The 2025 legislative session in Colorado runs from January 8 through May 7. Rulemaking from administrative agencies occurs throughout the year. Important updates taking effect or finalized in the first quarter of 2025 for employee benefits are detailed below.
On January 1, 2025, Amended Regulation 4-2-50 Concerning Pediatric Dental Coverage Requirements, which was adopted by the Colorado Division of Insurance (DOI) on October 11, 2024, took effect. The new rule prohibits health insurance carriers from selling individual or small group health plans ‒ whether on or off the exchange ‒ to consumers with children under 19 years old unless the plan includes pediatric dental coverage as an essential health benefit (EHB). If the plan does not include this coverage, carriers must obtain reasonable assurance that the consumer has or will purchase pediatric dental coverage separately.
On January 1, 2025, Amended Regulation 4-2-56 Concerning Continuity of Care Requirements for ACA-Compliant Health Benefit Plans took effect. The new rule provides state-level continuity of care requirements for ACA-compliant plans, including the timing of member notice when a provider is removed or leaves the network without cause, reasonable procedures for transferring care of an eligible enrollee, and making available a list of participating providers who are accepting new patients. Continuity of care protections apply when a provider leaves or is terminated from a plan’s network. This regulation was adopted by the Colorado DOI on November 8, 2024.
On January 30, 2025, Amended Regulation 4-2-64 Concerning Mental Health Parity in Health Benefit Plans took effect. The rule reiterates that all health benefit plans subject to the individual and group laws of Colorado must comply with the financial requirements and quantitative treatment limitations specified in federal mental health parity mandates. The regulation also establishes requirements, processes, and forms to be utilized by carriers to ensure compliance with Colorado Revised Statutes and the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This regulation was adopted by the Colorado DOI on December 16, 2024.
On March 17, 2025, the Colorado DOI issued Bulletin No. B-4.149 Concerning Prosthetic Devices for Recreational Activities Coverage. The bulletin clarifies that all fully insured group health plans are required to provide coverage for prosthetic devices which are necessary to engage in physical and recreational activities, including running, bicycling, swimming, climbing, skiing, snowboarding, and team as well as individual sports. The bulletin was issued to provide guidance to insurance carriers following 2023 legislation (HB23-1136) on the topic.
On March 19, 2025, the Colorado DOI adopted Regulation 4-2-103 Concerning Transparency in Coverage Reporting Requirements. The new rule outlines the form, manner, and submission of transparency files required by Section 10-16-168(4) of the Colorado Revised Statutes (CRS), as well as the prescription drug data collection files required under CRS Section 10-16-169. This state-level regulation applies to carriers and plans subject to the federal Transparency in Coverage rule and the Consolidated Appropriations Act, 2021 (CAA), including the group health plan market. The regulation will become effective April 14, 2025.
On March 20, 2025, Gov. Polis signed HB25-1002, the Medical Necessity Determination Insurance Coverage Act. The law clarifies that coverage for mental and behavioral health services must be no less extensive than coverage for physical health conditions, in compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA). The bill also mandates:
- Coverage for placement decisions, including admission, continued stay, transfer, and discharge for individuals with mental health conditions.
- Medically necessary treatment for behavioral health, mental health, and substance use disorders, using criteria.
- Utilization review standards, service intensity guidelines, level-of-care determinations, and provider reimbursement rules.
The new requirements take effect on January 1, 2026, unless a state referendum delays implementation.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier or third-party administrator for further details.
- Amended Regulation 4-2-50 Concerning Pediatric Dental Coverage Requirements
- Amended Regulation 4-2-56 Concerning Continuity of Care Requirements for ACA-Compliant Health Benefit Plans
- Amended Regulation 4-2-64 Concerning Mental Health Parity in Health Benefit Plans
- Bulletin No. B-4.149 Concerning Prosthetic Devices for Recreational Activities Coverage
- Regulation 4-2-103 Concerning Transparency in Coverage Reporting Requirements
- HB25-1002 Medical Necessity Determination Insurance Coverage