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Instructions
Instructions applicable to entire template (all tabs):

~ This template should be downloaded as an Excel file, filled out, and submitted back to the Division as an Excel file.

~ Most language used in this template is pulled directly from Emergency regulation 22-E-XX to facilitate data reporting by Health Care Sharing Associations (HCSAs).

~ All tabs must be completed and emailed to the Division. In addition, Colorado Revised Statute 10-16-107.4 specifies other material also required to be submitted to the Division as part of data reporting. These additional elements are also described on tab "Pg. 4 Attestation"

~ Unless explicitly noted otherwise all data fields in this template are related to participants in plans or arrangements who are Colorado residents. E.g., requests for national information use the word “nationally” to denote the data should be provided at a national and not Colorado level

~ Completed templates should be emailed to Leilani Russell (Leilani.Russell@state.co.us)

Instructions applicable to tab "Pg.2 Plan specific information"
~ If your organization has a TIN (Tax ID number) please provide that in the designated field, otherwise leave this field blank.

~ If data elements are not applicable to your organization's plan or arrangement please note "does not apply see note" and explain why this data element does not apply to your organization in the "Additional context" green box

~ Products will be the organization's specific titles. E.g. Classic membership

~ Required information "K. Total dollar amount of health-care costs or services that were submitted by or on behalf of the participant for sharing" This includes all requests for reimbursement of Colorado participants' health-care costs or services including any requests that were denied or approved or have not yet been denied or approved.

~ Please note element "M. For this product, the total amount of payments made to providers for Colorado participants' health care services" is the subset of dollars from element "L. For this product, the total dollar amount of requests for reimbursement of Colorado participants' health-care costs or services that were submitted and were paid" that were paid to providers for that product, in that reporting year.

~ Please note element "N. For this product, the total amount of reimbursements made to Colorado participants for health care services" is the subset of dollars from element "L. For this product, the total dollar amount of requests for reimbursement of Colorado participants' health-care costs or services that were submitted and were paid" that were reimbursed to participants for the product, in the reporting year.

Instructions applicable to tab "Pg. 4 Attestation”
~ Please provide the following required information via email to Leilani Russell (Leilani.Russell@state.co.us)
* Copies of consumer facing and marketing materials, including a link to the organizational website used for marketing, used in Colorado to promote the person’s plan or arrangement, including plan or arrangement and benefit descriptions, and other materials that explain the plan or arrangement
* Copies of any training materials provided to a third party and to a producer
* Organizational chart for the organization and a list of the officers and directors of the organization


Definitions
~ “Administrative expenses” shall mean costs incurred to operate and support the functioning of the health care sharing plan or arrangement. This includes but is not limited to bank fees, staff salaries, data processing, sales, and marketing efforts. This includes fees, commissions, and remuneration paid to contractors that acted on behalf of the HCPA to facilitate administrative expenses.

~ "Coloradans" shall mean residents of Colorado during the reporting period.

~ “Filing date” shall mean for the purposes of this regulation, the day after the HCSPR filing is received at the Division.

~ “Health care costs” or "health care expenses" shall mean any amount billed by a health care provider for health care services or related products or by a pharmacy.

~ “Health care services” means any services included in or incidental to the furnishing of medical, behavioral, mental health, or substance use disorder; dental, or optometric care; hospitalization; or nursing home care to an individual, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing, or healing human physical illness or injury, or behavioral, mental health, or substance use disorder. “Health-care services” includes the rendering of the services through the use of telehealth, as defined in § 10-16-123 (4)(e), C.R.S.

~ “Health care sharing plan” or “health care sharing arrangement” or “plan” or “arrangement” or “HCSPA” shall mean any organization that offers or markets products to facilitate payment or reimbursement of health-care costs or services for one (1) or more residents of Colorado. This does not include direct primary care agreements as defined in § 6-23-101, C.R.S.; consumer payment plans offered directly between a provider and patient (or patient’s responsible party); businesses used to facilitate the plan’s operations such as reimbursement handling, cost containment vendors, data processing; and crowdfunded sources for the purposes of paying for and/or reimbursement of health care services.

~ “Insurance producer” or “producer”, shall have the same meaning as found at § 10-2-103(6), C.R.S., with the exception that for the purposes of this regulation it does not include § 10-2-103(6)(b), C.R.S.”

~ “Program expenses” shall mean any service by the HCSPA or its contractors that, while not direct medical care, contributes to the care and overall experiences of HCSPA’s participants. This includes but is not limited to coaching and wellness programs, care navigation, care coordination, medical review, quality improvement efforts, cost containment, reimbursement handling, and bill negotiations. This includes fees, commissions, and remuneration paid to contractors that acted on behalf of the HCPA to facilitate program expenses.

~ “Product(s)” means, for the purposes of this regulation, the services covered as a package under a membership plan, tier, or level.

~ “Third party” shall mean contractors that are associated with or assist the plan or arrangement in offering or enrolling Colorado residents as participants in the plan or arrangement.
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