Department of Regulatory Agencies
Division of Insurance
3 ccr 702-4
Life, Accident and Health
Proposed Amended Regulation 4-6-5
CONCERNING SMALL EMPLOYER GROUP HEALTH BENEFIT PLANS AND THE BASIC AND STANDARD HEALTH BENEFIT PLANS
Section 1	Authority
Section 2	Scope and Purpose
Section 3	Applicability
Section 4	Rules
Section 5	Enforcement
Section 6	Severability
Section 7	Effective Date
Section 8	History
Section 1	Authority
This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§ 10-1-109, 10-16-105(7.2), 10-16-108.5(8), and 10-16-109, C.R.S.
Section 2	Scope and Purpose
The purpose of this regulation is to adopt recommendations from the Health Benefit Plan Advisory Committee for changes to the basic and standard health benefit plans required to be offered to small employer groups and which are used for the purpose of conversion from group coverage as well as to incorporate other changes necessary for compliance with Colorado law.  This regulation specifies the requirements for the basic and standard health benefit plans as well as other requirements for small employer carriers.
Section 3	Applicability
This regulation shall apply to all small employer carriers as defined in § 10-16-102(41), C.R.S., and to all carriers required to provide conversion products pursuant to § 10-16-108, C.R.S.
Section 7	Effective Date 
This amended regulation is effective on March 1, 2008.
Section 8	History
1.	Original regulation effective January 1, 1995.
2.	Amended regulation adopted recommended changes from Health Benefit Plan Advisory Committee to be effective January 1, 1996.
3.	Emergency amendment for exclusion of work related illnesses and injuries effective January 1, 1996.
4.	Amended regulation adopting emergency amendment as permanent effective April 1, 1996.
5.	Amended regulation adopting recommended changes from the Health Benefit Plan Advisory Committee effective January 1, 1997.
6.	Amended regulation incorporating changes required by 1997 legislation and recommendations of the Health Benefit Plan Advisory Committee effective January 1, 1998.
7.	Amended regulation incorporating recommendations from the Health Benefit Plan Advisory Committee effective January 1, 1999.
8.	Amended regulation incorporating recommendations from the Health Benefit Plan Advisory Committee effective January 1, 2000.
9.	Amended regulation, correcting errors in the Basic Indemnity Out-of-Pocket Maximum, the Basic PPO In-network Family Coinsurance, and the Standard Indemnity and PPO Maternity benefit.  Corrections effective January 1, 2000.
10.	Amended regulation incorporating recommendations from the Health Benefit Plan Advisory Committee effective January 1, 2001.
11.	Amended regulation incorporating recommendations from the Health Benefit Plan Advisory Committee effective January 1, 2002.
12.	Emergency regulation, effective January 1, 2003.
13.	Amended regulation effective February 1, 2003.
14.	Amended regulation effective January 1, 2004.
15.	Emergency Regulation 04-E-4 effective July 1, 2004.
16.	Emergency Regulation 04-E-9 effective September 29, 2004.
17.	Amended regulation effective November 1, 2004.
18.	Amended regulation effective January 1, 2006.
19.	Amended regulation effective January 1, 2008.
20.	Attachment 1 amended effective March 1, 2008.

Attachment 1

Covered Preventive Services 1	
All Persons	1 smoking cessation education program benefit under physician supervision or as authorized by plan per lifetime, not to exceed $150 payment by insurer.	
	Chicken pox vaccination for all persons who have not had chicken pox.	
Females	Full cost of cervical cancer vaccine 1a	
All Children	Immunizations. 
Immunization deficient children are not bound by “recommended ages”.	
Age 0-12 months	1 newborn home visit during first week of life if newborn released from hospital less than 48 hours after delivery.	
	6 well-child visits 2	
	1 PKU	
Age 13-35 months	3 well-child visits	
Age 3-6	4 well-child visits	
Age 7-12	4 well-child visits	

Age 13-18	1 age appropriate health maintenance visit 3 every year	
	1 Td	
	Females: screening pap smears not to exceed 1 per year 	
	1 hepatitis B vaccination if not given previously	
1	Not all preventive services and screenings are specifically listed, but the list is considered to include all services and screenings deemed to be preventive by the Federal Department of the Treasury for HSA (health savings account) compliant plans.
1a	Age limitations as recommended by the U.S. Department of Health and Human Services’ Advisory Committee on Immunization Practices.
2	"Well-child visit" means a visit to a primary care provider that includes the following elements:  age appropriate physical exam (but not a complete physical exam unless this is age appropriate), history, anticipatory guidance and education (e.g., examine family functioning and dynamics, injury prevention counseling, discuss dietary issues, review age appropriate behaviors, etc.), and growth and development assessment.  For older children, this also includes safety and health education counseling.  The schedule of these visits, through age 12, is based on the recommendations of the American Academy of Pediatrics.
3	“Age appropriate health maintenance visit” means an exam which includes the following components:  age appropriate physical exam (but not a complete physical exam unless this is age appropriate), history, anticipatory guidance and education (e.g., examine family functioning and dynamics, discuss dietary issues, review health promotion activities of the patient, etc.), and exercise and nutrition counseling (including folate counseling for women of child bearing age).

Age 19-39	1 Td every ten years	
	1 age appropriate health maintenance visit every three years	
	1 fasting lipid panel	
	Females ages 35-39: 1 baseline screening mammogram and clinical breast exam 
(Not covered under the Basic Limited Mandate Health Benefit Plans and the Basic HSA Limited Mandate Health Benefit Plans.)	
	Females: screening pap smears not to exceed 1 per year	
Age 40-64	1 Td every ten years	
	1 fasting lipid panel every five years	
	Either annual fecal occult blood testing or 2 colorectal visualizations between ages 50 and 75	
	1 age appropriate health maintenance visit every 24 months	
	Females ages 40-49: 1 screening mammogram and clinical breast exam every 2 years (annually, if high risk) 
(Not covered under the Basic Limited Mandate Health Benefit Plans and the Basic HSA Limited Mandate Health Benefit Plans.)	
	Females ages 50-64: 1 screening mammogram and clinical breast exam every 12 months 
(Not covered under the Basic Limited Mandate Health Benefit Plans and the Basic HSA Limited Mandate Health Benefit Plans.)	
	Females: screening pap smears not to exceed 1 per year 	
	Males: Prostate screening as specified in state law 
(Not covered under the Basic Limited Mandate Health Benefit Plans and the Basic HSA Limited Mandate Health Benefit Plans.)	
Age 65 and older	1 influenza immunization every year	
	1 pneumococcal vaccine at or after age 65	
	Females: screening pap smears not to exceed 1 per year 	
	1 Td every ten years	
	1 age appropriate health maintenance visit every year	
	Females age 65 to 74:  1 screening mammogram and clinical breast exam every 12 months	
	Either annual fecal occult blood testing or 2 colorectal visualizations between ages 50 and 75	
	Males: Prostate screening as specified in state law 
(Not covered under the Basic Limited Mandate Health Benefit Plans and the Basic HSA Limited Mandate Health Benefit Plans.)