Title 24, Insurance

§432G-1 Definitions. As used in this chapter: "Capitated basis" means fixed per member per month payment or percentage of premium payment wherein the provider assumes the full risk for the cost of contracted services without regard to the type, value, or frequency of services pro…

[§432G-10] Powers of insurers and hospital and medical service corporations. (a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly or through a subsidiary or affiliate, may organize a…

[§432G-11] Examinations. (a) The commissioner may examine the affairs of any dental insurer or of any providers with whom a dental insurer has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of thi…

§432G-12 Fees. (a) The commissioner shall collect, in advance, the following fees: The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order. (b) No certificate of authority shall contain an expiration date, but all …

[§432G-13] Suspension, revocation, or denial of certificate of authority. (a) The commissioner may suspend, revoke, or refuse to extend any certificate of authority issued under this chapter and may deny any application for a certificate of authority if the commissioner finds tha…

[§432G-14] Summary orders and supervision. (a) Whenever the commissioner determines that the financial condition of any dental insurer is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision…

[§432G-15] Administrative fines and enforcement. (a) The commissioner, in addition to or in lieu of suspension or revocation of a certificate of authority pursuant to section 432G‑13, may levy an administrative fine upon a dental insurer in an amount not less than $500 and not mo…

[§432G-16] Statutory construction and relationship to other laws. (a) Except as provided in subsection (c) and otherwise provided in this chapter, the insurance laws shall not apply to the activities authorized and regulated under this chapter of any dental insurer granted a cert…

[§432G-17] Acquisition of control of or merger of a dental insurer. No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a dental insurer o…

[§432G-18] Federally funded programs; exemption. Requirements provided in this chapter relating to mandated coverages or essential health benefits shall not be applicable to any dental insurer offering dental insurance under a federally funded program under the Social Security Ac…

[§432G-19] Coordination of benefits. (a) Dental insurers are required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans. (b) …

[§432G-2] Establishment of a dental insurer; certificate of authority. (a) Any person may apply to the commissioner for a certificate of authority to establish and operate a dental insurer in compliance with this chapter and chapter 423. No person shall establish or operate a den…

[§432G-20] Disclosure of dental care coverage and benefits. In order to ensure that all individuals understand their dental care options and are able to make informed decisions, all dental insurers shall provide current and prospective subscribers with written disclosure of cover…

[§432G-21] Federal law compliance. All dental insurers shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, Public Law 111…

[§432G-22 Rules; adoption by commissioner.] The commissioner may adopt rules under chapter 91 for the implementation and administration of this chapter. [L 2013, c 191, pt of §1]

[§432G-3] Fiduciary responsibilities. (a) Any director, officer, employee, or partner of a dental insurer who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary relationship to the…

[§432G-4] Annual reports. (a) Each dental insurer shall file with the commissioner: (b) The commissioner may require additional reports as are deemed necessary and appropriate to enable the commissioner to carry out the commissioner's duties under this chapter. (c) Any dental ins…

[§432G-5] Information to subscribers. (a) The dental insurer shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment. (b) Every dental insurer shall provide to its subscribers notice of any material change in the operatio…

§432G-6 Protection against insolvency; net solvency report. (a) Net worth requirements are as follows: (b) Deposit requirements are as follows: (c) Every dental insurer, when determining liabilities, shall include an amount estimated in the aggregate to provide for any unearned p…

[§432G-7] Uncovered expenditures insolvency deposit. (a) If, at any time, uncovered expenditures exceed ten per cent of total dental care expenditures, a dental insurer shall place with the commissioner or with any organization or trustee acceptable to the commissioner through wh…

[§432G-8] Reserve credit for reinsurance. Any dental insurer that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of article 4A of chapter 431. [L 2013, c 191, pt of §1]

[§432G-9] Replacement coverage. (a) Any carrier providing replacement coverage with respect to group dental benefits within a period of sixty days from the date of discontinuance of a prior dental insurer contract or policy providing such dental benefits shall immediately cover a…