Small and Large Group Health Insurance Reporting for Bulletin B-4.105
Carriers offering group health benefit plans in Colorado should complete and submit the Colorado DOI Small and Large Group Health Insurance Reporting Form for Bulletin B-4.105 (below).

The form must be submitted no later than one week from the last day of the previous calendar month for as long as Bulletin B-4.105 is in effect. If the date one week from the end of the previous calendar month falls on a weekend, submissions will be due the following Monday.

The initial report should include data from March 1- April 30, 2020, and is due on May 7. Subsequent reports should include data from the previous calendar month (i.e., the report for May 1 - May 31 will be due on June 8).  

By hitting submit on the form, carriers are acknowledging that the information submitted, to the best of their good faith knowledge and belief, is accurate and complete.

For questions about this form or the requirements of Bulletin B-4.105, please contact Tara Smith at tara.smith@state.co.us or (c) 720-701-0081.
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Name of carrier *
Name of person completing form *
How many small group policies do you currently have in the state of CO? *
How many large group policies do you currently have in the state of Colorado? *
Grace periods and premium deferrals
DOI Bulletin B-4.105 directs carriers to make reasonable accommodations to prevent businesses and employees from losing coverage due to non-payment of premiums during the COVID-19 public health emergency, including but not limited to: 1) extensions of premium grace periods or premium deferrals; 2) waivers of late payment fees or interest; and 3) a moratorium on cancellations for non-payment.
1) How many requests have you received in the current calendar month (between the 1st day of this month and the date of report submission) for an extension of a policyholder's grace period or a deferral of a monthly premium amount that was due? Please list the total number. *
1a) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #1.
2) Of the total requests for grace period extensions or premium deferrals you have received, how many were granted? Please list the total number. *
2a) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #2. This includes information about the number of request that are currently pending, have been withdrawn, or addressed through a different accommodation.
3) What is the total amount of late fees that were waived due to grace period extensions AND/OR premium deferrals? Please provide a total dollar figure. *
3a ) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #3.
4) How many group policies would have been cancelled during the current calendar month (between the 1st day of this month and the date of report submission) for non-payment of premiums in the absence of the grace period and/or premium deferral accommodations included in DOI Bulletin B-4.105? Please list the total number. *
4a) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #4.
Employee eligibility
DOI Bulletin B-4.105 also directs carries to make reasonable accommodations for employer requests to provide flexibility for health coverage policy provisions that would restrict or negatively impact employee eligibility and the continuation of coverage if an employee’s hours are reduced, or if they are laid off or furloughed, as a result of the COVID-19 public health emergency. Such flexibility should extend, but not be limited to: 1) waivers of minimum employee participation requirements; 2) waivers of employer and employee contribution requirements; 3) waivers of a minimum number of employee work hours required for benefit eligibility; 4) waivers of coverage waiting periods for employees; 5) allowing employers to include part-time and seasonal employees; and 6) allowing employees that initially declined coverage to enroll in coverage.
5) How many contractual modifications or policy waivers have you made in the last month, either through the request of the employer or through your own outreach? (Please list the total number.) *
5a) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #5.
6) What was the nature of the contract modification or policy waiver? Select all that apply. *
Required
6a) If other, please describe *
7) Of the total number of contractual modifications or policy waivers that were requested by employers, how many did you deny? Please list the total number. *
7a) Please provide any additional information that describes, explains, or offers relevant context for the number reported in question #7.
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