31.12.05.02

.02 Required Notice.

A. When a health maintenance organization or dental plan organization dental provider panel is the sole dental provider panel offered to group members by a group policyholder, the dental plan organization or the health maintenance organization:

(1) Shall offer the group policyholder a dental point-of-service option for the individual group member to accept or reject;

(2) May not impose a minimum participation level on the mandatory dental point-of-service option; and

(3) As part of the application, shall provide to each group policyholder the disclosure statement described in §B of this regulation, for each dental point-of-service option offered.

B. The notice shall read as follows:

Under Maryland law, if you choose a point-of-service option for your group members, your group member may select a dental point-of-service option as an additional benefit. A dental point-of-service option allows your group members to obtain dental care services from dentists and other providers outside the dental provider panel under certain circumstances that are described in Attachment A.

You have the choice to either pay for this point-of-service option, pay a percentage of the cost of this option, or require your group members to pay for the entire cost of this option. The cost of the dental point-of-service option described in Attachment A is identified in your proposal.

I HAVE READ AND UNDERSTAND THIS DISCLOSURE STATEMENT AND, IF I HAVE CHOSEN THE POINT-OF-SERVICE OPTION, I WILL PROVIDE NOTICE OF THE AVAILABILITY OF THIS ADDITIONAL BENEFIT TO MY ELIGIBLE GROUP MEMBERS.

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           Date       Group Policyholder