354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director--newborn child to be covered, when, extent of coverage, notification of birth and additiona

MISSOURI STATUTES AND CODES

354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director--newborn child to be covered, when, extent of coverage, notification of birth and additiona

Contract or contract certificate to be issued to enrollees, content,copy to be filed with director--newborn child to be covered, when,extent of coverage, notification of birth and additional premium,when, effect of.

354.712. 1. Every enrollee in a prepaid dental plan corporation shallbe issued a contract setting out the dental care benefits covered by hisprepayment or fee. If the enrollee is a beneficiary under a group contract,then the enrollee may alternatively be issued a contract certificatesummarizing the dental care benefits covered by the prepayment.

2. Any contract that provides family coverage shall, as to such coverageof individuals in the family, also provide that the benefits applicable forchildren shall be payable with respect to a newly born child of the insuredfrom the instant of such child's birth to the same extent that such coverageapplies to other individuals in the family. If payment of a specific premiumor capitation amount is required to provide coverage for a child, the contractmay require notification of birth of a newly born child and payment of therequired premium or capitation amount shall be furnished to the corporationwithin thirty-one days after the date of birth in order to have the coveragecontinue beyond the thirty-one-day period.

3. No enrollee contract, contract certificate, or contract amendmentshall be issued or delivered to any person in this state until a copy of theform has been filed with the director.

4. All enrollee contracts or contract certificates shall clearly setforth:

(1) The prepaid dental care benefits to which the enrollee is entitled;

(2) Any limitations of the benefits to be provided, including anydeductible or co-payment feature;

(3) Where and in what manner information is available as to how servicesmay be obtained; and

(4) The enrollee's obligation respecting charges for the prepaid dentalplan contract.

5. Enrollee contracts, contract certificates, advertising matter, andsales material shall not contain any provision or statements that aredeceptive, ambiguous, or misleading.

6. No enrollee contract, contract certificate, or contract amendmentsshall be used until such form is approved by the director. If the directordoes not approve or disapprove any such form within thirty days after itsfiling, it shall be deemed approved. If the director disapproves a form, thedirector shall notify the prepaid dental plan corporation in writing andspecify the reasons for disapproval. The director shall grant a hearing onsuch disapproval within fifteen days after a request in writing is receivedfrom the prepaid dental plan corporation.