Section 156.04 - Coverage Standards(1)Evidences of Coverage. Carriers are to file all insured Dental Benefit Plans offered under 211 CMR 156.00 with the Division. (a) All such Plans are to be reviewed for compliance with M.G.L. c. 175, § 2B.(b) Individually issued Dental Benefit Plans are to comply with the requirements of 211 CMR 42.00: Health Maintenance Organizations (HMOs).(c) Plans that provide or arrange for the delivery of dental benefits through a network of Dental Providers or use utilization management in the review of the necessity of certain Dental Services are to comply with the requirements of 211 CMR 52.00: Managed Care Consumer Protections and Accreditation of Carriers, as noted in 211 CMR 52.01: Applicability.(d) Plans that provide or arrange for the delivery of dental benefits through a network of Dental Providers and include dental networks that differ from those of a Dental Benefit Plan's overall network should prominently display on all Plan documents, including provider directory materials, a provider network name that distinguishes the network of the Plan from the other networks offered by the Carrier.(e) Plans that permit both an in-network and an out-of-network level of dental benefits are to comply with the requirements of 211 CMR 51.00: Preferred Provider Health Plans and Workers' Compensation Preferred Provider Arrangements.(2)Issuing Coverage.(a)1. No Carrier may exclude any Individual, Eligible Employee, or Eligible Dependent from a Dental Benefit Plan on the basis of any impermissible factors, including but not limited to race, color, religious creed, national origin, sex, gender identity, sexual orientation, genetic information, pregnancy, ancestry, or status as a veteran.2. No Carrier may modify the coverage of an Individual, Eligible Employee, or Eligible Dependent through riders or endorsements, or otherwise restrict or exclude coverage for certain diseases or conditions otherwise covered by the Dental Benefit Plan, except as permitted under 211 CMR 156.00.3. Every Carrier must make appropriate disclosures in plain language and provide access to information assistance to prospective group Insureds and prospective individual Insureds, as part of its solicitation and sales material, of: b. rating limitations according to 211 CMR 156.05; andc. availability of Dental Benefit Plans, including, but not limited to, situations where a plan has a dental provider network that is limited to a particular service area or to employees that live in the service area.(b) Carriers are permitted to underwrite Dental Benefit Plans that are issued to Individuals, provided that the applicant completes a dental coverage application and the Carrier uses the information from the application to determine whether to issue coverage based on its policy for underwriting individual dental policies. Carriers may apply waiting periods, deductibles, benefit limitations, or exclusions as a condition of issuing coverage, provided that the applicant is made aware of and is provided with complete written information regarding all conditions that differ from the coverage originally applied for. When issuing Individual Dental Benefit Plans, Carriers are required to prominently and clearly identify the renewal conditions of the policy on the cover page of the Individual policy, in a manner that is consistent with the requirements set forth in 211 CMR 42.00: Health Maintenance Organizations (HMOs).(c) Carriers are permitted to underwrite Dental Benefit Plans to be issued to Group Associations and may underwrite coverage issued to Individuals through Group Associations, provided that the applicant completes a dental coverage application and the Carrier uses the information from the application to determine whether to issue coverage based on its individual coverage policy. Carriers may apply waiting periods, deductibles, benefit limitations, or exclusions as a condition of issuing coverage, provided that the applicant is made aware of and is provided with complete written information regarding all conditions that differ from the coverage originally applied for. When issuing certificates of coverage for Group Association Dental Benefit Plans, Carriers are required to prominently and clearly identify the renewal conditions on the cover page of the certificate of coverage.(d) Carriers are permitted to underwrite the issuance of group dental coverage to Employer Groups, but are not permitted to underwrite coverage issued to Eligible Employees and their eligible dependents. Carriers may apply waiting periods, deductibles, benefit limitations, or exclusions as a condition of issuing coverage to an Employer Group, provided that the applicant is made aware of and is provided with complete written information regarding all conditions that differ from the coverage originally applied for. When issuing certificates of coverage to Employer Groups for Dental Benefit Plans, Carriers are required to prominently and clearly identify within the certificates all continuation of coverage provisions, including, but not limited, to those required under federal COBRA protections, in the event employment-based coverage is lost due to a qualifying event.Adopted by Mass Register Issue 1519, eff. 4/12/2024.