2023 Colorado Revised Statutes › Title 10 - INSURANCE (§§ 10-1-101 — 10-23-110) › HEALTH CARE COVERAGE (§§ 10-16-101 — 10-16.5-101) › Article 16 - HEALTH-CARE COVERAGE (§§ 10-16-101 — 10-16-1506) › Part 5 - PREPAID DENTAL CARE PLANS (§§ 10-16-501 — 10-16-512) › Section 10-16-507 - Enrollee coverage by prepaid dental care plan organizations - form filing requirements

(1)
Every enrollee in a prepaid dental care plan shall be issued an enrollee coverage form by the prepaid dental care plan organization.
(2)
(a)
No contract issued, renewed, or reinstated by a prepaid dental care plan organization shall contain any provision which limits or excludes payments under hospital or medical benefits coverage to or on behalf of the enrollee because the enrollee is eligible for or receiving medical assistance benefits under articles
4
,
5
, and
6
of title
25.5
, C.R.S.
(b)
The requirements of paragraph (a) of this subsection (2) shall apply to all such contracts issued, renewed, or reinstated on or after August 1, 1984.
(3)
(a)
For prepaid dental care plans, the prepaid dental care plan organization shall not issue or deliver enrollee coverage or an amendment, advertising matter, or sales material to any person in this state until the carrier has filed a copy of the form of the enrollee coverage or amendment, advertising matter, or sales material with the commissioner.
(b)
The enrollee coverage must contain a clear and complete statement, if a contract, or a reasonably complete summary, if a certificate of contract, of:
(I)
The prepaid dental care services to which the enrollee is entitled under the prepaid dental care plan;
(II)
Any limitations of the services, kind of services, or benefits to be provided, including any deductible or copayment feature;
(III)
Where and in what manner information is available as to how services may be obtained;
(IV)
The enrollee's obligation respecting charges for the prepaid dental care plan.
(c)
The enrollee coverage, advertising matter, and sales material must not contain any provisions or statements that are unjust, unfair, inequitable, misleading, or deceptive; encourage misrepresentation; or are untrue or misleading.
(d)
The commissioner shall approve any form of enrollee coverage if the requirements of paragraphs (b) and (c) of this subsection (3) are met and the prepaid dental care plan organization is able, in the judgment of the commissioner, to meet its financial obligations under the enrollee coverage. It is unlawful to issue the form until approved by the commissioner. If the commissioner fails to disapprove a form of enrollee coverage within thirty days after the filing, the form is deemed approved. If the commissioner disapproves a form of enrollee coverage, advertising matter, or sales material, the commissioner shall notify the prepaid dental care plan organization, specifying the reasons for disapproval. The commissioner shall grant a hearing on a disapproval within fifteen days after the commissioner receives a request in writing from the prepaid dental care plan organization.
Amended with relocated provisions by 2013 Ch. 217,§ 35, eff. 5/13/2013.
(1) This section is similar to former § 10-16.5-109 as it existed prior to 1992.
(2) Subsection (3) is similar to former § 10-16-107 (4) as it existed prior to 2013.