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31.10.45.00.htm 31.10.45.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 45 Dental Network Adequacy Authority: Insurance Article, §2-109(a)1) and 15-112(e) Annotated Code of Maryland
31.10.45.01.htm 31.10.45.01. 01 Scope.. This chapter applies to carriers that issue or renew dental plans in Maryland and use a provider panel for a dental plan offered in Maryland.
31.10.45.02.htm 31.10.45.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Carrier” means:. a) An insurer authorized to sell dental insurance;. b) A nonprofit health service plan that provides coverage for dental services; or. c) A dental plan organization as defined in Insurance Article, §14-401, Annotated Code of Maryland.. 2) “Dental plan” means a contractual arrangement for dental services.. 3) “Dental network adequacy waiver request” means
31.10.45.03.htm 31.10.45.03. 03 Travel Distance Standards.. A. Sufficiency Standards.. 1) Using the zip code list on the Maryland Insurance Administration’s website, each provider panel of a carrier shall have within the geographic area served by the carrier’s network or networks, sufficient dentists, including specialty providers, and facilities to meet the maximum travel distance standards listed in the chart under §A(2) of this regulation for each type of geographic area measured from the enrollee’s plac
31.10.45.04.htm 31.10.45.04. 04 Appointment Waiting Time Standards.. A. Sufficiency Standards.. 1) Subject to §B of this regulation, each carrier’s provider panel shall meet the waiting time standards listed in §C of this regulation for at least 95 percent of the enrollees covered under dental plans that use that provider panel.2) When it is clinically appropriate and an enrollee elects to utilize a telehealth appointment, a carrier may consider that utilization as a part of its meeting the standards
31.10.45.05.htm 31.10.45.05. 05 Waiver Request Standards.. A. A carrier may apply for a dental network adequacy waiver, for up to 1 year, of a dental network adequacy requirement listed in this chapter.B. The Commissioner may find good cause to grant the dental network adequacy waiver request only if the carrier demonstrates that the providers necessary for an adequate network:1) Are not available to contract with the carrier;. 2) Are not available in sufficient numbers;.
31.10.45.06.htm 31.10.45.06. 06 Dental Network Adequacy Executive Summary Form.. A. For each provider panel used by a carrier for a dental plan, the carrier shall provide the network sufficiency results for the dental plan service area as follows:1) Travel Distance Standards.. a) For each provider type listed in Regulation .03 of this chapter, list the percentage of enrollees for which the carrier met the travel distance standards, in the following format:Urban Area. Suburban Area. Specialty provider.
31.10.45.9999.htm 31.10.45.9999. Administrative History Effective date: Effective December 31, 2017 (44:25 Md. R. 1184).
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