Understanding Colorado Insurance Law and Cleft Lip Coverage
Introduction to Colorado Division of Insurance, its role in regulating insurance rates to protect consumers, divisions like Finance and Administration, Consumer Affairs, and Consumer Protection, along with guidelines on identifying Colorado-regulated insurance plans. It also outlines the limitations of the Division's assistance with certain types of policies.
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Colorado Insurance Law and Cleft Lip and Cleft Palate Coverage Dayle Axman, FLMI, ACS, AIE, AIS Colorado Division of Insurance October 10, 2015
Introduction to the Division of Insurance Regulate insurance to ensure that insurance rates are not excessive, inadequate, or unfairly discriminatory Give consumers the greatest choice of policies at the most reasonable cost possible Permit and encourage open competition between insurers on a sound financial basis CRS 10-1-101
Finance and Administration Actuarial Financial Examiners Corporate Affairs Rates and Forms Life and Health Property and Casualty Financial Affairs Market Regulation
Consumer Affairs Consumer Affairs Life and Health Property and Casualty Senior Health Insurance Program (SHIP/SMP) Compliance Licensing and Investigations
Consumer Protection Consumer Affairs Complaint process Referral to Market Regulation for enforcement action Referral to Licensing and Investigations Market Regulation Market Analysis Targeted Market Conduct Examinations
Consumer Affairs Education 13,000 calls, emails and written inquiries Consumer Recoveries (Fiscal Year 2014-2015) $7,436,522 for all lines of insurance
How do I know if my plan is a Colorado-regulated plan? Check your member ID card: Does it have a CO-DOI designation on it? If so, Colorado insurance laws apply and the Division can help you.
What Cant the Division Help With? Individual policies issued in other states Health plans that are self-funded by employers Single employer plans where the master contract is issued in another state Medicare and Medicaid Federal employee benefit plans
Cleft coverage mandates in other states 15 other states have some type of mandated coverage*: California New York Connecticut North Carolina Florida South Carolina Indiana Texas Louisiana Vermont Maryland Virginia Massachusetts Wisconsin Minnesota * According to CleftAdvocate.org and the internet
Section 10-16-104(1)(c)(II), C.R.S. Effective July 1, 1975 Generally covers cleft lip, cleft palate, or any condition or illness which is related to or developed as a result of the cleft lip or cleft palate and there is no age limit. Provides medically necessary coverage for: Oral and facial surgery
Coverage (continued) Surgical management and follow-up care by plastic and oral surgeons Prosthetic treatment, such as: Obturators Speech appliances Feeding appliances
Coverage(continued) Orthodontic treatment Prosthodontic treatment Habilitative speech therapy Otolaryngology treatment Audiological assessments and treatment
Other Requirements If there is also a dental policy: It must provide full coverage for all orthodontics or dental care needed. May apply the same copayment provisions that apply to other conditions or procedures covered by the policy.
Where do I go to ask a question or to file a complaint? If you have a Colorado plan: Call (303)894-7490 or 1-800-930-3745 www.dora.colorado.gov/Insurance Complaints file electronically through our website or send us a letter
DOI Mission: Promote compliance and enforce laws to help protect consumers 15
