A&C Colorado Flashcards
What is the required notice period for an insurer to cancel an individual health insurance policy for reasons other than non-payment?
60 days
How many employees must a business have to qualify for small group health insurance in Colorado?
At least 2 employees
What is the longest waiting period an insurer can impose before coverage takes effect for small group health plans?
90 days
Under Colorado law, how long must insurers retain policy records?
5 years
If an insurer denies a health insurance claim in Colorado, how long does the policyholder have to file a lawsuit?
2 years
Once an insurer receives a clean health insurance claim, how long do they have to process it?
30 days for electronic claims, 45 days for paper claims
Under Colorado law, how soon must an insurer provide a written reason for claim denial upon request?
Within 30 days
What happens if an insurer fails to pay a clean claim within the required time frame?
They must pay interest on the claim amount
What is the maximum pre-existing condition exclusion period for non-ACA compliant individual health policies in Colorado?
12 months
How long must an individual health policy cover newborns without additional premium?
At least 31 days from birth
What are Colorado’s requirements for maternity coverage?
Maternity coverage must be included in all individual and group health policies
What is the minimum employer contribution for small group health insurance premiums?
At least 50% of the employee’s premium cost
What is the required open enrollment period for Medicare Supplement policies in Colorado?
At least 6 months for individuals age 65 and older
What is the purpose of Colorado’s external review process for health insurance claims?
To allow policyholders to appeal claim denials through an independent third-party review
How long must insurers keep policy records under Colorado law?
5 years
What is the grace period for a monthly premium payment on an individual health insurance policy in Colorado?
31 days
How long must an insurer keep complaint records in Colorado?
At least 3 years
What is the minimum required free-look period for long-term care policies in Colorado?
30 days
What is the penalty for an insurer failing to comply with a Commissioner’s order in Colorado?
Up to $500 per violation, up to $10,000 in total
Within how many days must an insurer acknowledge receipt of a claim in Colorado?
15 days
How soon must an insurer notify a policyholder of a claim decision?
Within 60 days of receiving the completed claim
What is the time limit for an insured to take legal action against an insurer for a denied claim?
2 years
What happens if an insurer fails to pay a clean claim within the required timeframe?
The insurer must pay interest on the unpaid claim amount
What percentage of employee participation is required for an employer to obtain a small group health plan in Colorado?
70%
How many days of notice must a small group insurer provide before canceling coverage due to nonpayment?
30 days
Can small group health insurers in Colorado deny coverage based on health status?
No, small group plans are guaranteed issue
What is the minimum employer contribution required for small group health plan premiums?
50% of the employee’s premium cost
What is the maximum pre-existing condition exclusion period for a Medicare Supplement policy in Colorado?
6 months
How long is the open enrollment period for Medicare Supplement policies in Colorado?
At least 6 months after enrolling in Medicare Part B at age 65 or older
What is the minimum daily benefit amount required for long-term care insurance policies sold in Colorado?
There is no state-mandated minimum, but policies must comply with federal requirements
Under COBRA, how long can an employee continue coverage after termination of employment in Colorado?
18 months
How does Colorado define a ‘clean claim’?
A claim that contains all necessary information and documentation for processing
What is the maximum allowable waiting period before coverage takes effect in a Colorado small group plan?
90 days
What is the penalty for an agent engaging in unfair trade practices in Colorado?
Fines, license suspension, or revocation
