Colorado Course Update January 2017
Colorado Life & Health and Property & Casualty courses have been updated with outline changes effective March 1, 2016. Continue reading for Life & Health and Property & Casualty Addendums.
The following are content additions or revisions as indicated to supplement your existing text:
Colorado Statutes, Rules, and Regulations Common to All Lines
- Insurance Commissioner
- Power and Duties
Records and Requests for Information – new topic on the outline
All insurance companies doing business in this state must maintain all books, documents, and other business records for the current calendar year plus 2 prior calendar years unless a longer time period is specified by other laws. This includes any internal and external communications. The purpose of this regulation is to clarify rules regarding retention, maintenance, access to and retrievability of records.
Every entity subject to this regulation must maintain books, records and documents pertaining to all of following:
- Operations and management;
- Policyholder services;
- Claims handling;
- Rating;
- Underwriting;
- Advertising, marketing and sales;
- Complaint/grievance handling; and
- Producer licensing.
Health entities must also retain records regarding:
- Network adequacy;
- Utilization review;
- Quality assessment and improvement; and
- Provider credentialing.
Companies must provide a complete and accurate response to an Examination Request/Comment Form or Examination Request/Memo Form within 10 calendar days from the date on the form, unless another time period is specified in writing.
For any other inquiries from the Division of Insurance, companies must provide a complete and accurate response within 20 calendar days from the date of the inquiry.
If additional time is required to respond to an inquiry, the person must submit a written request for an extension of time to the Division making the inquiry. The request must
- Be made no later than 5 p.m. Mountain Time on the business day prior to the response due date;
- Include a specific period of time for the extension; and
- State in detail the reasons necessitating the extension.
The following may result in a $500 civil penalty for an initial violation, and may be increased up to a maximum penalty of $5,000 for each subsequent violation:
- Failure to provide a complete and accurate response to a Division inquiry;
- Failure to request an extension for a specified period; or
- Failure to provide a complete and accurate response to a Division inquiry when an extension is not granted.
- Licensing and Producer’s Legal Responsibility
- Persons Required to Be Licensed
Prelicensing Education and Examinations – first paragraph revised; the rest of the section remains unchanged
An individual seeking insurance producer licensure authority must complete at least 50 hours of an approved prelicensing course or program for certification in their line of authority (Life, Health, Property, Casualty, Property and Casualty, or Personal Lines), including at least 3 hours pertaining specifically to insurance industry ethics and 4 hours pertaining specifically to state laws related to the line of authority. Applicants must receive certificates of completion before taking their licensing exams. These certificates are valid for 1 year from the date of completion.
Colorado Statutes, Rules, and Regulations Pertinent to Life Only
- Sales and Marketing of Life Insurance and Annuities
- Advertisements – addition to the existing text:
All advertisements must be maintained on file for a period of 5 years after discontinuance of its use or publication.
Illustrations of benefits payable under any variable life insurance policy or variable annuity may not include projections of past investment experience into the future or attempted predictions of future investment experience.
Colorado Statutes, Rules, and Regulations for Sickness & Accident Insurance Only
- Individual Coverage
Enrollment Periods – new section on the outline:
This regulation applies to all carriers offering individual and/or group health benefit plans subject to the laws of Colorado and the requirements of the Affordable Care Act.
Carriers offering individual health benefit plans must display continuously and prominently on their web site:
- Notice of open enrollment dates;
- Notice of special enrollment for qualifying and triggering events;
- Notice of the enrollment periods for each qualifying and triggering event; and
- Instructions on how to enroll.
The open enrollment period for plans effective on or after January 1 must begin on November 1 of the previous year and extend through January 31 of the year of coverage.
Carriers must ensure that coverage is effective:
- January 1 for health benefit plans purchased on or before December 15 of the open enrollment period;
- February 1 for health benefit plans purchased between December 16 through January 15 of the open enrollment period; and
- March 1 for health benefit plans purchased between January 16 through January 31 of the open enrollment period.
The benefit year for individual health benefit plans purchased during the annual open enrollment period is a calendar year.
Carriers must establish a special enrollment period of 60 days for individuals who experience triggering events. The following are some of the triggering events for special enrollment in health plans issued in Colorado:
- An individual or his or her dependent involuntarily loses existing creditable coverage for any reason other than fraud, misrepresentation, or failure to pay a premium.
- An individual loses pregnancy-related Medicare coverage.
- An Exchange enrollee loses a dependent or is no longer considered a dependent through divorce or legal separation.
- An individual gains a dependent or becomes a dependent through marriage, civil union, birth, adoption, or placement in foster care.
- An individual gains access to other creditable coverage as a result of a permanent change in residence.
- Native Americans may enroll in a qualified health plan or change from one qualified health plan to another one time per month.
- Fair Marketing Standards – addition to the existing text:
The format and content of an advertisement of an accident and sickness insurance policy must be complete and clear to avoid deception or the capacity or tendency to mislead or deceive.
Distinctly different advertisements are required for publication in different media, such as newspapers or magazines of general circulation as compared to scholarly, technical or business journals and newspapers. Where an advertisement consists of more than one piece of material, each piece of material must, independent of all other pieces of material, conform to the disclosure requirements.
If a company uses testimonials or endorsements in its advertisements for more than 1 year, it must obtain a confirmation. When a testimonial refers to benefits received under an accident and sickness insurance policy, the specific claim data, including claim number, date of loss and other pertinent information must be retained by the insurer for inspection for a period of 4 years or until the filing of the next regular report of examination of the insurer, whichever is the longer period of time.
Whether an advertisement has a capacity or tendency to mislead or deceive will be determined by the Commissioner from the overall impression that the advertisement may be reasonably expected to create within the segment of the public to which it is directed.
Each insurer must maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of any of its policies for a period of either 4 years of until the filing of the next regular report on examination of the insurer, whichever is the longer period of time.
Addendum: for use with Colorado Property and Casualty online ExamFX courses and study guide version 19188en/19189en, per exam content outline updates effective January 1, 2017.
The following are content additions to supplement your existing text:
Colorado Statutes, Rules, and Regulations Common to All Lines
- Insurance Commissioner
- Power and Duties
Records and Requests for Information – new topic on the outline
All insurance companies doing business in this state must maintain all books, documents, and other business records for the current calendar year plus 2 prior calendar years unless a longer time period is specified by other laws. This includes any internal and external communications. The purpose of this regulation is to clarify rules regarding retention, maintenance, access to and retrievability of records.
Every entity subject to this regulation must maintain books, records and documents pertaining to all of following:
- Operations and management;
- Policyholder services;
- Claims handling;
- Rating;
- Underwriting;
- Advertising, marketing and sales;
- Complaint/grievance handling; and
- Producer licensing.
Health entities must also retain records regarding:
- Network adequacy;
- Utilization review;
- Quality assessment and improvement; and
- Provider credentialing.
Companies must provide a complete and accurate response to an Examination Request/Comment Form or Examination Request/Memo Form within 10 calendar days from the date on the form, unless another time period is specified in writing.
For any other inquiries from the Division of Insurance, companies must provide a complete and accurate response within 20 calendar days from the date of the inquiry.
If additional time is required to respond to an inquiry, the person must submit a written request for an extension of time to the Division making the inquiry. The request must
- Be made no later than 5 p.m. Mountain Time on the business day prior to the response due date;
- Include a specific period of time for the extension; and
- State in detail the reasons necessitating the extension.
The following may result in a $500 civil penalty for an initial violation, and may be increased up to a maximum penalty of $5,000 for each subsequent violation:
- Failure to provide a complete and accurate response to a Division inquiry;
- Failure to request an extension for a specified period; or
- Failure to provide a complete and accurate response to a Division inquiry when an extension is not granted.
- Licensing and Producer’s Legal Responsibility
- Persons Required to Be Licensed
Prelicensing Education and Examinations – first paragraph revised; the rest of the section remains unchanged
An individual seeking insurance producer licensure authority must complete at least 50 hours of an approved prelicensing course or program for certification in their line of authority (Life, Health, Property, Casualty, Property and Casualty, or Personal Lines), including at least 3 hours pertaining specifically to insurance industry ethics and 4 hours pertaining specifically to state laws related to the line of authority. Applicants must receive certificates of completion before taking their licensing exams. These certificates are valid for 1 year from the date of completion.