CO| Amended Colorado Regulation 4-2-39 sets out detailed standards and filing requirements to ensure that rates for non-grandfathered individual, small group, large group, student health, and stand-alone pediatric dental health benefit plans are neither excessive, inadequate, nor unfairly discriminatory, and that they comply with Colorado and federal rating laws, including ACA and related requirements, by prescribing definitions, actuarial assumptions, data elements, and procedures carriers must follow when submitting rates to the Division of Insurance for review and potential approval or enforcement action.
Key Points:
- Applies to all carriers writing non-grandfathered individual, small group, and large group health benefit plans, student health coverage, and stand-alone pediatric dental plans subject to Colorado law, but excludes individual short-term policies and only governs plans or rates not previously reviewed and approved by the Division.
- Establishes comprehensive rate filing content and format requirements (including summaries, requested and overall rate actions, trend and benefit factor changes, rate history, retention, and use of SERFF/Excel templates) and defines key concepts such as excessive, inadequate, and unfairly discriminatory rates, actuarial value, index rate, MLR, and trend.
- Authorizes the Commissioner to require additional actuarial and financial information, enforce compliance, and apply review-and-approval or file-and-use procedures, with an effective date and severability provisions included along with incorporation by reference of federal tools and standards like the Federal Actuarial Value Calculator.