23 CAR Part 115 — Dental Point of Service Option

Chapter I

Subchapter B

Subpart 1

23 CAR § 115-101 Purpose {#sec-23-car-115-101 omnilex-key=us-ar-regs-official--title-23-part-115--23 CAR § 115-101}

23 CAR § 115-101. Purpose.

The purpose of this part is to require health carriers to provide full, written disclosure to covered persons of the availability of a dental point of service option in their health plans, where such health plans provide for dental benefits.

23 CAR § 115-102 Applicability and scope {#sec-23-car-115-102 omnilex-key=us-ar-regs-official--title-23-part-115--23 CAR § 115-102}

23 CAR § 115-102. Applicability and scope.

This part applies to all health plans that provide dental benefits issued, renewed, extended, or modified by a health carrier.

23 CAR § 115-103 Definitions {#sec-23-car-115-103 omnilex-key=us-ar-regs-official--title-23-part-115--23 CAR § 115-103}

23 CAR § 115-103. Definitions.

As used in this part:

(1) "Covered person" means a person defined in Arkansas Code § 23-99-603(2);

(2) "Health carrier" means that company or organization defined in Arkansas Code § 23-99-603(5); and

(3) "Health plan" means any contract, policy, or agreement defined in Arkansas Code § 23-99-603(6).

23 CAR § 115-104 Required notice {#sec-23-car-115-104 omnilex-key=us-ar-regs-official--title-23-part-115--23 CAR § 115-104}

23 CAR § 115-104. Required notice.

(a) Upon the issuance, extension, modification, or renewal of every health plan that provides dental benefits, the health carrier shall provide written notification to either the covered person, employer, or other purchaser of the health plan, of the following notice:

Under Arkansas law, you may purchase a dental point-of-service option as an additional benefit. A dental point-of-service option allows you to obtain dental care services from dentists and other providers outside the dental provider network or panel of your health plan. Arkansas law requires that the dental benefits offered under this option shall be the same as those offered through the network. Please be advised that although the out of network dental benefits offered are required to be equal to those provided through your in network health plan, the co-payment, co-insurance, and other cost sharing features may be higher should you use an out-of-network dentist, on a non -emergency basis. No co-payment or co-insurance, however, may exceed 25% of the co-payment required to be paid to in network dentists. The out-of- network dentist may also bill you for the balance of any charges which are not otherwise reimbursed by the health carrier.

(b) Every explanation of benefits following a covered person's use of out-of-network dental benefits under this option shall contain an explanation of coverage for out-of-network dental benefits that allows each enrollee or covered person to determine his or her obligations with respect to such services.

(c) The health plan must provide an explanation of this point-of-service product in marketing materials, evidences of coverage, enrollee handbooks, and other materials, which may be provided to either the covered person, employer, or purchaser of the health plan.