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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 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
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