Dental Insurance Articles
State Regulations Governing The Administration Of Dental Insurance
2010-11-18
A concerned consumer may wonder about what state regulations govern dental insurance plans. Insurance is a complicated business, and often the laws regarding what insurance companies can and cannot do are inaccessible or difficult to understand. However, every customer purchasing a dental insurance plan should take the time to research their rights and know what to do in the event of a problem with a claim.
The insurance policy is a legal contract between the insurer and the policyholder which spells out the terms, premiums, coverage and any applicable deductibles or co-pay amounts. The insurance company should always provide the policyholder with a copy of the policy at the time of purchase or upon request. It is advisable for a policyholder to have a copy of the policy on hand when attempting to find the answer to coverage questions. If there is a dispute over what is covered then the plain language of the policy is going to provide the basis for an appeal. Likewise, if the dispute should go to court, the court system will rely upon the language of the policy and the laws of the state in order to render a ruling.
Of course, a policyholder who feels that their dental insurance company is doing something wrong is not obligated to file a lawsuit as their only recourse. State regulations governing the administration of dental insurance plans will be handled by the state's Department of Insurance (DOI). Sometimes known as the Division of Insurance, the DOI's authority extends to health, life, dental, auto and homeowner's insurance.
Often, state insurance laws do not apply to self-funded employer plans or to federal benefit plans. For questions related to self-funded plans, contact the U.S. Department of Labor at 866-275-7922. For questions related to Medicare, call 1-800-Medicare. The National Association of Insurance Commissioners at http://www.naic.org/ can be used to obtain contact information for Insurance Departments of other states.
A policyholder can make inquiry on the DOI's website. There will usually be a section of the website dedicated to consumers which explains how to go about filing a complaint against a particular insurance company. Typically, the DOI website will also list brochures and directories relating to insurance, and provide an 800-inquiry number (and email address) which customers can contact to pose specific questions.
There are a great many resources available to consumers who need help dealing with their dental insurance company. Remember to have a copy of your dental insurance plan's policy available when making inquiries into the state regulations governing your dental insurance plan. Then start with your state's department of insurance as the primary resource to tell you where to go for answers.