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

17:48D-11.2 Increase in amount of capital or surplus required of dental plan organization. 27. The commissioner may increase the amount of capital or surplus required of a dental plan organization, or subsequently revise or redetermine that increase, using appropriate methods and…

17:48D-11.3 Determination of increase, revision or redetermination; factors. 28. In determining any increase, revision or redetermination in the capital or surplus of a dental plan organization pursuant to the provisions of section 27 of P.L.2014, c.81 (C.17:48D-11.2) the commiss…

17:48D-11.4 Suspension, revocation of authority to do business. 29. The commissioner may suspend or revoke the authority to do business in this State of any dental plan organization that does not comply with the provisions of sections 26 through 30 of P.L.2014, c.81 (C.17:48D-11.…

17:48D-11.5 Rules, regulations. 30. 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 26 through 30 of P.L.2014, c.81 (C.17:48D-11.1 through C.17:48D-11…

17:48D-12 Complaint system, records. 12. a. A dental plan organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by covered persons concerning dental plan services. The dental plan organizat…

17:48D-13 Annual report; filing; forms. 13. a. Every dental plan organization annually on or before March 1 shall file with the commissioner a report covering its activities for the preceding calendar year. b. The reports shall be on forms prescribed by the commissioner and shall…

17:48D-14 Percentage of premiums used for payments. 14. At least 70 percent of every dental plan organization's earned premium in the first year of operation, 75 percent in the second year, and 80 percent in all subsequent years shall be used for payments to dentists for dental s…

17:48D-15 False or misleading advertising; enforcement. 15. a. No dental plan organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of covera…

17:48D-16 Suspension, revocation of certificate of authority. 16. a. The commissioner may suspend or revoke any certificate of authority issued to a dental plan organization pursuant to this act, if he finds that any of the following conditions exist: (1) The dental plan organiza…

17:48D-17. Cease and desist orders a. The commissioner may issue an order directing a dental plan organization or a representative of a dental plan organization to cease and desist from engaging in any act or practice in violation of the provisions of this act. b. Within 20 days …

17:48D-18 Violations; civil penalty. 18. Any dental plan organization which violates any provisions of this act, or neglects, fails or refuses to comply with any of the requirements of this act shall be liable for a civil penalty of not less than $500.00 nor more than $10,000.00 …

17:48D-2 Definitions. 2. In this act, unless the context otherwise requires: "Capitation" means a method of compensation by a dental plan organization to its contracted dentists for dental services and supplies provided to covered persons of the dental plan organization on the ba…

17:48D-20. Applications, filings and reports treated as public documents Applications, filings and reports required under this act except contracts referred to in section 3. c. (4) and 3. c. (5) of this act, shall be treated as public documents and shall not be considered confide…

17:48D-21 Confidentiality of diagnostic, treatment information. 21. Data or information pertaining to the diagnosis, treatment or health of any covered person obtained by the dental plan organization from the covered person or any dentist shall be confidential and shall not be di…

17:48D-23. Rules and regulations The commissioner may promulgate such rules and regulations as he may deem necessary to effectuate the purposes of this act. L.1979, c. 478, s. 23.

17:48D-24. Severability If any section, term or provision of this act shall be adjudged invalid for any reason, such judgment shall not affect, impair or invalidate any other section, term or provision of this act, and the remaining sections, terms and provisions shall be and rem…

17:48D-3 Application for certificate of authority. 3. a. No person may establish, operate or administer a dental plan organization, or sell or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration in conjunction with any dental plan organizati…

17:48D-3.1. Consultants No person shall be employed as a consultant by an employer, union, trust fund or dental plan organization or applicant, except in accordance with the provisions of this section. A consultant, entering into a contract or agreement to provide consulting serv…

17:48D-3.2. Fiduciary capacity of consultants; compensation A consultant shall be a fiduciary of the employer, union, trust fund or dental plan organization with which employed and shall not be entitled to: a. Any compensation in excess of the amount specified in the contract or …

17:48D-3.3. Report regarding finders A dental plan organization, employer, union or trust fund shall report to the commissioner the name and address of, and the amount of any fee paid to a finder within 30 days of the use or employment of the finder or within 30 days of the opera…

17:48D-4 Notice of modification of information. 4. Sixty days prior to any significant modification of information submitted with the application for a certificate of authority or a subsequent modification, a dental plan organization shall file notice of the modification with the…

17:48D-5 Conditions for issuance; notice of disapproval. 5. a. The commissioner shall issue a certificate of authority if he is satisfied that the following conditions are met: (1) The persons responsible for conducting the affairs of the dental plan organization are competent an…

17:48D-6. General surplus of plan The commissioner may determine, at his discretion, the amount of a general surplus, if any, that the dental plan organization shall be required to maintain. L.1979, c. 478, s. 6.

17:48D-7. Special contingent surplus for organizations using more than 20 full-time dentists A dental plan organization utilizing in the aggregate the services of more than 20 full-time equivalent dentists shall accumulate and maintain a special contingent surplus in excess of it…

17:48D-8 Fidelity bonding of officers, etc., malpractice insurance of dentists. 8. a. Any director, officer, employee or partner of a dental plan organization who receives, collects, reimburses or invests moneys in connection with the activities of the organization shall be bonde…

17:48D-9 Evidence of coverage. 9. a. An enrollee shall be 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…

17:48D-9.1. 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 plan organizatio…

17:48D-9.2. 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 plan organization contract which limits t…

17:48D-9.3. 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, employe…

17:48D-9.4 Dental plan organization to receive, transmit transactions electronically. 9. 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 plan organization, or a subsidiary that processes health …

17:48D-9.5 Dental plan organization to offer coverage for domestic partner. 56. Every dental plan organization contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1979, c.478 (C.17:48D-1 et seq.) or approved for issuance or renewal in this State …

17:48D-9.6 Payment of out-of-network benefits by dental plan organization. 2. a. (1) Except as provided in subsection e. of this section, a dental plan organization that makes a dental benefit payment to an enrollee for services rendered by an out-of-network dentist shall issue t…