Request for Comment on DRAFT Proposed Amended Regulations 4-2-78 Concerning Cost Sharing Reduction Enhancements and 4-2-83 Concerning Health Insurance Affordability Enterprise Subsidies for Qualified Individuals and DRAFT Proposed New Regulation 5-1-XX Co

The Division is seeking informal comments on the following DRAFT proposed amended regulations:

• DRAFT Proposed Amended Regulation 4-2-78 Concerning Cost Sharing Reduction Enhancements

The purpose of this regulation is to provide standards for including payments to carriers pursuant to C.R.S. § 10-16-1205(1)(b)(II) in health benefit plans regulated by the Colorado Division of Insurance.

This regulation is being amended to reflect updated consumer eligibility requirements for plan year 2024: consumers between 150-250% Federal Poverty Level (FPL) will be eligible for the on-exchange Health Insurance Affordability Enterprise subsidy. The amended regulation also updates the carrier reimbursement methodology to use an adjusted metal Actuarial Value (AV) factor.

• DRAFT Proposed Amended Regulation 4-2-83 Concerning Health Insurance Affordability Enterprise Subsidies for Qualified Individuals through Premium Wrap and Cost Sharing Reduction Enhancements on the Colorado Option Silver Plan

The purpose of this regulation is to provide standards for including payments to carriers pursuant to C.R.S. § 10-16-1205(1)(b)(III) in rate filings for health benefit plans regulated by the Colorado Division of Insurance and guidelines for the Colorado Option Silver Enhanced Benefit Plan.

This regulation is being amended to update the carrier reimbursement methodology for the Health Insurance Affordability Enterprise Qualified Individual subsidy on Colorado Connect (i.e., OmniSalud) to use an adjusted metal Actuarial Value (AV) factor. 

The Division is also seeking informal comments on the following DRAFT proposed new regulation: 

• DRAFT Proposed New Regulation 5-1-XX Concerning Tolling Certain Time Limits of Policyholder Benefits in the Event of a Catastrophic Disaster

The purpose of this regulation is to protect homeowner policyholders who have suffered a loss during a catastrophic disaster, such as the 2020 Colorado East Troublesome Fire and the 2021 Marshall and Middle Fork Fires, from insurers that cause unreasonable delays in claim handling. Such delays may result in delays to rebuilding the homeowner policyholders’ property, which is often further exacerbated by labor and material shortages. The Division is specifically concerned with ALE benefits and time limits on repair or replacement for recoverable coverage. This regulation identifies specific acts or practices that may constitute unfair claim settlement practices.

The Division is requesting informal comments be submitted no later than 5 PM, May 23, 2023, to DORA_INS_RulesandRecords@state.co.us.

These draft proposed amended and new regulations, as well as other draft regulations and bulletins currently released for informal public comment, can be found on the Division's DRAFT Regulations and Bulletins for Informal Public Comment website.