COLORADO LIFE LAWS PART 3
Adverse determination - answer-If an adverse determination is made during a covered person's
hospital stay or course of treatment, the health care services must be continued without liability
until the covered person is notified of the carrier's adverse determination.
Advertisements - answer-Insurers are expected to keep a copy of every advertisement used in the
state for 5 years after it was last used. These copies are subject to examination by the insurance
department.
Appeals of adverse determinations - answer-A health carrier must establish written procedures for
the review of an adverse determination if the time frame of the review would not jeopardize either
the life or health of the covered person or the covered person's ability to regain maximum function.
Certification of extended stay - answer-In the case of a determination to certify an extended stay or
additional services, the carrier must notify the covered person and the provider providing the service
as soon as possible, taking into account the person's medical condition, but no later than 24 hours
after receiving the request.
Claim forms - answer-An insurance company will send forms for filing proof of loss to a claimant
within 15 days after company
receives notice of a claim.
Colon cancer - answer-All health policies must provide coverage for the early detection of colorectal
cancer for average risk adults who are 50 years or older and asymptomatic or those at high risk due
to a prior occurrence or other predisposing factor.
Commission disclosure - answer-An insurance producer who solicits or negotiates an application for
health care insurance on behalf of
a carrier must disclose to the person purchasing the plan that the insurance producer will receive a
commission from the carrier.
Complications of pregnancy - answer-Any accident and health policy that provides coverage for
disability due to accident or sickness must provide similar coverage for a sickness or disease that is a
complication of pregnancy or childbirth. A complication of pregnancy is any disease or condition
that:
Is adversely affected or caused by pregnancy
Requires physician-prescribed supervision
Results in a loss or expense that would, if not related to pregnancy, be covered by the policy
Conservation - answer-A producer's attempt to stop the replacement of an existing life insurance
policy or annuity is known as conservation.
Coverage for mammography - answer-All individual and group health insurance policies providing
coverage on an expense incurred basis must provide benefits or coverage for mammography
screening for any nonsymptomatic woman covered under such policy or contract which meets the
minimum requirements of this section of the statutes. Each mammogram will pay up to $100, or the
actual cost adjusted for CPI. Such benefits or coverage will include at least the following:
A single baseline mammogram for women age 35-44
A mammogram once every two years for women age 45-49
28• A mammogram once every year for women age 50-65
, Diabetes - answer-All policies must cover diabetes, including equipment, supplies, self-management
training and education.
Disclosure - answer-Any information required to be disclosed by the insurer cannot be minimized or
intermingled within the text of advertisement so as to be confusing or misleading. Also,
advertisements may not omit information or use statements, references, or illustrations that will
mislead or deceive prospective purchasers.
Duties of the replacing insurance company - answer-Require from the producer a list of the
applicant's life insurance or annuity contracts to be replaced and a copy of the replacement notice
provided to the applicant.
Send each existing insurance company a written communication advising of the proposed
replacement within a specified period of time of the date that the application is received in the
replacing insurance company's home or regional office. A policy summary or ledger statement
containing policy data on the proposed life insurance or annuity must be included.
Duties of the replacing producer - answer-Present to the applicant a Notice Regarding Replacement
that is signed by both the applicant and the producer. A copy must be left with the applicant.
Obtain a list of all existing life insurance and/or annuity policies to be replaced including policy
numbers and the names of all companies being replaced.
Leave the applicant with the original or a copy of written or printed communications used for
presentation to the applicant.
Submit to the replacing insurance company a copy of the Replacement Notice with the application.
Duties of the replacing producer - answer-Present to the applicant a Notice Regarding Replacement
that is signed by both theapplicant and the producer. A copy must be left with the applicant.
Obtain a list of all existing life insurance and/or annuity policies to be replaced including policy
numbers and the names of all companies being replaced.
Leave the applicant with the original or a copy of written or printed communications used for
presentation to the applicant.
Submit to the replacing insurance company a copy of the Replacement Notice with the application.
Early intervention services - answer-All health plans that cover dependent children must provide
coverage for early intervention services delivered by a qualified early intervention provider to an
eligible child.
An eligible child is an infant or toddler from birth through two years of age who has significant
developmental delays or has a diagnosed physical or mental condition with a high probability of
resulting in significant developmental delays.
The coverage available annually for each eligible child is $6,067
Emergency services - answer-A health carrier may not deny a claim for emergency services necessary
to screen and stabilize a covered person on the grounds that an emergency medical condition did
not actually exist if a prudent lay person having average knowledge of health services and medicine
and acting reason- ably believed that an emergency medical condition or life- or limb-threatening
emergency existed.
Entire contract - answer-A provision that the policy (including the endorsements and the attached
papers) along with the application shall constitute the entire contract between the parties.
Adverse determination - answer-If an adverse determination is made during a covered person's
hospital stay or course of treatment, the health care services must be continued without liability
until the covered person is notified of the carrier's adverse determination.
Advertisements - answer-Insurers are expected to keep a copy of every advertisement used in the
state for 5 years after it was last used. These copies are subject to examination by the insurance
department.
Appeals of adverse determinations - answer-A health carrier must establish written procedures for
the review of an adverse determination if the time frame of the review would not jeopardize either
the life or health of the covered person or the covered person's ability to regain maximum function.
Certification of extended stay - answer-In the case of a determination to certify an extended stay or
additional services, the carrier must notify the covered person and the provider providing the service
as soon as possible, taking into account the person's medical condition, but no later than 24 hours
after receiving the request.
Claim forms - answer-An insurance company will send forms for filing proof of loss to a claimant
within 15 days after company
receives notice of a claim.
Colon cancer - answer-All health policies must provide coverage for the early detection of colorectal
cancer for average risk adults who are 50 years or older and asymptomatic or those at high risk due
to a prior occurrence or other predisposing factor.
Commission disclosure - answer-An insurance producer who solicits or negotiates an application for
health care insurance on behalf of
a carrier must disclose to the person purchasing the plan that the insurance producer will receive a
commission from the carrier.
Complications of pregnancy - answer-Any accident and health policy that provides coverage for
disability due to accident or sickness must provide similar coverage for a sickness or disease that is a
complication of pregnancy or childbirth. A complication of pregnancy is any disease or condition
that:
Is adversely affected or caused by pregnancy
Requires physician-prescribed supervision
Results in a loss or expense that would, if not related to pregnancy, be covered by the policy
Conservation - answer-A producer's attempt to stop the replacement of an existing life insurance
policy or annuity is known as conservation.
Coverage for mammography - answer-All individual and group health insurance policies providing
coverage on an expense incurred basis must provide benefits or coverage for mammography
screening for any nonsymptomatic woman covered under such policy or contract which meets the
minimum requirements of this section of the statutes. Each mammogram will pay up to $100, or the
actual cost adjusted for CPI. Such benefits or coverage will include at least the following:
A single baseline mammogram for women age 35-44
A mammogram once every two years for women age 45-49
28• A mammogram once every year for women age 50-65
, Diabetes - answer-All policies must cover diabetes, including equipment, supplies, self-management
training and education.
Disclosure - answer-Any information required to be disclosed by the insurer cannot be minimized or
intermingled within the text of advertisement so as to be confusing or misleading. Also,
advertisements may not omit information or use statements, references, or illustrations that will
mislead or deceive prospective purchasers.
Duties of the replacing insurance company - answer-Require from the producer a list of the
applicant's life insurance or annuity contracts to be replaced and a copy of the replacement notice
provided to the applicant.
Send each existing insurance company a written communication advising of the proposed
replacement within a specified period of time of the date that the application is received in the
replacing insurance company's home or regional office. A policy summary or ledger statement
containing policy data on the proposed life insurance or annuity must be included.
Duties of the replacing producer - answer-Present to the applicant a Notice Regarding Replacement
that is signed by both the applicant and the producer. A copy must be left with the applicant.
Obtain a list of all existing life insurance and/or annuity policies to be replaced including policy
numbers and the names of all companies being replaced.
Leave the applicant with the original or a copy of written or printed communications used for
presentation to the applicant.
Submit to the replacing insurance company a copy of the Replacement Notice with the application.
Duties of the replacing producer - answer-Present to the applicant a Notice Regarding Replacement
that is signed by both theapplicant and the producer. A copy must be left with the applicant.
Obtain a list of all existing life insurance and/or annuity policies to be replaced including policy
numbers and the names of all companies being replaced.
Leave the applicant with the original or a copy of written or printed communications used for
presentation to the applicant.
Submit to the replacing insurance company a copy of the Replacement Notice with the application.
Early intervention services - answer-All health plans that cover dependent children must provide
coverage for early intervention services delivered by a qualified early intervention provider to an
eligible child.
An eligible child is an infant or toddler from birth through two years of age who has significant
developmental delays or has a diagnosed physical or mental condition with a high probability of
resulting in significant developmental delays.
The coverage available annually for each eligible child is $6,067
Emergency services - answer-A health carrier may not deny a claim for emergency services necessary
to screen and stabilize a covered person on the grounds that an emergency medical condition did
not actually exist if a prudent lay person having average knowledge of health services and medicine
and acting reason- ably believed that an emergency medical condition or life- or limb-threatening
emergency existed.
Entire contract - answer-A provision that the policy (including the endorsements and the attached
papers) along with the application shall constitute the entire contract between the parties.
