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Textbook
1. General Insurance Concepts
2. Producer Roles and Receipt Types
3. Principles of Life Insurance
4. Underwriting
5. Term Life Insurance
6. Whole Life Insurance
7. Variable Insurance Products
8. Group Life Insurance
9. Life Insurance Provisions
10. Annuities
11. Taxation of Life Insurance Products
12. Qualified Retirement Plans
13. Health Insurance Basics
14. Required Policy Provisions
15. Optional Policy Provisions
16. Medical Expense Insurance
17. Group Health Insurance
18. The Affordable Care Act (ACA)
19. Disability Income Insurance
20. Accidental Death and Dismemberment Insurance
21. Long Term Care Insurance
22. Dental Insurance
23. Section 125 Plans and Limited Policies
24. Federal Government Programs
25. Medigap and Medicaid
26. Health Insurance Taxation
Wrapping Up
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Achievable Life & Health
39. Colorado Ethics
39.5. Colorado Accident & Health Insurance Statutes and Regulations

Introduction

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Colorado’s accident and health (also called sickness and accident) insurance laws set key consumer protections, require minimum benefit standards, and regulate how insurers market, issue, and administer health coverage in the state. These laws apply to individual, group, small-group, and specialized health insurance products, including Medicare Supplement policies, long-term care coverage, disability income policies, and major medical plans.

Understanding these regulations matters for two main reasons:

Exam success

The Colorado-specific portion of the licensing exam places heavy emphasis on accident and health regulations. Pearson VUE’s content outline expects you to know key areas such as:

  • Mandatory health benefits
  • Individual and group policy standards
  • Guaranteed renewability rules
  • Prompt pay requirements
  • Utilization review procedures
  • Replacement rules
  • Small group eligibility, rating, and participation guidelines
  • Sales and marketing restrictions
  • Special product regulations (LTC, Med Supp, benefit plan summaries)

This chapter follows the exam outline closely, so you’ll learn the material in the same structure you’ll see on the test.

Real-world application

As a licensed Accident & Health producer in Colorado, these statutes guide day-to-day work, including:

  • Explaining minimum mandated benefits to clients (e.g., diabetes supplies, maternity/newborn coverage, mental health parity).
  • Ensuring accurate and ethical marketing of health insurance.
  • Advising clients about enrollment periods, continuation rules, and termination rights.
  • Complying with guaranteed-issue requirements in the individual and small-group markets.
  • Understanding what carriers can and cannot consider when underwriting or setting rates.
  • Navigating prompt-payment expectations to prevent delays in claims.
  • Assisting consumers with appeals, grievances, and utilization review procedures. :::

If you don’t know these regulations, you’re more likely to run into compliance violations, consumer complaints, and potential loss of licensure. This chapter focuses on the practical knowledge you need to stay compliant and provide competent, ethical service.

How this chapter is organized

Each topic corresponds directly to a section of the Colorado Revised Statutes (C.R.S.) Title 10 and applicable Colorado Division of Insurance Regulations. You’ll find clear explanations of:

  • What the rule requires
  • Why it exists
  • When and how it applies in real insurance transactions

Examples and plain-language explanations are used throughout to translate legal requirements into situations you’ll actually encounter.

How to interpret statutory references

Throughout the chapter, you’ll see citations like:

  • C.R.S. 10-16-104 (refers to Title 10, Article 16, Section 104 of the Colorado Revised Statutes)

  • Reg. 4-2-8 (refers to a Colorado Division of Insurance regulation within Series 4, Part 2, Section 8)

You are not required to memorize statute numbers for the exam. However, understanding what these references mean helps you:

  • See where the rules come from
  • Understand how Colorado organizes its insurance laws
  • Find the exact legal language when you need it in professional practice

What you will gain from this chapter

By the end of this chapter, you will be able to:

  • Identify Colorado’s mandatory health insurance benefits and explain them to consumers
  • Understand the differences between individual, group, and small-group regulatory requirements
  • Comply with renewal, termination, and continuation rules
  • Recognize rules around replacements, disclosures, and suitability
  • Navigate Utilization Review, Appeals, and Prompt Pay regulations
  • Understand the strict marketing and ethical standards for Accident & Health coverage
  • Apply state-specific rules for Medicare Supplement, Long Term Care, and other regulated health products
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