514C.3A - DISCLOSURES RELATING TO DENTAL COVERAGE REIMBURSEMENT RATES.
514C.3A DISCLOSURES RELATING TO DENTAL COVERAGE REIMBURSEMENT RATES. 1. An individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, and delivered, amended, or renewed on or after July 1, 1995, that provides dental care benefits with a base payment for those benefits determined upon a usual and customary fee charged by licensed dentists, shall disclose all of the following: a. The frequency of the determination of the usual and customary fee. b. A general description of the methodology used to determine usual and customary fees, including geographic considerations. c. The percentile that determines the maximum benefit that the insurer or nonprofit health service corporation will pay for any dental procedure, if the usual and customary fee is determined by taking a sample of fees submitted on actual claims from licensed dentists and then determining the benefit by selecting a percentile of those fees. 2. The disclosure shall be provided upon request to all group and individual policyholders and subscribers. All proposals for dental care benefits shall inform the prospective policyholder or subscriber that information regarding usual and customary fee determinations is available from the insurer or nonprofit health service corporation. All employee benefit descriptions or supplemental documents shall notify the employee that information regarding reimbursement rates is available from the employer.
Section History: Recent Form 95 Acts, ch 78, §1; 95 Acts, ch 209, §26