Download Sed Euismod Risus Scelerisque Aliquet

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 Can’t 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