17:48D-5 Conditions for issuance; notice of disapproval.
5. a. The commissioner shall issue a certificate of authority if he is satisfied that the following conditions are met:
(1)The persons responsible for conducting the affairs of the dental plan organization are competent and trustworthy and are professionally capable of providing, arranging for or administering the services offered by the plan;
(2)The dental plan organization constitutes an appropriate mechanism to achieve an effective dental plan, as determined by the commissioner;
(3)The dental plan organization has demonstrated the potential to provide dental services in a manner that will assure both availability and accessibility of adequate personnel and facilities;
(4)The dental plan organization has arrangements for an ongoing quality of dental care assurance program;
(5)The dental plan organization has a procedure to establish and maintain uniform systems of cost accounting and reports and audits that meet the requirements of the commissioner;
(6)The dental plan organization is financially responsible and may reasonably be expected to meet its obligations to covered persons. In making this determination the commissioner shall consider:
(a)The financial soundness of the dental plan's arrangements for services and the schedule of premiums used;
(b)Any arrangement with an insurer or medical or dental service corporation for continuation of coverage in the event of discontinuance of the plan, on an indemnity basis through a group vehicle to the end of the period for which premiums were paid to the discontinued dental plan organization; and
(c)The sufficiency of an agreement with dentists for the provision of dental services;
(7)A general surplus is maintained as required in section 6 of this act;
(8)A contingent surplus is accumulated and maintained as required in section 7 of this act;
(9)The condition or methods of operation of the dental plan organization are not such as would render its operations hazardous to its enrollees or the public; and
(10) The persons responsible for conducting the affairs of the dental plan organization are: (a) of good moral character, and (b) have not been convicted, within 7 years of the filing of the application for a certificate of authority, of a crime listed in N.J.S.2C:41-1 or, at any time, of engaging in a pattern of racketeering activity, as defined in N.J.S.2C:41-1 and 2C:41-2.
b.When the commissioner disapproves an application for a certificate of authority, he shall notify the dental plan organization in writing of the reasons for the disapproval.
c.(Deleted by amendment, P.L.2005, c.38).
L.1979,c.478,s.5; amended 1983, c.24, s.3; 2005, c.38, s.4.
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Last modified: October 11, 2016