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Colorado Insurance Law and Cleft Lip and Cleft Palate CoverageDayle Axman, FLMI, ACS, AIE, AISColorado Division of InsuranceOctober 10, 2015Introduction to the Division of InsuranceRegulate insurance to ensure that insurance rates are not excessive, inadequate, or unfairly discriminatoryGive consumers the greatest choice of policies at the most reasonable cost possiblePermit and encourage open competition between insurers on a sound financial basisCRS 10-1-101Finance and AdministrationActuarialFinancial ExaminersCorporate AffairsRates and FormsLife and HealthProperty and Casualty

Financial AffairsMarket RegulationConsumer AffairsConsumer AffairsLife and HealthProperty and CasualtySenior Health Insurance Program (SHIP/SMP)Compliance Licensing and Investigations

Consumer ProtectionConsumer AffairsComplaint processReferral to Market Regulation for enforcement actionReferral to Licensing and Investigations

Market Regulation Market Analysis Targeted Market Conduct ExaminationsConsumer AffairsEducation13,000 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 statesHealth plans that are self-funded by employersSingle employer plans where the master contract is issued in another stateMedicare and MedicaidFederal employee benefit plansCleft coverage mandates in other states15 other states have some type of mandated coverage*:CaliforniaNew YorkConnecticutNorth CarolinaFloridaSouth CarolinaIndianaTexasLouisianaVermontMarylandVirginiaMassachusettsWisconsinMinnesota

* According to CleftAdvocate.org and the internetSection 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 appliancesCoverage (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 letterDOI Mission:Promote compliance and enforce laws to help protect consumers15