1.  Each copayment and deductible required to be paid by a member must be reasonable and reasonably related to the cost of the particular service.

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

2.  Every organization for dental care shall submit to the Commissioner for approval any proposal for copayment or deductible before it is imposed on the members. The Commissioner shall approve or disapprove the proposal within 30 days after it is submitted to the Commissioner. If the Commissioner disapproves a copayment or deductible, the Commissioner shall notify the organization of the reasons for disapproval. The Commissioner shall grant a hearing on any such disapproval within 15 days after the organization requests, in writing, a hearing on the matter.

3.  The Commissioner may adopt regulations to define:

(a) ’Reasonable’ as it relates to copayments and deductibles; and

(b) A ‘reasonable relationship’ between the cost of particular services and the amount of related copayments and deductibles.