Delaware Code Title 18 Sec. 3809 – Schedule of charges
(a) No schedule of charges for enrollee coverage for dental services, or amendment thereto, may be used by a dental plan organization until a copy of such schedule, or amendment thereto, has been filed with the Commissioner. The Commissioner may disapprove the schedule of charges at any time if he or she finds that the charges are excessive, inadequate or unfairly discriminatory. If the Commissioner disapproves the schedule of charges he or she shall notify the dental plan organization within 5 days of the day of disapproval and specify in the notice the reason for his or her disapproval. A hearing shall be granted within 20 days after a request in writing by the filer. It shall be unlawful for any dental plan organization whose schedule of charges has been disapproved to effect any contract or issue any subscription certificate which uses the disapproved schedule of charges until a revised schedule of charges has been filed.
Terms Used In Delaware Code Title 18 Sec. 3809
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Contract: A legal written agreement that becomes binding when signed.
- Dental plan: means any contractual arrangement for dental services provided directly or arranged for or administered directly on a prepaid or postpaid individual or group capitation basis. See Delaware Code Title 18 Sec. 3802
- Dental plan organization: means any person who undertakes to provide directly or to arrange for or administer 1 or more dental plans providing dental services. See Delaware Code Title 18 Sec. 3802
- Dental services: means services included in the practice of dentistry as defined in § 1121 of Title 24. See Delaware Code Title 18 Sec. 3802
- Enrollee: means an individual and that individual's dependents who are enrolled in a dental plan organization. See Delaware Code Title 18 Sec. 3802
(b) Charges shall be established in accordance with actuarial principles, but charges applicable to an enrollee shall not be individually determined based on the status of his or her health.