Title 17, Title 17: CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE

17:48C-13. Filing form of subscription certificate; disapproval No subscription certificate shall be issued by any dental service corporation to any subscriber unless and until the form thereof shall have been filed with the commissioner, together with all applications, riders an…

17:48C-14. Schedule of rates; filing; disapproval No dental service corporation shall enter into any contract with a subscriber unless and until it shall have filed with the commissioner a full schedule of the rates to be paid by the subscribers to such contracts. The commissione…

17:48C-15 Agreements with dentists; approval of payments; corporate records. 15. No dental service corporation shall enter into any contract with a subscriber unless and until it shall have filed with the commissioner a copy of the agreement proposed to be entered into by the cor…

17:48C-16 Group contract; benefits; "employees" defined. 16. A dental service corporation may also issue to a policyholder a group contract, covering at least one employee other than a proprietor, a partner in a partnership or a shareholder that owns more than two percent of the …

17:48C-17. Application of act to group contracts; "subscriber" defined The provisions of this act shall apply to group contracts except that sections 7, 8, 11 and 14 of this act shall not apply. The word "subscriber" as used in this act means the policyholder under a group contra…

17:48C-18 Written group contracts; statements. 18. Every group contract entered into by a dental service corporation with any policyholder shall be in writing and a contract form stating the terms and conditions thereof shall be furnished to the policyholder to be kept by him. No…

17:48C-18.1. Alternative dental coverage; original coverage restricted to limited number of providers Each employer or other organization which employs or has 25 or more employees or members during the full preceding calendar year and which contributes to a dental service corpora…

17:48C-18.2. Employer contribution An employer or other organization shall be required to pay for or contribute towards the provision of alternative coverage an amount equal to the premium or cost which it pays or contributes to the dental service corporation contract which limit…

17:48C-18.3. Rules and regulations Within 120 days of the effective date of this act, the Commissioner of the Department of Insurance shall promulgate rules and regulations necessary to effectuate the purpose of this act, including procedures for notice to covered persons, employ…

17:48C-19.1 Adjustment of rate of premium for dental service corporations, certain circumstances. 1. a. A group contract covering at least 10 employees or members may provide for the adjustment of the rate of premium based on past or projected experience, and may include those cl…

17:48C-2 Definitions. 2. As used in this act the following words and phrases shall have the stated meanings unless a different meaning clearly appears from the context: (a) The term "dental service corporation" or "the corporation" shall mean a corporation which is (1) organized,…

17:48C-20 Agreements for participation with other corporations for issuance of group contracts. 20. A dental service corporation of this State may enter into agreements to participate with other corporations in the issuance of group contracts to policyholders whose employees or m…

17:48C-21 Experience rates, commissioner's determination. 21. No dental service corporation shall issue group contracts which are not experience rated pursuant to section 20 of this act, if the commissioner has determined that those rates are excessive, inadequate or unfairly dis…

17:48C-22. Practices, rules and procedures subject to review; orders; disapproval; judicial review All practices, rules and procedures of a dental service corporation, involving termination or refusal to renew coverage, modification of coverage or rates in the case of persons cla…

17:48C-23. Fees Every corporation to which this act shall be applicable shall pay the following fees to the commissioner for enforcement of the provisions of this act, viz.: for filing its application and charter, $10.00; for filing each annual statement, $20.00; for each copy of…

17:48C-24. Disbursements by corporation If the commissioner shall determine that the amount disbursed during any 12-month period by a dental service corporation as expenses of operation is excessive in proportion to the amount it received from subscribers during that period, the …

17:48C-25. Investments; surplus The funds of any dental service corporation may be invested only in accordance with the requirements now or hereafter provided by law for the investment of funds of life insurance companies. Every dental service corporation after the first full cal…

17:48C-26. Statement of financial condition; inquiries by commissioner Every dental service corporation transacting business in this State shall file annually, on or before March 1, in the Department of Banking and Insurance, a statement in such form and detail as the commissione…

17:48C-27. Failure to file statement or answer inquiries; penalty Any dental service corporation neglecting to make and file its annual statement as required by section 26 of this act, or neglecting to reply in writing to inquiries of the commissioner within such reasonable time …

17:48C-28. Examination of assets and affairs (a) The commissioner shall have the power, whenever he deems the same expedient, to make or cause to be made an examination of the assets and liabilities, method of conducting business and all other affairs of every dental service corp…

17:48C-28.1 Definitions. 21. As used in sections 21 through 25 of P.L.2014, c.81 (C.17:48C-28.1 through C.17:48C-28.5): "Commissioner" means the Commissioner of Banking and Insurance. "Dental service corporation" means an entity authorized to transact business in this State pursu…

17:48C-28.2 Increase in amount of capital or surplus required of dental service corporation. 22. The commissioner may increase the amount of capital or surplus required of a dental service corporation, or subsequently revise or redetermine that increase, using appropriate methods…

17:48C-28.3 Determination of increase, revision or redetermination; factors. 23. In determining any increase, revision or redetermination in the capital or surplus of a dental service corporation pursuant to the provisions of section 22 of P.L.2014, c.81 (C.17:48C-28.2) the commi…

17:48C-28.4 Suspension, revocation of authority to do business. 24. The commissioner may suspend or revoke the authority to do business in this State of any dental service corporation that does not comply with the provisions of sections 21 through 25 of P.L.2014, c.81 (C.17:48C-2…

17:48C-28.5 Rules, regulations. 25. The commissioner may promulgate regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to effectuate the purposes of sections 21 through 25 of P.L.2014, c.81 (C.17:48C-28.1 through C.17:48C-28…

17:48C-3. Nonprofit corporation; restrictions as to methods of diagnosis and treatment; dissolution No dental service corporation shall be converted into a corporation organized for pecuniary profit. Every such corporation shall be operated for the benefit of the subscribers. No …

17:48C-30. Violations of chapter; penalty and recovery thereof; misdemeanors Any dental service corporation which shall have violated any of the provisions of, or shall have neglected, failed or refused to comply with, any of the requirements of this act, except the failure to fi…

17:48C-31. Grants or allocation of funds A dental service corporation may receive and accept from any governmental agencies, Federal, State or local, any grant or allocation of funds for the purpose of providing payment for dental services to eligible persons under such terms or …

17:48C-32. Corporation as charitable and benevolent institution; tax exemption Every dental service corporation is hereby declared to be a charitable and benevolent institution, and its funds and property shall be exempt from taxation by the State or any political subdivision the…

17:48C-33. Partial invalidity Should any provision or section of this act be held invalid for any reason, such holding shall not be construed as affecting the validity of any remaining portion of such section or of this act, it being intent of the Legislature that this act shall …

17:48C-34. Application of act No person, association or corporation shall engage in any activity provided for in this act unless organized and authorized in accordance with its provisions; but this shall not preclude activities authorized under other enabling acts, nor shall it a…

17:48C-35. Liberal construction This act shall be liberally construed to the end that its objectives may be achieved with maximum flexibility and variety. L.1968, c. 305, s. 35, eff. Sept. 26, 1968.

17:48C-36. Short title This act shall be known and may be referred to by its short title as the "Dental Service Corporation Act of 1968." L.1968, c. 305, s. 36, eff. Sept. 26, 1968.

17:48C-4. Certificate of authority; application; issuance; amendment A nonprofit corporation organized under Title 15 of the Revised Statutes for the purpose of establishing, maintaining and operating a nonprofit dental service plan, as described in section 2(a) of this act, inte…

17:48C-4.1. Supplying administrative services by dental service corporation 1. A dental service corporation may supply administrative services only. L.1993,c.261,s.1.

17:48C-5 Standards in reviewing application. 5. In reviewing any application for authority to operate under this act, the commissioner shall be guided by the following standards: (a) It shall be shown that the initial working funds are adequate. No certificate of authority shall …

17:48C-6 Board of trustees; membership; chairman. 6. The activities and operations of a dental service corporation shall be conducted by a board of trustees composed initially of an even number of persons, not less than 10 in all, as may be specified in the certificate of incorpo…

17:48C-7 Contracts; provisions. 7. Every contract made by any dental service corporation to provide payment for dental service shall provide for the payment for dental service for a period of 12 months or less, and no contract shall be made providing for the inception of such ser…

17:48C-8. Written contracts required; subscription certificate; provisions required Every contract entered into by the corporation with any subscriber shall be in writing and a certificate stating the terms and conditions thereof shall be furnished to the subscriber. No such subs…

17:48C-8.1 Dental service corporation to receive, transmit transactions electronically. 8. a. Within 180 days of the adoption of a timetable for implementation pursuant to section 1 of P.L.1999, c.154 (C.17B:30-23), a dental service corporation, or a subsidiary that processes hea…

17:48C-8.2 Dental service corporation to offer coverage for domestic partner. 55. Every dental service corporation contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1968, c.305 (C.17:48C-1 et seq.) or approved for issuance or renewal in this St…

17:48C-8.3 Payment of out-of-network benefits by dental service corporation. 1. a. (1) Except as provided in subsection e. of this section, a dental service corporation that makes a dental benefit payment to a covered person for services rendered by an out-of-network dentist shal…

17:48C-9. Additional payments by subscribers Any dental service corporation may classify subscribers whereby under specified circumstances a subscriber or covered dependents may pay a participating dentist for dental services an amount in addition to that payable by the corporati…