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Code of Colorado Regulations eDocket
Details of Tracking Number
2020-00916
CCR details
| Tracking Number |
2020-00916 |
| Type of Filing |
Permanent Rule |
| Department |
700 Department of Regulatory Agencies |
| Agency |
702 Division of Insurance |
| CCR Number |
3 CCR 702-4 |
| CCR Title |
LIFE, ACCIDENT AND HEALTH |
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Proposed rule
| Notice Filed with SOS |
11/30/2020 |
| Rule |
ProposedRuleAttach2020-00916.doc |
| Statutory Authority |
§§ 10-1-109, 10-3-1110, 10-16-109, and 10-16-113(2) and (10), C.R.S. |
| Description of Subjects/Issues |
The purpose of this regulation is to set forth guidelines for carrier compliance with the provisions of §§ 10-3-1104(1)(h), 10-16-409(1)(a), and 10-16-113, C.R.S., in situations involving utilization review and certain denials of benefits for treatment, as well as rescission, cancellation, or denial of coverage based on an eligibility determination, as described herein. Among other things, § 10-3-1104(1)(h), C.R.S., requires carriers to adopt and implement reasonable standards for the prompt investigation of claims arising from health coverage plans; promptly provide a reasonable explanation of the basis in the health coverage plan 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 health coverage plans, 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 carrier compliance with the provisions of §§ 10-3-1104(1)(h), 10-16-409(1)(a), and 10-16-113, C.R.S., in situations involving utilization review and certain denials of benefits for treatment, as well as rescission, cancellation, or denial of coverage based on an eligibility determination, as described herein. Among other things, § 10-3-1104(1)(h), C.R.S., requires carriers to adopt and implement reasonable standards for the prompt investigation of claims arising from health coverage plans; promptly provide a reasonable explanation of the basis in the health coverage plan 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 health coverage plans, and as otherwise required by § 10-16-113, C.R.S. |
| Comments |
Due to concerns with the spread of COVID-19, this Permanent RulemakingHearing will be held via WEBINAR ONLY, unless the COVID-19 State ofEmergency is lifted by the date of the hearing. Please click on the link below orvisit the Division of Insurance's website on the Notice of RulemakingHearings/Proposed Regulations" page, which is located under the link to "Statutes,Regulations and Bulletins" found on the main page.https://www.colorado.gov/pacific/dora/notice-rule-making-hearings-proposed-regulations Please register here to attend the hearing via webinar:https://attendee.gotowebinar.com/register/644403285646661647 Webinar ID: 365-933-803 After registering, you will receive a confirmation email containinginformation about joining the webinar. Participants can use their telephone orcomputer mic & speakers (VoIP). UNITED STATES +1 (631) 992-3221 AUDIOPIN: 993-533-652 |
| Submitted in response to issues raised by COLS/OLLS? |
No
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| Is this rule adopted in response to recent legislation? |
No
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| Hearing Date |
01/05/2021 |
| Hearing Time |
10:00 AM |
| Hearing Location |
Webinar or 1560 Broadway, Suite 110D, Denver, CO 80202 |
| Contact Name |
Christine Ferrer |
| Contact Title |
Rulemaking Coordinator |
| Contact Telephone |
3038942157 |
| Contact email |
christine.gonzales-ferrer@state.co.us |
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Adopted rule
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