 10-16-104 (5) and (5.5), C.R.S.
Section 2	Scope and Purpose
The purpose of this regulation is to clarify the implementation of SB07-36 and the coordination of subsections (5) and (5.5) of § 10-16-104, C.R.S.  
Section 3	Applicability and Scope
This regulation applies to every entity issuing group health benefit plans, except for an exemption for small group health benefit plans related to the inclusion of mental disorders as defined in § 10‑16‑104(5.5)(IV)(B), C.R.S.
Section 4	Definitions
Biologically based mental illness (BBMI) and mental disorders shall have the same meaning as in § 10‑16‑104(5.5), C.R.S.
Section 5	Rules
A.	Section 10-16-104 (5), C.R.S., applies broadly to all mental illness conditions or disorders and includes the following mandated benefits:
1.	At least 45 inpatient (90 partial hospitalization) days in any one twelve-month period;
2.	No less than 20 outpatient visits or no less than $1,000 paid for outpatient visits in any twelve-month period; and 
3.	Copayment or coinsurance shall not exceed a 50% requirement.
B.	Section 10-16-104 (5.5), C.R.S., applies to a defined subset of mental illness conditions for BBMI and mental disorders.  Section 10-16-104 (5.5), C.R.S., provides coverage for treatment that is no less extensive than coverage provided for any other physical illness.
C.  	Based on sections (A) and (B) of this section 5, the following findings are made:
1.	Section 10-16-104 (5.5), C.R.S., recognizes that BBMI are biologically based and more akin to other physical illnesses and should be differentiated from other forms of mental illness;
2.	The General Assembly determined that insurance coverage for BBMI under § 10‑16‑104(5), C.R.S., was inadequate and therefore enacted § 10-16-104(5.5), C.R.S., to attain some parity for BBMI with insurance coverage for other types of physical illness;
3.	The General Assembly determined that insurance coverage for mental disorders under § 10-16-104(5), C.R.S., was inadequate and therefore expanded the coverage being provided under § 10-16-104(5.5), C.R.S., to include coverage for these conditions in non-small employer group health benefit plans.
4.	The increased insurance coverage of § 10-16-104 (5.5) C.R.S., was not intended to duplicate coverage provided in § 10-16-104 (5), C.R.S. or provide a double benefit;
5.	Treatment for BBMI and mental disorders under subsection (5.5) might permit “different” types of treatment than would be permitted under subsection (5) but will provide “additional” insurance benefits above the limitations set out in subsection (5) 
6.	Benefits in accordance with § 10-16-104 (5.5), C.R.S. reduce or exhaust the benefits mandated by § 10-16-104 (5), C.R.S.
7.	The copayment or coinsurance protections of § 10-16-104 (5) (c), C.R.S., apply to benefits provided in accordance with § 10-16-104 (5.5), C.R.S.
8.	Benefits provided in accordance with § 10-16-104 (5.5), C.R.S., must be provided at the more generous of the physical illness or mental illness benefits of section 10-16-104 (5), C.R.S., through the 20th visit.  Thereafter, only the copayment or coinsurance protections continue to apply to BBMI and mental disorders pursuant to § 10-16-104 (5.5), C.R.S., and the mental illness benefit of § 10-16-104 (5), C.R.S.
Section 6	Severability
If any provision of this regulation or the application of it to any person or circumstance is for any reason held to be invalid, the remainder of this regulation shall not be affected. 
Section 7	Enforcement
Noncompliance with this Regulation may result, after proper notice and hearing, in the imposition of any of the sanctions made available in the Colorado statutes pertaining to the business of insurance or other laws that include the imposition of fines, issuance of cease and desist orders, and/or suspensions or revocation of license.  Among others, the penalties provided for in §10-3-1108, C.R.S. may be applied.  

Section 8	Effective Date
This emergency regulation shall become effective on January 1, 2008.
Section 9	History
Emergency regulation effective January 1, 2008.