Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 12 - HEALTH MAINTENANCE ORGANIZATIONS; ENTITIES THAT ACT AS HEALTH INSURERS
Chapter 31.12.05 - Dental Benefit Plan Coverage - Mandatory Point-of-Service Option
Section 31.12.05.02 - Required Notice
Current through Register Vol. 51, No. 6, March 22, 2024
A. When a health maintenance organization or dental plan organization dental provider panel is the sole dental provider panel offered to group members by a group policyholder, the dental plan organization or the health maintenance organization:
B. The notice shall read as follows:
Under Maryland law, if you choose a point-of-service option for your group members, your group member may select a dental point-of-service option as an additional benefit. A dental point-of-service option allows your group members to obtain dental care services from dentists and other providers outside the dental provider panel under certain circumstances that are described in Attachment A.
You have the choice to either pay for this point-of-service option, pay a percentage of the cost of this option, or require your group members to pay for the entire cost of this option. The cost of the dental point-of-service option described in Attachment A is identified in your proposal.
I HAVE READ AND UNDERSTAND THIS DISCLOSURE STATEMENT AND, IF I HAVE CHOSEN THE POINT-OF-SERVICE OPTION, I WILL PROVIDE NOTICE OF THE AVAILABILITY OF THIS ADDITIONAL BENEFIT TO MY ELIGIBLE GROUP MEMBERS.
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Date Group Policyholder
