| (a) Each point-of-service group enrollment application
and, if the employer, association, or private group arrangement elects
to offer the point-of-service option, each enrollment form, must include
a disclosure statement written in a readable and understandable format
that includes the following information:
(1) a statement that the dental indemnity benefits
are provided through an insurer and that the dental care services
are offered or arranged by the HMO;
(2) the name of the insurer and the name of the HMO
offering the benefits; and
(3) an explanation that, in order to receive benefits:
(A) under the HMO, an enrollee must use only network
providers, except for emergency dental care, and pay the copayments
specified in the evidence of coverage;
(B) under the indemnity plan, an enrollee may use any
provider but before receiving reimbursement, the enrollee must meet
the required deductible and is responsible for the coinsurance amount
specified in the policy or certificate.
(b) Each HMO offering a point-of-service plan must
retain on file a certification by an HMO officer that the point-of-service
plan includes dental indemnity benefits that correspond to the benefits
contained in the HMO evidence of coverage. The HMO may enter into
agreement with the insurer or a qualified actuary to prepare the certification,
provided that the HMO retains responsibility for obtaining the certification
and must keep the certification in its possession.
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