Colorado Revised Statutes Title 10. Insurance § 10-16-121.7. Prohibited contract provisions in contracts between carriers and eye care providers--definitions

(a) Provide services or materials to a covered person at a fee set by, or subject to the approval of, the carrier or entity unless the services or materials are covered services or covered materials under the covered person's vision care plan and the amount of coverage is neither nominal nor de minimis;

(b) Charge a covered person for a noncovered service or noncovered materials in an amount less than the usual and customary amount that the eye care provider charges individuals who do not have coverage for such materials and services; or

(c) Participate, as a condition of participation in a vision care plan, in any of the carrier's or entity's other vision plan networks.

(a) Institute a corrective action plan for the carrier to follow;

(b) Use any of the commissioner's enforcement powers to obtain the carrier's or entity's compliance with this section.

(a) “Covered materials” means materials for which reimbursement is available under a covered person's vision care plan, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other contractual limitations.

(b) “Covered services” means eye care provider services for which reimbursement is available under a covered person's vision care plan, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other contractual limitations.

(c) “Eye care provider” means:

(d) “Materials” means ophthalmic devices including lenses, devices containing lenses, artificial intraocular lenses, ophthalmic frames and other lens mounting apparatus, prisms, lens treatments and coatings, contact lenses, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye.

(e) “Usual and customary amount” means an amount established pursuant to an appropriate methodology that is based on generally accepted industry standards and practices.

(f) “Vision care plan” means: