CO| Amended Regulation 4-2-85 from the Colorado Division of Insurance establishes the methodology for calculating required premium rate reductions for Colorado Option Standardized Health Benefit Plans (bronze, silver, and gold) offered in the individual and small group markets, effective for plans issued or renewed on or after January 1, 2026. The regulation details the specific calculation methods, adjustment factors, and filing requirements that carriers must follow to ensure compliance with mandated premium reductions and annual rate increase limits tied to medical inflation. Enforcement provisions, definitions, and references to relevant federal and state statutes are included to support consistent application and regulatory oversight. This regulation shall be effective June 14, 2025.
Key Points:
- Carriers must reduce premiums for Colorado Option Standardized Plans by 5% (2023), 10% (2024), and 15% (2025 and beyond) relative to 2021 baseline rates, with future annual increases limited to medical inflation.
- The regulation prescribes a detailed methodology for calculating maximum allowable premiums, including adjustments for actuarial value, cost-sharing, CSR loads, induced demand, essential health benefits, non-EHB benefits, and medical inflation.
- Carriers are required to submit compliance notifications and supporting documentation annually, with noncompliance subject to regulatory sanctions such as penalties or license actions.