Maryland Code, INSURANCE 14-410
Terms Used In Maryland Code, INSURANCE 14-410
- 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.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- including: means includes or including by way of illustration and not by way of limitation. See
(b) (1) Except as provided under paragraph (2) of this subsection, a dental plan organization shall issue evidence of coverage to each enrollee of the dental plan organization.
(2) If an individual enrollee obtains coverage through a policy or through a contract issued by a medical or dental service corporation, the insurer that issued the policy or the medical or dental service corporation shall issue evidence of coverage.
(c) The dental plan organization, insurer, or medical or dental service corporation may not issue or deliver evidence of coverage or an amendment to evidence of coverage until a copy of the form of evidence of coverage or amendment is filed with and approved by the Commissioner.
(d) The evidence of coverage shall contain:
(1) a clear and complete statement if a contract, or a reasonably complete summary if a certificate, of:
(i) the dental services and the insurance or other benefits, if any, to which enrollees are entitled;
(ii) any limitations on the services or kind of benefits to be provided, including any charge, deductible, or copayment feature; and
(iii) where and in what manner information is available about how services may be obtained; and
(2) a clear and understandable description of the dental plan organization’s method for resolving enrollee complaints.
(e) A dental plan organization, insurer, or medical or dental service corporation that makes a change in evidence of coverage or the amount or percentage of payment that the enrollee must pay, shall issue to the enrollee evidence of the change in a separate document.