The Colorado Division of Insurance (DOI) regulates Colorado’s insurance industry, which includes homeowners and renters insurance, auto insurance, life insurance and annuities, and health insurance.
Who do they serve?
If you have a DOI-regulated health insurance plan, the two-letter state abbreviation followed by “DOI” will be printed on your insurance identification card (e.g. Colorado regulated plans say “CO-DOI”). All plans sold on the Connect for Health CO marketplace are DOI regulated, so if you enrolled in a plan during Open Enrollment or are planning to enroll during the Special Enrollment Period (February 8, 2021 — May 15, 2021), you are protected.
However, not all health insurance plans are regulated at the state level. The Division can only regulate health plans from state-licensed issuers. If your plan is sponsored by your employer, it’s likely that you are not protected by the Division. For self-funded or self-insured plans, the employer assumes the financial risk for providing health care benefits to its employees. Employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier. These self-funded plans are regulated by the federal government and national laws like the Employee Retirement Income Security Act of 1974 (ERISA). ERISA sets minimum standards that private health plans must meet to provide protection for their consumers. The federal government also regulates DOI plans. Therefore, if you have DOI-regulated plan, then you have federal protections and additional protections from state-wide legislature.
What can the DOI do for you?
The Division can investigate complaints, help you understand your insurance, and answer your questions. In 2019, they recovered $8,452,684 through the investigation of consumer complaints.
When you submit a complaint to the DOI, they communicate directly with your insurance carrier with regulatory and disciplinary actions to enforce our health insurance laws. For example, Colorado has House Bill 19-1174, which prohibits providers from balance billing. This is when you visit an in-network facility and are inadvertently treated by an out-of-network provider. Out-of-network providers do not have a contract with your insurance company, so the insurer may decide not to pay the entirety of your medical bill. The “balance bill” refers to when the out-of-network provider bills you, the patient, for the remaining balance of the bill. The DOI can reprimand providers for failing to adhere to Colorado’s legislation.
Disciplinary actions can include cease and desist orders, final agency orders, and summary suspensions. The DOI keeps a public record of these disciplinary actions. The searchable index includes enforcement actions taken to-date against insurance agents, agencies or companies.
If you believe your rights as a Colorado consumer have been violated, contact the Division.
Resources and Information
- Here, you can verify the license of your insurance agent, agency, or company.
- You can also read some of the legislation they apply, such as Public Option for Health Coverage (HB19-1004) or Out-of-Network Health Care Provider Reimbursement (HB19-1174), on the DOI’s website.
- Or, you can browse information and FAQs on insurance topics like, LGBTQ health care rights or mental and behavioral health.
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