§432G-1 Definitions. As used in this chapter: “Capitated basis” means fixed per member per month payment or percentage of premium payment wherein the provider assumes the full risk for the cost of contracted services without regard to the type, value, or frequency of services provided. For purposes of this chapter, “capitated basis” includes the cost […]
§432G-10 Powers of insurers and hospital and medical service corporations. (a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly or through a subsidiary or affiliate, may organize and operate a dental insurer under the provisions of this chapter. Notwithstanding any […]
§432G-11 Examinations. (a) The commissioner may examine the affairs of any dental insurer or of any providers with whom a dental insurer has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State. (b) Every dental insurer and provider shall submit its […]
§432G-12 Fees. (a) The commissioner shall collect, in advance, the following fees: (1) Certificate of authority: (A) Application for a certificate of authority: $900; and (B) Issuance of certificate of authority: $600; and (2) For all services subsequent to the issuance of a certificate of authority, including extension of the certificate of authority: $600 per […]
§432G-13 Suspension, revocation, or denial of certificate of authority. (a) The commissioner may suspend, revoke, or refuse to extend any certificate of authority issued under this chapter and may deny any application for a certificate of authority if the commissioner finds that: (1) The dental insurer is operating significantly in contravention of its basic organizational […]
§432G-14 Summary orders and supervision. (a) Whenever the commissioner determines that the financial condition of any dental insurer is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this chapter, the commissioner, after notice and hearing, may order the dental […]
§432G-15 Administrative fines and enforcement. (a) The commissioner, in addition to or in lieu of suspension or revocation of a certificate of authority pursuant to section 432G-13, may levy an administrative fine upon a dental insurer in an amount not less than $500 and not more than $50,000. The dental insurer may request, in writing, […]
§432G-16 Statutory construction and relationship to other laws. (a) Except as provided in subsection (c) and otherwise provided in this chapter, the insurance laws shall not apply to the activities authorized and regulated under this chapter of any dental insurer granted a certificate of authority under this chapter. (b) Solicitation of enrollees by a dental […]
§432G-17 Acquisition of control of or merger of a dental insurer. No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a dental insurer or enter into any other agreement […]
§432G-18 Federally funded programs; exemption. Requirements provided in this chapter relating to mandated coverages or essential health benefits shall not be applicable to any dental insurer offering dental insurance under a federally funded program under the Social Security Act, as amended; provided that this exemption shall apply only to that part of the dental insurer’s […]
§432G-19 Coordination of benefits. (a) Dental insurers are required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans. (b) Provisions adopted pursuant to subsection (a) for the coordination of […]
§432G-2 Establishment of a dental insurer; certificate of authority. (a) Any person may apply to the commissioner for a certificate of authority to establish and operate a dental insurer in compliance with this chapter and chapter 423. No person shall establish or operate a dental insurer in this State without meeting the requirements of chapter […]
§432G-20 Disclosure of dental care coverage and benefits. In order to ensure that all individuals understand their dental care options and are able to make informed decisions, all dental insurers shall provide current and prospective subscribers with written disclosure of coverages and benefits, including information on coverage principles and any exclusions or restrictions on coverage. […]
§432G-21 Federal law compliance. All dental insurers shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, Public Law 111-148. [L 2013, c 191, pt of §1]
§432G-22 Rules; adoption by commissioner. The commissioner may adopt rules under chapter 91 for the implementation and administration of this chapter. [L 2013, c 191, pt of §1] Revision Note This section, enacted as §432G-2(e), was redesignated pursuant to §23G-15.
§432G-3 Fiduciary responsibilities. (a) Any director, officer, employee, or partner of a dental insurer who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary relationship to the organization. (b) A dental insurer shall maintain in force a fidelity bond or fidelity […]
§432G-4 Annual reports. (a) Each dental insurer shall file with the commissioner: (1) An audit, by an independent certified public accountant or an accounting firm designated by the dental insurer of the financial statements, reporting the financial condition and results of operations of the dental insurer, annually on or before June 1, or a later […]
§432G-5 Information to subscribers. (a) The dental insurer shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment. (b) Every dental insurer shall provide to its subscribers notice of any material change in the operation of the organization that will affect them directly within thirty days of the material […]
§432G-6 Protection against insolvency; net solvency report. (a) Net worth requirements are as follows: (1) Before issuing any certificate of authority, the commissioner shall require that the dental insurer has an initial net worth of $2,000,000 and shall thereafter maintain the minimum net worth required under paragraph (2); (2) Except as provided in paragraphs (3) […]
§432G-7 Uncovered expenditures insolvency deposit. (a) If, at any time, uncovered expenditures exceed ten per cent of total dental care expenditures, a dental insurer shall place with the commissioner or with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is maintained, an uncovered expenditures insolvency deposit consisting of […]
