Health-care Sharing Plan Reporting Requirements

Starting October 1, 2022, and by each March 1 thereafter, the act requires any person that is not authorized to engage in the business of insurance in this state but that offers or intends to offer a plan or arrangement to facilitate payment or reimbursement of health-care costs or services for Colorado residents to annually submit to the commissioner of insurance (commissioner) specified information and a certification that the information is accurate and complies with the requirements of the act. The submission must include information about the operation of the plan or arrangement in this state in the immediately preceding calendar year, including: The number of participants in the plan or arrangement and, if the person offers a plan or arrangement in other states, the total number of participants nationally; Any contracts the person has entered into with providers that provide health-care services to plan or arrangement participants; The total amount of fees, dues, or other payments collected from participants and the percentage of fees, dues, or other payments that the person retained; The total dollar amount of requests for reimbursement of health-care services submitted by participants or providers, the total dollar amount of requests for reimbursement that were determined to qualify for reimbursement, and the total dollar amount of requests for reimbursement that were denied; The total amount of payments made to providers or to reimburse participants for health-care services provided or received and the total amount of requests determined to qualify for reimbursement but not yet reimbursed as of the end of the preceding calendar year; The estimated number of participants the person anticipates in the next calendar year; The counties in which the person offers or intends to offer a plan or arrangement and any other states in which the person offers a plan or arrangement; A list of third parties associated with, or offering or enrolling participants in a plan or arrangement on behalf of, the person and a detailed accounting of commissions or other remuneration paid to a third party for services provided in promoting or administering the plan or arrangement; The total number of insurance brokers that are associated with or assist the person in offering or enrolling participants in the plan or arrangement, the total number of participants enrolled in the plan or arrangement through a broker, copies of training materials provided to a broker, and a detailed accounting of commissions or other remuneration paid to a producer for marketing, promoting, and enrolling participants in a plan or arrangement; and Contact information for an individual serving as the person's contact person in this state, a list of the person's officers and directors, and the person's organizational chart. Within 45 days after receipt, the commissioner is to determine whether a submission by a person is complete. Each year, the commissioner is to compile a report summarizing the information submitted by persons and post the report on the division of insurance (division) website. The commissioner is authorized to adopt rules to implement the act. If the commissioner determines that a person has failed to comply with the submission requirements, the commissioner must notify the person of the deficiency and allow the person 30 days to correct the deficiency. If a person fails to timely correct the deficiency, the commissioner may impose a fine not to exceed $5,000 per day, and if the person fails to correct the deficiency within 30 days after the initial fine is imposed, the commissioner may issue an emergency cease-and-desist order against the person. The act appropriates $84,568 from the division of insurance cash fund to the department of regulatory agencies to implement the act as follows: $39,097 for use by the division for personal services; $6,875 for use by the division for operating expenses; $19,714 for legal services, which amount is reappropriated to the department of law to provide the legal services; and $18,882 for information technology services, which amount is reappropriated to the office of information technology in the office of the governor to provide information technology services.(Note: This summary applies to this bill as enacted.)