CO| Emergency Regulation 25-E-01 outlines the Colorado Option Standardized Health Benefit Plans. This regulation establishes rules for bronze, silver, and gold standardized plans to be offered by all carriers in the individual and small group health insurance markets starting January 1, 2026. The regulation aims to comply with state and federal laws while providing guidance for carriers to develop and adjust their standardized plans. The regulation is effective February 14, 2025.
Key points:
- The regulation requires carriers to offer standardized plans at bronze, silver, and gold metal levels, with specific naming conventions and co-branded logos.
- Standardized plans must provide essential health benefits as defined in Colorado Insurance Regulation 4-2-42, with specific cost-sharing requirements outlined in Appendix A.
- The regulation mandates coverage for mental health, behavioral health, substance use disorder visits, primary care visits, and prenatal and postnatal care with specified cost-sharing structures.
- Diabetes supplies, including Continuous Glucose Monitors, must be provided with no cost-sharing, and carriers must maintain a transparent list of covered diabetic supplies on their websites.
- The regulation includes detailed plan designs for different metal tiers and cost-sharing reduction variants, specifying deductibles, out-of-pocket maximums, and cost-sharing amounts for various medical services.