New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 10 - DENTAL SERVICES › Subchapter 1 - DENTAL PLAN ORGANIZATIONS › Section 11:10-1.7 - Financial reporting

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every DPO shall submit a quarterly report and the DPO Supplement to the Quarterly Report for each of the first three calendar quarters ending March, June and September within 45 days of the end of each quarter. Every DPO shall also submit the DPO Supplement to the Annual Report. Instructions for the filing of quarterly reports and copies of the DPO Supplements to the Quarterly and Annual Report forms are available on the Department's website at
www.state.nj.us/dobi/division_insurance/managedcare/dpoqtrsup.pdf
and
www.state.nj.us/dobi/division_insurance/managedcare/dpoannsup.pdf
.
(b) A DPO which also maintains a non-dental plan practice shall segregate its non-dental plan activities from its dental plan activities and report its dental plan activities only in the quarterly and annual report forms prescribed by the Commissioner. Non-dental plan activities include those activities involving private practice dentistry.
(c) A DPO which is engaged in a non-dental plan practice shall also report the activities of the entire organization in financial reports prepared by its accountant within 15 working days of completion of the report, but no later than June 1 of each year. The assets of the entire organization of which the DPO is a part are considered to be assets of the DPO.
(d) All financial reports from DPOs which are not incorporated shall include a breakdown of the personal finances of its proprietors and the finances of the dental plan.
(e) An annual financial report of the DPO shall be prepared by an independent certified public accountant or independent public accountant on a statutory basis and attested to by an officer of the DPO. This report shall include full disclosure of all assets and liabilities of the DPO, the terms and conditions thereof, and the sources and disposition of all funds for the calendar year immediately preceding. The report shall be completed as prescribed by the National Association of Insurance Commissioners (NAIC) Annual Statement Instructions Health that is applicable to the reporting year, and shall be completed on a statutory accounting basis (SAP) in accordance with the NAIC Accounting Practices and Procedures Manual applicable to the reporting year. The Instructions and the Manual are incorporated herein by reference. Copies of the Instructions and Manual may be obtained from the NAIC Publications Department, 2301 McGee Street, Kansas City, MO 64108-2660. Telephone number: 816-783-8300. Revisions may be obtained on the NAIC website at www.publdist @naic.org. Three copies of the report shall be submitted on or before March 1 of each year to the following address:
HMO Financial Operations
Office of Financial Examinations
New Jersey Department of Banking and Insurance
20 West State Street
PO Box 325
Trenton, NJ 08625-0325
(f) If a DPO's records have been audited by an independent certified public accountant, the audited financial report shall be certified by the certified public accountant having conducted the audit and shall be forwarded to the Department on or before June 1 of each year.
(g) In the event of discontinuance of the plan, every DPO shall maintain an arrangement with an insurer or medical or dental service corporation for continuation of coverage on an indemnity basis through a group policy to the end of the period for which premiums were paid to the discontinued dental plan organization.
(h) The Commissioner may, upon reasonable notice, conduct an examination of a DPO as often as he or she deems necessary. A DPO shall make its books and records available for examination by the Commissioner, and maintain its records for at least seven years.
1. The Commissioner may employ such persons to conduct or assist in conducting the examination as he or she may deem advisable.
2. The DPO shall bear the reasonable cost of the examination. A DPO having direct premiums written in this State of less than $ 2,000,000 in any calendar year shall be subject to a limited scope examination, and expenses for such examination shall not exceed $ 5,000.