C.R.S.A. § 10-16-111

Annual statements and reports-repeal

Non-profit hospitals, medical-surgery, and health services corporations must file with the Commissioner, an annual statement that states:

• The amount of membership dues or subscriber fees paid;
• Amounts actually paid for hospital, medical-surgery, and health services for the subscribers or members;
• The amounts put in reserves for services that have been billed but not yet paid, unreported, unbilled cases, retroactive cost adjustments, membership dues paid in advance, and all other liabilities and obligations.

All statements must be filed in accordance with standards set by the National Association of Insurance Commissioners.   If the following of such standards would cause a 10% or more reduction in the total capital or profits of an insurer or would cause the insurer to fall below the company action level, an insurer may file a request to phase the standard in within three years.  The request must be accompanied by a thorough analysis.  The Commissioner may not deny such a request without notice and opportunity for a hearing. 

Each health maintenance organization (HMO) must annually file a report that includes:

• The organization’s financial statement;
• Material changes from establishment;
• Number of people enrolled during the year, the number of enrollees at the end of the year, and the number of terminated enrollments;
• Summary of information as required by Colorado law on HMOs;
• Other information related to the HMO necessary for the Insurance Commissioner to carry out his duties.

HMOs must report any determination of noncompliance by HHS to the Insurance Commissioner within 5 days.  Any report regarding loan repayment or modifications of financial commitments must made the Commissioner within 5 days. 

Prepaid dental plans must also submit an annual report that includes:

• A financial statement;
• Any material changes from establishment;
• Number of people enrolled during the year, the number of enrollees at the end of the year, and the number of terminated enrollments;
• Statistics on operations costs, utilization of services, and accessibility of services;
• Information related to performance necessary for the Insurance Commissioner to carry out his duties.

All carriers must submit to the Commissioner the following cost information:

• Medical trend itemized by medical provider price increases, utilization changes, medical cost shifting, and new medical procedures and technology;
• Medical trend itemized by pharmaceutical price increases, utilization changes, cost shifting, and the introductions of new brand and generic drugs;
• Dividends paid;
• Salaries, stock options, or bonuses;
• Insurance producer commissions; 
• Attorney payments;
• Provision for profit and contingencies;
• Administrative expenditures broken down by advertising or marketing expenditures, paid lobbying expenditures, and staff salaries;
• Expenditures for disease or case management programs or patient education and other cost containment or quality improvement expenses;
• Charitable contributions;
• Losses on investments or investment income;
• Reserves on hand;
• The amount of surplus and the amount of surplus relative to the carrier's risk-based capital requirement;
• Itemized taxes;
• Administrative ratio;
• Actual benefits ratio;
• The number of lives insured under each benefit plan the carrier offers to small employers; and
• The cost of providing or arranging health care services.

Carriers must also submit the following information to the Commissioner until January 1, 2014:

• The number of applicants for a child-only plan;
• The number of individuals enrolled in a child-only plan; and
• The number of applicants denied enrollment in a child-only plan and the reasons for the denials.

If a carrier is licensed in multiple states, it may submit the Colorado allocated portion of the data if the actual data is not available.  The Commissioner must aggregate the data submitted for all carriers and publish the information on the division's web site. The Commissioner must also submit an annual report to the general assembly on cost.