956 CMR, § 12.16 - Dental Plans
(1)
Eligibility for Dental Plans.
(a) Any individual who meets the eligibility
requirements for Non-group Health Plans without Financial Assistance, listed at
956 CMR 12.04(1)(a)
through (c), shall also be eligible to
purchase a Dental Plan; for purposes of clarity, an individual does not need to
be eligible for a Connector Program for Non-group Health Plans to be eligible
for Dental Plans. Any time an individual no longer meets the requirements
listed at
956 CMR 12.04(1)(a)
through (c), such individual shall no longer
be eligible for a Dental Plan.
(b)
Any Employer that is eligible to offer a Small Group Health Plan, in accordance
with
956 CMR
12.04(4)(a), shall be
eligible to offer a Dental Plan for its Employees. Any time an Employer loses
eligibility for Small Group Health Plan coverage through the Connector, such
Employer shall also lose eligibility for a Dental Plan.
(2) Applicability of Other Provisions. In
general, any regulation in
956 CMR 12.00 that applies to
a Health Carrier or a Health Plan shall apply equally to a Dental Carrier or a
Dental Plan including, but not limited to, eligibility review; eligibility
effective dates; responsibilities of Applicants, Eligible Individuals, Eligible
Small Employers, and Enrollees; termination of coverage; Premiums; and the
right to appeal.
(3)
Exceptions to Applicability of Other Provisions.
Notwithstanding the foregoing, the following shall apply to Dental Plans:
(a) Eligible Individuals do not need a
Special Enrollment Period to Enroll in a Dental Plan outside of the Open
Enrollment Period;
(b) Where no
APTC is applied to a Dental Plan, the delinquency, termination, and
reinstatement rules applicable to Non-group Health Plans without Financial
Assistance, found at
956 CMR 12.12(2), (3), and
(6) shall apply to Dental Plans, even where
an enrollee is eligible for Non-group Health Plans with Financial
Assistance;
(c) Dental Plans are
not eligible for Premium waivers or reductions under
956 CMR
12.12(7); and
(d) Dental Plans are not subject to the
participation and contribution requirements applicable to Small Group Health
Plans at
956 CMR
12.04(4)(a)5.
(4)
Dental Plan
Waiting Periods. A Dental Carrier may impose waiting periods on
certain services following the start date of coverage in the Dental Plan, as
consistent with state and federal law.
(5)
Dental Plan Lockout
Periods. A Dental Carrier may impose lockout periods on Dental
Plans during which individuals and Employees cannot enroll, if the Eligible
Individual or Employee is terminated from the Dental Plan because of failure to
pay Dental Plan Premium or because of voluntary termination, as consistent with
state and federal law.
Notes
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