A. The director may suspend or revoke any certificate of authority issued to a prepaid dental plan organization pursuant to this article if the director finds that any of the following conditions exists:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

1. The prepaid dental plan organization is operating significantly in contravention of its basic organizational documents or in a manner contrary to that described in, and reasonably inferred from, any other information submitted pursuant to section 20-1003.

2. The prepaid dental plan organization issued membership coverage that does not comply with the requirements of section 20-1007.

3. The prepaid dental plan does not provide or arrange for basic dental services appropriate to such plan as determined by the director.

4. The prepaid dental plan organization can no longer be expected to meet its obligations to members or prospective members.

5. The prepaid dental plan organization, or any authorized person on its behalf, has advertised or merchandised its services in a materially untrue, misleading, deceptive or unfair manner.

6. The prepaid dental plan organization has failed to substantially comply with this article or any rules adopted pursuant to this article.

7. The prepaid dental plan organization is in an unsound condition or in such a condition as to render its further transaction of business in this state hazardous to its members or to the residents of this state.

B. If the certificate of authority of a prepaid dental plan organization is suspended, the organization shall not accept, during the period of the suspension, any additional members except newborn children or other newly acquired dependents of existing members and shall not engage in any advertising or solicitation.

C. If the certificate of authority of a prepaid dental plan organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to conclude its affairs and shall conduct no further business except as may be essential to the orderly conclusion of solicitation. The director, by written order, may permit such further operation of the organization as the director finds to be in the best interest of members to the end that members shall be afforded the greatest practical opportunity to obtain continuing prepaid dental plan coverage.

D. Notwithstanding subsections B and C of this section, a prepaid dental plan organization that has had its certificate of authority denied, suspended or revoked, or that is subject to an adverse action by the director, is entitled to a hearing pursuant to Title 41, Chapter 6, Article 10 and, except as provided in Section 41-1092.08, subsection H, is entitled to judicial review pursuant to Title 12, Chapter 7, Article 6.

E. If, after a hearing, the director finds grounds pursuant to subsection A of this section to suspend or revoke an organization’s certificate of authority, the director may impose, in lieu of or in addition to that suspension or revocation, the following civil penalties that shall be remitted to the state treasurer for deposit, pursuant to sections 35-146 and 35-147, in the state general fund:

1. For an unintentional violation, not more than one thousand dollars for each violation and not more than an aggregate of ten thousand dollars in any six month period.

2. For an intentional violation, not more than five thousand dollars for each violation and not more than an aggregate of fifty thousand dollars in any six month period.