Skip to Main Content
<< Back | Return to Main COMAR Search Page

12 records match your request.

FileAbstract
31.12.04.00.htm 31.12.04.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 12 HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS Chapter 04 Dental Plans ― General Provisions Authority: Insurance Article, §2-109, 14-124(b) 14-410, 14-412, 15-112(b)1)i) 15-122(b) 15-833(j) and Title 15, Subtitles 10A and 10D, Annotated Code of Maryland
31.12.04.01.htm 31.12.04.01. 01 Purpose.. The purpose of this chapter is to provide appropriate standards and requirements for dental plan contracts.
31.12.04.02.htm 31.12.04.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Closed panel dental benefit contract” means a dental benefit contract that does not provide benefits for services provided by a dentist who is not a plan dentist, with the exception of:a) Emergency services; and. b) Out-of-network services required by Insurance Article, §15-830, Annotated Code of Maryland.. 2) "Contract holder" means for:.
31.12.04.03.htm 31.12.04.03. 03 Applicability.. This chapter applies to:. A. Dental plan organizations authorized under Insurance Article, Title 14, Subtitles 1 and 4, Annotated Code of Maryland; andB. Contracts issued or renewed by the dental plan organizations listed in §A of this regulation on or after the effective date of this chapter.
31.12.04.04.htm 31.12.04.04. 04 Dental Benefit Contract.. Each dental benefit contract shall contain the following provisions:. A. The effective date of contract provision;. B. A provision describing the payment of required subscription fees or premiums;. C. A grace period provision, pursuant to Regulation .05 of this chapter;. D. For group dental benefit contracts, the eligibility requirements and effective date of coverage for members of the group and their dependents;
31.12.04.05.htm 31.12.04.05. 05 Grace Period Requirements.. A. Individual Dental Benefit Contracts.. 1) If the individual dental benefit contract is guaranteed renewable for the life of the individual dental benefit contract, the dental benefit contract shall contain in substance the following provision: "Grace Period: A grace period of 31 days will be granted for the payment of each premium falling due after the first premium, during which grace period this contract shall continue in force.
31.12.04.06.htm 31.12.04.06. 06 Evidence of Coverage.. A. Except for Regulation .04A―C of this chapter, the evidence of coverage under any group contract shall contain all of the provisions required in Regulation .04 of this chapter.B. The name of the group shall be specified in the evidence of coverage..
31.12.04.07.htm 31.12.04.07. 07 Optional Provisions.. A. Dental benefit contracts may contain the provisions in §B―D of this regulation, and if any of the provisions are included in a group dental benefit contract, the same provision shall be contained in the corresponding evidence of coverage.B. General Provisions.. 1) A provision may be included specifying the dental plan organization's intention to charge a specified missed appointment fee. The fee shall be reasonable in relation to the
31.12.04.08.htm 31.12.04.08. 08 Provider Contracts.. A. Each provider contract shall contain the provisions in §B―G of this regulation.. B. A provision shall be included to require the provider to make an initial commitment to the plan of at least 12 months. The provider may not terminate the contract during this 12-month period unless the provider becomes unavailable during that initial time for reasons beyond the control of the dental plan organization or the provider.C. Hold-Harmless Clause.
31.12.04.09.htm 31.12.04.09. 09 Contract Forms.. A. The dental plan organization:. 1) Shall provide a written dental benefit contract to each group contract holder;. 2) Shall provide a written evidence of coverage to each individual covered under a group dental benefit contract;3) Shall provide a written dental benefit contract to each individual who applies for individual dental coverage;4) Shall execute a written provider contract with each of the dental plan organization's plan dentists;
31.12.04.10.htm 31.12.04.10. 10 Filing Requirements for Premium Rates and Subscription Fees.. A. The filing of any dental plan contract or rider or endorsement by a dental plan organization in accordance with Regulation .09A(5) of this chapter shall be accompanied by the filing of premium rates or subscription fees.B. A subsequent change in premium rates or subscription fees shall be filed with supporting data at least 30 days before the change is proposed to become effective.
31.12.04.9999.htm 31.12.04.9999. Administrative History Effective date: September 16, 1991 (18:18 Md. R. 2004). Chapter recodified from COMAR 09.30.82 to COMAR 31.12.04, July 1998. Regulation .02B amended effective August 2, 2004 (31:15 Md. R. 1187) August 3, 2015 (42:15 Md. R. 1019)Regulation .04 amended effective August 2, 2004 (31:15 Md. R. 1187) August 3, 2015 (42:15 Md. R. 1019)Regulation .05 repealed and new Regulation .05 adopted effective August 2, 2004 (31:15 Md. R. 1187).
<< Back | Return to Main COMAR Search Page