Home

 Colorado Revised Statutes

 Search

 Browse

 Colorado Register

 eDocket

 Log in

 Contact Us

Code of Colorado Regulations eDocket
Official Publication of the State Administrative Rules (24-4-103(11) C.R.S.)

Details of Tracking Number  2018-00352


CCR details

Tracking Number 2018-00352
Type of Filing Permanent Rule
Department 700 Department of Regulatory Agencies
Agency 702 Division of Insurance
CCR Number 3 CCR 702-4 Series 4-4
CCR Title LIFE, ACCIDENT AND HEALTH, Series 4-4 Long Term Care

Proposed rule

Notice Filed with SOS 07/30/2018
Rule ProposedRuleAttach2018-00352.doc
Statutory Authority 10-1-109, 10-3-1110, 10-16-109, and 10-16-113(2) and (10)
Description of Subjects/Issues 4-4-5 - PROMPT INVESTIGATION OF LONG-TERM CARE INSURANCE CLAIMS INVOLVING UTILIZATION REVIEW AND DENIAL OF BENEFITS AND RULES RELATED TO INTERNAL CLAIMS AND APPEALS PROCESSES The purpose of this regulation is to set forth guidelines for insurer compliance with the provisions of 10-3-1104(1)(h) and 10-16-113, C.R.S., in situations involving utilization review and certain denials of long-term care insurance benefits as described herein. Among other things, 10-3-1104(1)(h), C.R.S., requires insurers to adopt and implement reasonable standards for the prompt investigation of claims arising from long-term care policies; promptly provide a reasonable explanation of the basis in the long-term care policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; and refrain from denying a claim without conducting a reasonable investigation based upon all available information. This regulation is designed to provide minimum standards for handling appeals and grievances involving utilization review determinations, certain denials of benefits for treatments excluded by long-term care policies, and as otherwise required by 10-16-113, C.R.S.
Purpose/Objective of Rule The purpose of this regulation is to set forth guidelines for insurer compliance with the provisions of 10-3-1104(1)(h) and 10-16-113, C.R.S., in situations involving utilization review and certain denials of long-term care insurance benefits as described herein. Among other things, 10-3-1104(1)(h), C.R.S., requires insurers to adopt and implement reasonable standards for the prompt investigation of claims arising from long-term care policies; promptly provide a reasonable explanation of the basis in the long-term care policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; and refrain from denying a claim without conducting a reasonable investigation based upon all available information. This regulation is designed to provide minimum standards for handling appeals and grievances involving utilization review determinations, certain denials of benefits for treatments excluded by long-term care policies, and as otherwise required by 10-16-113, C.R.S.
Submitted in response to issues raised by COLS/OLLS? No
Is this rule adopted in response to recent legislation? No
Hearing Date 09/04/2018
Hearing Time 01:00 PM
Hearing Location 1560 Broadway, Ste 110 D, Denver CO 80202
Contact Name Christine Gonzales-Ferrer
Contact Title Rulemaking Coordinator
Contact Telephone 303-894-2157
Contact email christine.gonzales-ferrer@state.co.su

Adopted rule

Adopted Rules AdoptedRules02018-00352.doc
Redline Redline2018-00352.doc
Adopted Date 02/13/2019
AGO requested date 02/19/2019
Attorney General Opinion 03/04/2019
Colorado Register publication date 03/25/2019
Effective Date 06/01/2019
Inserted into CCR 05/30/2019