HARRY HUGHES, Governor

3077

587.

(A) (1) AN ENROLLEE IS ENTITLED TO RECEIVE EVIDENCE OF
COVERAGE OR A CERTIFICATE INDICATING SPECIFICALLY THE NATURE AND
EXTENT OF COVERAGE AND EVIDENCE OF THE TOTAL AMOUNT OR PERCENTAGE
OF PAYMENT, IF ANY, WHICH THE ENROLLEE IS OBLIGATED TO PAY FOR
DENTAL SERVICES.

(2) IF AN INDIVIDUAL ENROLLEE OBTAINS COVERAGE
THROUGH AN INSURANCE POLICY OR THROUGH A CONTRACT ISSUED BY A
MEDICAL OR DENTAL SERVICE CORPORATION, WHETHER BY OPTION OR
OTHERWISE, THE INSURER OR MEDICAL OR DENTAL SERVICE CORPORATION
SHALL ISSUE THE EVIDENCE OF COVERAGE. IN ALL OTHER CASES, THE
DENTAL PLAN ORGANIZATION SHALL ISSUE THE EVIDENCE OF COVERAGE.

(B)  THE INSURER, MEDICAL OR DENTAL SERVICE CORPORATION, OR
DENTAL PLAN ORGANIZATION MAY NOT ISSUE OR DELIVER EVIDENCE OF
COVERAGE OR AMENDMENT TO ANY PERSON UNTIL A COPY OF THE FORM OF
EVIDENCE OF COVERAGE OR AMENDMENT IS FILED WITH THE COMMISSIONER
AND APPROVED BY HIM.

(C)  EVIDENCE OF COVERAGE SHALL CONTAIN A CLEAR AND COMPLETE
STATEMENT IF A CONTRACT, OR A REASONABLY COMPLETE SUMMARY IF A
CERTIFICATE, OF:

(1)  THE DENTAL SERVICES AND THE INSURANCE OR OTHER
BENEFITS, IF ANY, TO WHICH ENROLLEES ARE ENTITLED;

(2)  ANY LIMITATIONS ON THE SERVICES, OR KIND OF
BENEFITS TO BE PROVIDED, INCLUDING ANY CHARGE, DEDUCTIBLE OR
COPAYMENT FEATURE;

(3)  WHERE AND IN WHAT MANNER INFORMATION IS AVAILABLE
AS TO HOW SERVICES MAY BE OBTAINED; AND

(4)  A CLEAR AND UNDERSTANDABLE DESCRIPTION OF THE
DENTAL PLAN ORGANIZATION'S METHOD FOR RESOLVING ENROLLEE
COMPLAINTS.

(D)  ANY SUBSEQUENT CHANGE IN THE EVIDENCE OF COVERAGE OR
THE AMOUNT OR PERCENTAGE OF PAYMENT WHICH THE ENROLLEE IS
OBLIGATED TO PAY, SHALL BE EVIDENCED IN A SEPARATE DOCUMENT
ISSUED TO THE ENROLLEE.

588.

(A) (1) THE COMMISSIONER MAY INVESTIGATE THE BUSINESS AND
EXAMINE THE BOOKS, ACCOUNTS, RECORDS, AND FILES OF EVERY DENTAL
PLAN ORGANIZATION.

(2) FOR THE PURPOSE OF PARAGRAPH (1) OF THIS
SUBSECTION, THE COMMISSIONER SHALL HAVE REASONABLY FREE ACCESS TO
THE OFFICES AND PLACES OF BUSINESS, BOOKS, ACCOUNTS, PAPERS,
RECORDS, AND FILES OF ALL DENTAL PLAN ORGANIZATIONS.