20-1019. Order of benefit determination for
dental care
A. If a person receiving dental care is a member of a prepaid dental plan and is an
insured or certificate holder under an indemnity health insurance policy which provides
benefits for the same treatment as the person's prepaid dental plan, the indemnity health
insurance policy, if issued after the effective date of this section, shall pay benefits
to its insured or certificate holder or the assignee thereof without regard to the
existence of the prepaid dental plan.
B. Notwithstanding subsection A, the indemnity plan insurer is not obligated to pay
any amount for a procedure covered without charge to the member of the prepaid dental
plan or to pay in excess of the amount of the member's obligation under the prepaid
dental plan.
C. In the event that the member's copayment obligation under the prepaid dental
plan has been met, then the indemnity insurer shall remit any payments due under this
section directly to its insured or certificate holder.
D. The director may adopt rules to enforce this section.
|