Request for Comment on DRAFT Proposed New and Amended Regulations 4-2-17, 4-2-49,4-2-101, and 5-1-XX

The Division is seeking comments on the following draft proposed regulations:

• DRAFT Proposed New Regulation 5-1-XX Concerning Requests for Commercial or Personal Automobile Policy Information from a Claimant or Claimant’s Attorney and Policyholder’s Requests for a Certified Copy of the Homeowner Policy

The purpose of this regulation is to establish rules concerning requests for policy information pursuant to §§ 10-3-1117 and 10-4-110.8 (10), C.R.S.

Please submit your comments on this draft proposed regulation no later than 5 PM, August 7, 2025 to DORA_INS_RulesandRecords@state.co.us.

• DRAFT Proposed Amended Regulation 4-2-17 Prompt Investigation of Health 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 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 being amended to make changes based on HB24-1149 and to streamline the regulation.

• DRAFT Proposed Amended Regulation 4-2-49 Concerning the Development and Implementation of a Uniform Drug Benefit Prior Authorization Process and the Required Drug Appeals Process

The purpose of this regulation is to establish the requirements, process, and form to be utilized by carriers, contracted pharmacy benefit management firms, and private utilization organizations for the prior authorization process for prescription drug benefits.

This regulation is being amended to incorporate changes from HB24-1149 and SB25-301.

• DRAFT Proposed New Regulation 4-2-101 Concerning Prior Authorization Reporting Requirements and Annual Attestation Requirements

The purpose of this regulation is to establish the requirements, processes, and forms to be utilized by carriers to ensure compliance with the required disclosure of prior authorization requests and exemptions pursuant to § 10-16-112.5 (2)(c)(I) and (2)(c)(IV), C.R.S. and prior authorization reporting applicable to the prescription drug formulary for each health benefit plan pursuant to § 10-16-124.5(3.5)(a), C.R.S. The regulation also requires carriers offering health benefit plans to attest to the Commissioner of Insurance compliance with these annual reporting requirements.

Please submit your comments on these draft proposed regulations no later than 5 PM, August 15, 2025  to DORA_INS_RulesandRecords@state.co.us.

These draft proposed 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.