Oklahoma § 36-6148 - Policy for membership coverage

§ 36-6148. Policy for membership coverage

A. Every member in a prepaid dental plan shall be issued a

membership coverage policy by the prepaid dental plan organization.

Oklahoma Statutes - Title 36. Insurance

B. No policy for membership coverage or amendment to said

policy shall be issued or delivered to any person in this state

until a copy of the policy for membership coverage or amendment to

said policy has been filed with and approved by the Commissioner.

C. A policy for membership coverage shall contain a statement

of:

1. The prepaid dental services or other benefits to which the

member is entitled under the prepaid dental plan; and

2. Any limitations of the services or benefits to be provided,

including any deductible or co-payment feature; and

3. Information as to how services may be obtained; and

4. The obligation of the member for charges for the prepaid

dental plan.

D. Any member in a prepaid dental plan shall be free to select

any licensed dental practitioner to provide dental services and

prepayment or reimbursement determinations shall be made without

regard to whether the provider is a participating or

nonparticipating member of the plan. This provision shall be

printed on the policy for membership coverage.

E. Membership coverage shall contain no provisions or

statements which are unjust, unfair, untrue, inequitable,

misleading, deceptive, or which encourage misrepresentation as

determined by the Commissioner.

F. The Commissioner shall approve any policy of membership

coverage if the requirements of this section are complied with and

the prepaid dental plan, in the judgment of the Commissioner, is

able to meet its financial obligations for the membership coverage.

It shall be unlawful for a prepaid dental plan organization to issue

a policy until approved. If the Commissioner does not disapprove

any such policy within thirty (30) days after filing, said policy

shall be deemed approved. If the Commissioner disapproves a policy

of membership coverage, the Commissioner shall notify the prepaid

dental plan organization, specifying the reasons for disapproval.

The Commissioner shall grant a hearing on such disapproval within

thirty (30) days after a request in writing for a hearing is

received by the Commissioner from the prepaid dental plan

organization.

Added by Laws 1983, c. 66, § 8, eff. Nov. 1, 1983.