Colorado Health Plans Face New Rules to Reduce Prior Authorization Barriers and Improve Access.
CO| Colorado Division of Insurance Regulation 4-2-101 establishes comprehensive prior authorization reporting and attestation requirements for health benefit plan carriers operating in Colorado, effective January 1, 2026. The regulation mandates annual standardized public disclosures related to prior authorization requests, exemptions, and prescription drug formulary requirements, along with a formal annual attestation of compliance. Carriers are […]
Colorado Expands Health Coverage: Biomarker Testing Now Required in Most Insurance Plans Starting 2025
CO| This Colorado Division of Insurance Bulletin No. B-4.155 explains the Division’s interpretation and expectations regarding coverage of biomarker testing under Senate Bill 24-124, which requires coverage of biomarker tests used for diagnosis, treatment, appropriate management, and ongoing monitoring of a covered person’s disease or condition when such testing is medically necessary and supported by […]
New Law Brings Relief: Insurance Must Cover Pediatric PANS/PANDAS Essentials Under Colorado’s Latest Mandate
CO| The Colorado Division of Insurance issued Bulletin No. B-4.154 to explain the impact of House Bill 24-1382, which concerns required coverage for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) in health benefit plans. Effective January 1, 2025, large group health plans must include coverage of prophylaxis, […]
New Hampshire Insurance Department Restores Coordination of Benefits for Retiree Health Plans
NH| The New Hampshire Insurance Department has issued Bulletin 25-083-AB announcing a waiver to the rule prohibiting coordination of benefits (COB) for limited benefit retiree health plans. This action addresses unintended issues caused by the strict prohibition, restoring the intended function for retiree health plans when coordinating with Medicare and similar coverage. The waiver is […]
Important Update: Medicare Advantage Plan Service Area Reductions Coming to Colorado in 2026
CO| The Colorado Division of Insurance‘s Bulletin No. B-4.153 requests information from insurers that will implement Medicare Advantage Plan service area reductions (SARs) in Colorado for the 2026 calendar year, due to some insurers withdrawing plans from certain areas or counties. Affected insurers must submit, by November 25, 2025, details about the company, the specific […]
NM Bulletin 2025-015 Aligns Child COB Order-of-Benefits with NAIC Model Regulation MO-120
NM| The New Mexico Office of the Superintendent of Insurance Bulletin 2025-015 clarifies that for New Mexico insurers offering major medical, dental, or vision coverage, coordination of benefits (COB) provisions for minor dependents covered under more than one plan must align with Section 6(D)(2) of the NAIC Coordination of Benefits Model Regulation MO-120 (October 2013). […]
New Colorado Bulletin Clarifies Reporting Rules for Auto & Health Insurers on Algorithmic Data Use
CO| Colorado Bulletin No. B-10.005 provides guidance for private passenger auto and health insurers in Colorado who use external consumer data and information sources (ECDIS), or algorithms and predictive models incorporating ECDIS, regarding the interim progress report required by Colorado Insurance Regulation 10-1-1. The bulletin clarifies that insurers can use any report format that addresses […]
Nevada DOI Launches Flex-Rated Filing Option for Property Insurers, Capping Overall and Individual Increases at 3%
NV| Nevada Division of Insurance Bulletin 25-005 announces that, effective January 1, 2026, insurers writing property insurance on real property may use a new “Program of Flex-Rated Filing” under Section 20.3 of Assembly Bill 376 instead of filing rate increases under NRS 686B.070, provided filings are submitted via SERFF and clearly identified as flex-rated filings […]
New Mexico Extends Off-Exchange Open Enrollment to January 15 for 2026 Coverage
NM| The New Mexico Office of Superintendent of Insurance (OSI) issues Bulletin 2025-014 to replace Bulletin 2023-037 and clarify how annual open enrollment periods (OEPs) and special enrollment periods (SEPs) apply to individual, fully insured, major medical off-exchange plans that meet qualified health plan standards. The bulletin revises the off-exchange individual OEP to run from […]
Colorado Modernizes Insurance Standards: Key Repeals & Consumer-Focused Health Plan Enhancements
CO| Recent regulatory actions by the Colorado Division of Insurance includes amendments to health insurance regulations, enhancements to the Colorado Option, and the formal repeal of several existing property and casualty rules and bulletins. These changes modernize standards for claims, appeals, prior authorization, insurance policy language, and health plan coverage, and they also remove guidance […]