Effective 28 Aug 1987

354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director — newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of. — 1. Every enrollee in a prepaid dental plan corporation shall be issued a contract setting out the dental care benefits covered by his prepayment or fee. If the enrollee is a beneficiary under a group contract, then the enrollee may alternatively be issued a contract certificate summarizing the dental care benefits covered by the prepayment.

2. Any contract that provides family coverage shall, as to such coverage of individuals in the family, also provide that the benefits applicable for children shall be payable with respect to a newly born child of the insured from the instant of such child's birth to the same extent that such coverage applies to other individuals in the family. If payment of a specific premium or capitation amount is required to provide coverage for a child, the contract may require notification of birth of a newly born child and payment of the required premium or capitation amount shall be furnished to the corporation within thirty-one days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.

3. No enrollee contract, contract certificate, or contract amendment shall be issued or delivered to any person in this state until a copy of the form has been filed with the director.

4. All enrollee contracts or contract certificates shall clearly set forth:

(1) The prepaid dental care benefits to which the enrollee is entitled;

(2) Any limitations of the benefits to be provided, including any deductible or co-payment feature;

(3) Where and in what manner information is available as to how services may be obtained; and

(4) The enrollee's obligation respecting charges for the prepaid dental plan contract.

5. Enrollee contracts, contract certificates, advertising matter, and sales material shall not contain any provision or statements that are deceptive, ambiguous, or misleading.

6. No enrollee contract, contract certificate, or contract amendments shall be used until such form is approved by the director. If the director does not approve or disapprove any such form within thirty days after its filing, it shall be deemed approved. If the director disapproves a form, the director shall notify the prepaid dental plan corporation in writing and specify the reasons for disapproval. The director shall grant a hearing on such disapproval within fifteen days after a request in writing is received from the prepaid dental plan corporation.

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(L. 1987 S.B. 272 § 7)