Guaranteed renewability - exceptions - individual and small employer health benefit plans - rules - notice to revisor of statutes

(a) Nonpayment of the required premium or failure to timely pay premiums in accordance with the terms of the health benefit plan;

(b) The policyholder or the policyholder's representative has performed an act or practice that constitutes fraud or has made an intentional misrepresentation of a material fact under the terms of coverage;

(c) For small group health benefit plans, the policyholder fails to comply with the carrier's minimum participation or employer contribution requirements or the small employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan;

(d) In the case of a carrier that offers coverage through a managed care plan, there are no longer any enrolled individuals or employees living, working, or residing within the carrier's established geographic service area and the carrier would deny enrollment in the plan pursuant section 10-16-105 (4)(a)(III);

(e) In the case of an individual or small employer health benefit plan that is made available only through one or more bona fide associations, the membership of the policyholder or small employer in the association on the basis of which the coverage is provided ceases, but only if the coverage is terminated under this paragraph (e) uniformly without regard to any health-status-related factor relating to any covered person;

(f) In the case of individual health benefit plans that are made available as student health insurance coverage, the student policyholder covered under the coverage ceases to be a student at the institution of higher education through which the student health insurance coverage is offered, as long as the coverage is terminated under this paragraph (f) uniformly without regard to any health-status-related factor related to any covered person;

(g) The carrier elects to discontinue offering a particular individual or small group health benefit plan, but only if the carrier:

(I) Provides notice of the decision not to renew coverage at least ninety days before the nonrenewal of the health benefit plan to each policyholder, individual, certificate holder, participant, or beneficiary covered by the plan;

(II) Offers each policyholder covered by the plan the option to purchase any other health benefit plans currently being offered by the carrier in this state and specifies the special enrollment periods for the plans pursuant to section 10-16-105.7;

(III) In exercising the option to discontinue that particular type of health benefit plan, acts uniformly without regard to the claims experience of the policyholders or any health-status-related factor relating to any individual, participant, or beneficiary covered by the plan or new individuals, participants, or beneficiaries who may become eligible for coverage;

(IV) Provides notice to the commissioner before providing the notice pursuant to subparagraph (I) of this paragraph (g) and certifies the following to the commissioner:

(A) The premiums for other health benefit plans the carrier offers pursuant to subparagraph (II) of this paragraph (g) are not excessive, inadequate, or unfairly discriminatory relative to the plan that the carrier is discontinuing; and

(B) The benefit levels the carrier offers in the other health benefit plans comply with the requirements of law applicable to individual and small employer health benefit plans; or

(h) (I) The carrier elects to discontinue offering and renewing all of its individual, small group, or large group health benefit plans delivered or issued for delivery in this state, but only if the carrier:

(A) Provides notice of the decision to discontinue coverage, at least one hundred eighty days before the discontinuance, to all policyholders and covered persons; and

(B) Provides the notice to the commissioner at least three business days before the date the notice is sent to the affected policyholders and covered persons pursuant to sub-subparagraph (A) of this subparagraph (I).

(II) In the case of a discontinuance under subparagraph (I) of this paragraph

(h), the carrier shall:

(A) Continue to provide coverage through the first renewal period not to exceed twelve months after the notice provided pursuant to subparagraph (I) of this paragraph (h); and

(B) Not write new health benefit plans of the same type as those the carrier discontinued in this state for five years after the date of the notice to the commissioner pursuant to sub-subparagraph (B) of subparagraph (I) of this paragraph (h).

(3) A carrier offering individual or small employer health benefit plans shall clearly disclose in its contracts and marketing materials the conditions of renewability, which conditions must conform with the requirements of this section.

(3.5) (a) [Editor's note: This version of subsection (3.5)(a) is effective until January 1, 2026.] If a carrier issues a small group health benefit plan to a small employer that, at the time the plan was issued, was a small employer but subsequently employs more than one hundred eligible employees, this article 16 and any rules promulgated by the commissioner concerning small group health benefit plans continue to apply to the health benefit plan as long as the employer renews its current small group health benefit plan or a similar plan offered by the carrier pursuant to subsection (3.5)(b) of this section, in accordance with the renewal requirements applicable to other small group health benefit plans subject to this article 16 and rules promulgated by the commissioner pursuant to this article 16.

(3.5) (a) [Editor's note: This version of subsection (3.5)(a) is effective January 1, 2026.] If a carrier issues a small group health benefit plan to a small employer that, at the time the plan was issued, was a small employer but subsequently employs more than fifty eligible employees, this article 16 and any rules promulgated by the commissioner concerning small group health benefit plans continue to apply to the health benefit plan as long as the employer renews its current small group health benefit plan or a similar plan offered by the carrier pursuant to subsection (3.5)(b) of this section, in accordance with the renewal requirements applicable to other small group health benefit plans subject to this article 16 and rules promulgated by the commissioner pursuant to this article 16.

(b) [Editor's note: This version of subsection (3.5)(b) is effective until January 1, 2026.] If a small employer was issued a small group health benefit plan and subsequently employs more than one hundred employees and the employer opts to renew the small group health benefit plan, the carrier that issued the small group health benefit plan shall offer the employer the same small group health benefit plan or, if the same plan is no longer being offered to any small employer, a similar small group health benefit plan that the carrier offers to other small employers.

(b) [Editor's note: This version of subsection (3.5)(b) is effective January 1, 2026.] If a small employer was issued a small group health benefit plan and subsequently employs more than fifty employees and the employer opts to renew the small group health benefit plan, the carrier that issued the small group health benefit plan shall offer the employer the same small group health benefit plan or, if the same plan is no longer being offered to any small employer, a similar small group health benefit plan that the carrier offers to other small employers.

(c) [Editor's note: This version of subsection (3.5)(c) is effective until January 1, 2026.] A carrier that issued a small group health benefit plan to a small employer shall notify the employer, within sixty days after becoming aware that the employer employs more than one hundred employees, but no later than the anniversary date of the issuance of the employer's health benefit plan, that the provisions of Colorado law governing small group health benefit plans will cease to apply to the employer if the employer fails to renew its current small group health benefit plan or elects to enroll in a different health benefit plan.

(c) [Editor's note: This version of subsection (3.5)(c) is effective January 1, 2026.] A carrier that issued a small group health benefit plan to a small employer shall notify the employer, within sixty days after becoming aware that the employer employs more than fifty employees, but no later than the anniversary date of the issuance of the employer's health benefit plan, that the provisions of Colorado law governing small group health benefit plans will cease to apply to the employer if the employer fails to renew its current small group health benefit plan or elects to enroll in a different health benefit plan.

(d) [Editor's note: Subsection (3.5)(d) is effective January 1, 2026.]

(I) If an employer was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees, the employer may elect to remain in the small group health benefit market for five years after the date of the issuance of the employer's existing health benefit plan or elect to enter the large group health benefit market at the expiration of the employer's existing health benefit plan.

(II) (A) An employer that was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees may switch between small group health benefit plans being offered by the carrier for five years after the date of the issuance of the employer's health benefit plan.

(B) An employer that switches between small group health benefit plans offered by the carrier must switch to a small group health benefit plan that is one metal level above or below the employer's existing small group health benefit plan.

(III) If an employer that was issued a small group health benefit plan before January 1, 2026, and employs between fifty-one and one hundred employees elects to enter the large group health benefit market and not to continue receiving coverage under a small group health benefit plan before the expiration of the five-year period described in subsection (3.5)(d)(I) of this section, the employer may not switch back to receiving small group health benefit coverage within the five-year period and is classified as a large employer, as defined in section 10-16-102 (40.5).

(e) (I) On or before July 1, 2025, carriers offering small group health benefit plans shall submit to the commissioner two rate filings for plan year 2026. The two rate filings must demonstrate the impact of Senate Bill 24-073, enacted in 2024, on premiums for small group health benefit plans for employers with fewer than fifty-one eligible employees.

(II) This subsection (3.5), section 10-16-102 (40.5) and (61), and section 10-16-1401 (15), as amended by Senate Bill 24-073, enacted in 2024, will be repealed if the rate filings submitted by carriers pursuant to subsection (3.5)(e)(I) of this section demonstrate that the premiums for the majority of individuals covered by small group health benefit plans would increase by more than three percent after accounting for normal premium trends for small group health benefit plans.

(III) The commissioner shall notify the revisor of statutes in writing of the date when the conditions specified in subsection (3.5)(e)(II) of this section have occurred by emailing the notice to revisorofstatutes.ga@coleg.gov. This subsection

(3.5), section 10-16-102 (40.5) and (61), and section 10-16-1401 (15), as amended by Senate Bill 24-073, enacted in 2024, are repealed upon the date identified in the notice that the conditions specified in subsection (3.5)(e)(II) of this section have occurred or, if the notice does not specify that date, upon the date of the notice to the revisor of statutes.

(IV) Notwithstanding section 10-16-155, the commissioner shall utilize resources allocated for actuarial review pursuant to section 10-16-155 to analyze the rate filings submitted by carriers pursuant to subsection (3.5)(e)(I) of this section.

(4) A carrier offering a large group health benefit plan may modify the plan at renewal if the carrier modifies the plan uniformly for all large groups covered by the same plan.

(5) With respect to benefits provided under an individual or small employer health benefit plan, a carrier may make reasonable modifications if:

(a) The modification is effective only upon renewal of the plan;

(b) The carrier modifies the benefits uniformly for all individuals and groups covered by the plan;

(c) The carrier provides the proposed modification to policyholders and the commissioner at least ninety days before the effective date of the modification; and

(d) The carrier provides each affected policyholder the opportunity to purchase any other health benefit plan offered by the carrier.

(6) (a) The commissioner may promulgate rules as necessary to implement and administer this section.

(b) Repealed.