CO| Amended Regulation 4-2-81 establishes the rules for Colorado Option Standardized Health Benefit Plans, mandating that all carriers offering individual and small group health plans in Colorado must provide standardized bronze, silver, and gold plans starting January 1, 2026.
These standardized plans are required to:
- Offer comprehensive coverage at all metal tiers (bronze, silver, gold), including essential health benefits, mental and behavioral health services, prenatal and postnatal care, and diabetes supplies at no cost-sharing, while adhering to strict naming conventions, branding, and consumer information requirements.
- Follow specific cost-sharing structures outlined in Appendix A, such as $0 copays for primary care, mental health office visits, and preventive services, with tiered prescription drug copays and embedded deductibles and out-of-pocket maximums for individuals and families.
- Ensure compliance with federal and state laws (including the Mental Health Parity and Addiction Equity Act), annual filing requirements, and transparency mandates, with enforcement provisions that allow for penalties or sanctions for noncompliance, and an effective date of June 14, 2025.