A. Every member in a prepaid dental plan shall be issued a membership coverage policy by the prepaid dental plan organization.
B. No policy for membership coverage or amendment to said policy shall be issued or delivered to any person in this state until a copy of the policy for membership coverage or amendment to said policy has been filed with and approved by the Commissioner.
C. A policy for membership coverage shall contain a statement of:
1. The prepaid dental services or other benefits to which the member is entitled under the prepaid dental plan; and
2. Any limitations of the services or benefits to be provided, including any deductible or co-payment feature; and
3. Information as to how services may be obtained; and
4. The obligation of the member for charges for the prepaid dental plan.
D. Any member in a prepaid dental plan shall be free to select any licensed dental practitioner to provide dental services and prepayment or reimbursement determinations shall be made without regard to whether the provider is a participating or nonparticipating member of the plan. This provision shall be printed on the policy for membership coverage.
E. Membership coverage shall contain no provisions or statements which are unjust, unfair, untrue, inequitable, misleading, deceptive, or which encourage misrepresentation as determined by the Commissioner.
F. The Commissioner shall approve any policy of membership coverage if the requirements of this section are complied with and the prepaid dental plan, in the judgment of the Commissioner, is able to meet its financial obligations for the membership coverage. It shall be unlawful for a prepaid dental plan organization to issue a policy until approved. If the Commissioner does not disapprove any such policy within thirty (30) days after filing, said policy shall be deemed approved. If the Commissioner disapproves a policy of membership coverage, the Commissioner shall notify the prepaid dental plan organization, specifying the reasons for disapproval. The Commissioner shall grant a hearing on such disapproval within thirty (30) days after a request in writing for a hearing is received by the Commissioner from the prepaid dental plan organization.
Added by Laws 1983, c. 66, § 8, eff. Nov. 1, 1983.
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