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<section article="gin" article_name="Insurance" number="14-410" title_number="14" title_name="Entities That Act as Health Insurers" subtitle_number="4" subtitle_name="Dental Plan Organization Act">
  <level label="a">
    <text>Each enrollee shall receive evidence of coverage that indicates specifically the nature and extent of coverage and the total amount or percentage of payment, if any, that the enrollee must pay for dental services.</text>
  </level>
  <level label="b">
    <level label="1">
      <text>Except as provided under paragraph (2) of this subsection, a dental plan organization shall issue evidence of coverage to each enrollee of the dental plan organization.</text>
    </level>
    <level label="2">
      <text>If an individual enrollee obtains coverage through a policy or through a contract issued by a medical or dental service corporation, the insurer that issued the policy or the medical or dental service corporation shall issue evidence of coverage.</text>
    </level>
  </level>
  <level label="c">
    <text>The dental plan organization, insurer, or medical or dental service corporation may not issue or deliver evidence of coverage or an amendment to evidence of coverage until a copy of the form of evidence of coverage or amendment is filed with and approved by the Commissioner.</text>
  </level>
  <level label="d">
    <text>The evidence of coverage shall contain:</text>
    <level label="1">
      <text>a clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:</text>
      <level label="i">
        <text>the dental services and the insurance or other benefits, if any, to which enrollees are entitled;</text>
      </level>
      <level label="ii">
        <text>any limitations on the services or kind of benefits to be provided, including any charge, deductible, or copayment feature; and</text>
      </level>
      <level label="iii">
        <text>where and in what manner information is available about how services may be obtained; and</text>
      </level>
    </level>
    <level label="2">
      <text>a clear and understandable description of the dental plan organization’s method for resolving enrollee complaints.</text>
    </level>
  </level>
  <level label="e">
    <text>A dental plan organization, insurer, or medical or dental service corporation that makes a change in evidence of coverage or the amount or percentage of payment that the enrollee must pay, shall issue to the enrollee evidence of the change in a separate document.</text>
  </level>
</section>
