(1) (a) A carrier offering an individual health benefit plan in this state shall permit an individual to purchase an individual health benefit plan during the initial and annual open enrollment periods.
The initial open enrollment period begins October 1, 2013, and extends through March 31, 2014.
For benefit years beginning on or after January 1, 2015, the annual open enrollmentperiod begins October 15 and extends through December 7 of the preceding calendar year.
For purposes of this subsection (1), the benefit year for health benefit plans purchased during the initial and annual enrollment periods is a calendar year.
The commissioner shall establish rules in accordance with federal law for the implementation of this subsection (1).
(2) (a) A carrier offering a group health benefit plan in this state shall permit an employer to purchase a group health benefit plan at any point during the year.
In the case of health benefit plans offered in the small group market, a carrier maydecline to offer coverage to a small employer that is unable to comply with a material plan provision relating to employer contribution or group participation rules, as required by section 10-16-105 (3)(b), and that carrier may limit the availability of coverage for a group it has declined to an enrollment period that begins November 15 and ends December 15 of each year or begins and ends on dates set by the commissioner by rule.
The coverage is effective consistent with the dates determined by the commissionerby rule.
(3) (a) (I) A carrier offering an individual health benefit plan in this state shall establish special enrollment periods during which an individual for whom a triggering event has occurred may enroll in an individual health benefit plan offered by the carrier.
(II) A triggering event occurs when:
An individual involuntarily loses existing creditable coverage for any reason otherthan fraud, misrepresentation, or failure to pay a premium;
An individual gains a dependent or becomes a dependent through marriage, civilunion, birth, adoption, or placement for adoption or by entering into a designated beneficiary agreement pursuant to article 22 of title 15, C.R.S.;
An individual's enrollment or nonenrollment in a health benefit plan is unintentional,inadvertent, or erroneous and is the result of an error, misrepresentation, or inaction of the carrier, producer, or exchange established pursuant to article 22 of this title;
An individual adequately demonstrates to the commissioner that the health benefitplan in which the individual is enrolled has substantially violated a material provision of its contract in relation to the individual;
The exchange established pursuant to article 22 of this title determines an individualto be newly eligible or newly ineligible for the federal advance payment tax credit or costsharing reductions available through the exchange pursuant to federal law;
An individual gains access to other creditable coverage as a result of a permanentchange of residence;
(F.5) An uninsured individual was included in the calculation of "family size" as defined in the federal "Internal Revenue Code of 1986", 26 U.S.C. sec. 36B (d)(1), as amended, by a tax filer who filed an income tax return for the prior calendar year by the April 15 tax deadline, and the exchange notifies the individual based on information provided through the Colorado affordable health care coverage easy enrollment program created in section 10-22-113 that the individual qualifies for a subsidized health benefit plan; or
Any other event or circumstance occurs as set forth in rules of the commissionerdefining triggering events.
(III) For the purposes of subsection (3)(a)(II)(F.5) of this section, a carrier is not required to further verify that an individual is eligible for a special enrollment period.
(b) (I) A carrier offering a group health benefit plan in this state shall establish special enrollment periods during which an individual for whom a qualifying event has occurred may enroll in a group health benefit plan offered by the carrier.
(II) A qualifying event occurs when:
An individual loses coverage under a health benefit plan due to the death of a covered employee; the termination or reduction in number of hours of the covered employee's employment; or the covered employee becoming eligible for benefits under Title XVIII of the federal "Social Security Act", as amended;
An individual loses coverage under a health benefit plan due to the divorce or legalseparation of the covered employee from the covered employee's spouse or partner in a civil union;
An individual becomes a dependent of a covered person through marriage, civil union, birth, adoption, or placement for adoption, by entering into a designated beneficiary agreement pursuant to article 22 of title 15, C.R.S., or pursuant to a court or administrative order mandating that the individual be covered;
An individual loses other creditable coverage due to the termination of his or heremployment or eligibility for the coverage; reduction in number of hours of employment; involuntary termination of coverage; or reduction or elimination of his or her employer's contributions toward the coverage;
An individual loses eligibility under the "Colorado Medical Assistance Act", articles4 to 6 of title 25.5, C.R.S., or the children's basic health plan, article 8 of title 25.5, C.R.S.; or
Any other event or circumstance occurs as set forth in rules of the commissionerdefining qualifying events.
(c) The commissioner shall adopt rules in accordance with federal law for the implementation of this section. The commissioner may adopt rules to allow individuals enrolled in a health benefit plan through an exchange established under article 22 of this title to enroll in or change from one health benefit plan to another under circumstances specified in the rules.
Source: L. 2013: Entire section added, (HB 13-1266), ch. 217, p. 936, § 10, effective May 13. L. 2020: (3)(a)(II)(F) amended and (3)(a)(II)(F.5) and (3)(a)(III) added, (HB 20-1236), ch. 236, p. 1143, § 1, effective September 14.