DEPARTMENT OF REGULATORY AGENCIES
Division of Insurance
3 CCR 702-4
life, accident and health
Emergency Regulation 09-E-02
MANDATORY COVERAGE OF MENTAL ILLNESSES PURSUANT TO §10-16-104 (5) AND (5.5), C.R.S., FOR SMALL GROUP POLICIES
Section 1	Authority
Section 2	Scope and Purpose
Section 3	Applicability
Section 4	Definitions
Section 5	Rules
Section 6	Severability
Section 7	Enforcement
Section 8	Effective Date
Section 9	History
Section 1	Authority
This regulation is promulgated and adopted by the Commissioner of Insurance under the authority of §§10-1-109 and 10-16-104(5) and (5.5), C.R.S.
Section 2	Scope and Purpose
The purpose of this emergency regulation is to provide health carriers with guidance on implementation of House Bill 1338 enacted during the 2009 General Assembly to comply with federal law, Public Law 110-343, enacted October 3, 2008. The Division of Insurance finds that immediate adoption of this regulation is necessary due to the effective date of House Bill 1338 of July 1, 2009 and that compliance with the requirements of §24-4-103(3), C.R.S., would not be in the public’s interest. It replaces Colorado Insurance Regulation 4-6-12 in its entirety.
Section 3	Applicability 
This emergency regulation applies to every entity issuing small group health benefit plans pursuant to §10-16-105, C.R.S. 
Section 4	Definitions
Biologically based mental illness (BBMI) shall have the same meaning as in §10-16-104 (5.5), C.R.S.
Section 5	Rules
A.	Section 10-16-104(5), C.R.S. applies to small group policies as defined in §10-16-102(42), C.R.S. and which are subject to §10-16-105, C.R.S.
B.	Section 10-16-104(5), C.R.S., applies to all mental illness conditions, including, but not limited to the BBMI benefits required by §10-16-104(5.5), C.R.S. under small employer group health benefit plans and includes the following mandated benefits:
1.	At least 45 inpatient (90 partial hospitalization) days in any one twelve-month period;
2.	No less than 20 outpatient visits or no less than $1,000 paid for outpatient visits in any twelve-month period; and 
3.	Copayment or coinsurance shall not exceed a 50% requirement.
C.	Section 10-16-104 (5.5), C.R.S., applies to a defined subset of mental illness conditions for BBMI for small employer group health benefit plans. Section 10-16-104 (5.5), C.R.S., provides coverage for treatment for BBMI that is no less extensive than coverage provided for any other physical illness.
D.  	Based on subsections A. and B. of this section 5, the following findings are made:
1.	The increased insurance coverage of §10-16-104(5.5) C.R.S., for BBMI was not intended to duplicate coverage provided in §10-16-104(5), C.R.S. or provide a double benefit;
2.	Treatment for BBMI under subsection (5.5) of §10-16-104, C.R.S. might permit “different” types of treatment than would be permitted under subsection (5) of §10-16-104, C.R.S. but will provide “additional” insurance benefits above the limitations set out in subsection (5).
3.	BBMI benefits in accordance with §10-16-104 (5.5), C.R.S. reduce or exhaust the benefits mandated by §10-16-104(5), C.R.S.
4.	The copayment or coinsurance protections of §10-16-104(5)(c), C.R.S., apply to BBMI benefits provided in accordance with §10-16-104(5.5), C.R.S.
5.	BBMI benefits provided in accordance with §10-16-104(5.5), C.R.S., must be provided at the more generous of the physical illness or mental illness benefits of §10-16-104(5), C.R.S., through the 20th visit. Thereafter, only the copayment or coinsurance protections continue to apply to BBMI pursuant to §10-16-104(5.5), C.R.S., and the mental illness benefit of §10-16-104(5), C.R.S.
Section 6	Severability
If any provision of this regulation or the application of it to any person or circumstance is for any reason held to be invalid, the remainder of this regulation shall not be affected. 
Section 7	Enforcement
Noncompliance with this regulation may result, after proper notice and hearing, in the imposition of any of the sanctions made available in the Colorado statutes pertaining to the business of insurance or other laws that include the imposition of fines, issuance of cease and desist orders, and/or suspensions or revocation of license or certificate of authority. Among others, the penalties provided for in §10-3-1108, C.R.S. may be applied.  
Section 8	Effective Date
This emergency regulation shall become effective on July 1, 2009.

Section 9	History
Emergency regulation 08-E-2 effective January 1, 2008.
New regulation effective February 1, 2008.
Emergency Regulation 09-E-02 effective July 1, 2009.