(1) Every enrollee in a prepaid dental care plan shall be issued an enrollee coverage form by the prepaid dental care plan organization.
(2) (a) No contract issued, renewed, or reinstated by a prepaid dental care plan organization shall contain any provision which limits or excludes payments under hospital or medical benefits coverage to or on behalf of the enrollee because the enrollee is eligible for or receiving medical assistance benefits under articles 4, 5, and 6 of title 25.5, C.R.S.
(b) The requirements of paragraph (a) of this subsection (2) shall apply to all such contracts issued, renewed, or reinstated on or after August 1, 1984.
(3) (a) For prepaid dental care plans, the prepaid dental care plan organization shall not issue or deliver enrollee coverage or an amendment, advertising matter, or sales material to any person in this state until the carrier has filed a copy of the form of the enrollee coverage or amendment, advertising matter, or sales material with the commissioner.
(b) The enrollee coverage must contain a clear and complete statement, if a contract, or a reasonably complete summary, if a certificate of contract, of:
The prepaid dental care services to which the enrollee is entitled under the prepaiddental care plan;
Any limitations of the services, kind of services, or benefits to be provided, including any deductible or copayment feature;
Where and in what manner information is available as to how services may beobtained;
The enrollee's obligation respecting charges for the prepaid dental care plan.
The enrollee coverage, advertising matter, and sales material must not contain anyprovisions or statements that are unjust, unfair, inequitable, misleading, or deceptive; encourage misrepresentation; or are untrue or misleading.
The commissioner shall approve any form of enrollee coverage if the requirements ofparagraphs (b) and (c) of this subsection (3) are met and the prepaid dental care plan organization is able, in the judgment of the commissioner, to meet its financial obligations under the enrollee coverage. It is unlawful to issue the form until approved by the commissioner. If the commissioner fails to disapprove a form of enrollee coverage within thirty days after the filing, the form is deemed approved. If the commissioner disapproves a form of enrollee coverage, advertising matter, or sales material, the commissioner shall notify the prepaid dental care plan organization, specifying the reasons for disapproval. The commissioner shall grant a hearing on a disapproval within fifteen days after the commissioner receives a request in writing from the prepaid dental care plan organization.
Source: L. 92: Entire article R&RE, p. 1719, § 1, effective July 1. L. 2006: (2)(a) amended, p. 2000, § 39, effective July 1. L. 2013: (3) added with relocations, (HB 13-1266), ch. 217, p. 981, § 35, effective May 13.
Editor's note: (1) This section is similar to former § 10-16.5-109 as it existed prior to 1992.
(2) Subsection (3) is similar to former § 10-16-107 (4) as it existed prior to 2013.