Colorado Code § 10-18-103

Standards for policy provisions - guarantee issue
Open in Lexace · Ask the AI about this section
(1) No medicare
supplement insurance policy, contract, or certificate in force in this state shall contain benefits
that duplicate benefits provided by medicare.
(2) The commissioner shall issue reasonable regulations to establish specific standards
for policy provisions of medicare supplement policies and certificates. Such standards shall be in
addition to and in accordance with all applicable laws under this title. No requirement of this title
relating to minimum required policy benefits, other than the minimum standards contained in
this article, shall apply to medicare supplement policies. The standards shall include, but need
not be limited to:
(a) Terms of renewability which shall provide that the policy cannot be canceled or
nonrenewed by the insurer solely on the grounds of deterioration of health or of age;
(b) Initial and subsequent conditions of eligibility, which shall include the guaranteed
issue requirements in subsection (5) of this section;
(c) Nonduplication of coverage;
(d) Preexisting conditions;
(e) Benefit limitations, exceptions, and reductions which shall not include those which
are more restrictive than those of medicare for any type of care covered under the policy;
(f) Elimination, waiting, or probationary periods;
(g) Recurrent conditions;
(h) Definition of terms, including, but not limited to, accident, sickness, benefit period,
hospital, nurse, physician, and skilled nursing facility;
(i) Readability standards;
(j) Continuing care coverage as required by section 10-16-413.5.
(3) The commissioner may issue reasonable regulations that specify prohibited policy
provisions not otherwise specifically authorized by statute which, in the opinion of the
commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed
for coverage under a medicare supplement policy.
(4) Notwithstanding any other provision of law of this state to the contrary, a medicare
supplement policy may not deny a claim for losses incurred more than six months from the
effective date of coverage for a preexisting condition. The policy may not define a preexisting
condition more restrictively than a condition for which medical advice was given or treatment
was recommended by or received from a physician within six months before the effective date of
coverage.
(5) The guaranteed issue period for a medicare supplement policy shall not be for less
than six months after a previous policy has been involuntarily terminated for reasons other than
nonpayment of premiums or for fraud or abuse. For purposes of this subsection (5), termination
of coverage in the CoverColorado coordination of benefits plan due to the plan's termination is
an involuntary termination of a previous policy.

‹ Prev All Colorado sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.