Dental Plans

(1) Eligibility for Dental Plans. (a) Any individual who meets the eligibility requirements for Non-group Health Plans without Financial Assistance, listed at 956 CMR 12.04(1)(a) through (c), shall also be eligible to purchase a Dental Plan; for purposes of clarity, an individual does not need to be eligible for a Connector Program for Non-group Health Plans to be eligible for Dental Plans. Any time an individual no longer meets the requirements listed at 956 CMR 12.04(1)(a) through (c), such individual shall no longer be eligible for a Dental Plan. (b) Any Employer that is eligible to offer a Small Group Health Plan, in accordance with 956 CMR 12.04(4)(a), shall be eligible to offer a Dental Plan for its Employees. Any time an Employer loses eligibility for Small Group Health Plan coverage through the Connector, such Employer shall also lose eligibility for a Dental Plan. (2) Applicability of Other Provisions. In general, any regulation in 956 CMR 12.00 that applies to a Health Carrier or a Health Plan shall apply equally to a Dental Carrier or a Dental Plan including, but not limited to, eligibility review; eligibility effective dates; responsibilities of Applicants, Eligible Individuals, Eligible Small Employers, and Enrollees; termination of coverage; Premiums; and the right to appeal. (3) Exceptions to Applicability of Other Provisions. Notwithstanding the foregoing, the following shall apply to Dental Plans: (a) Eligible Individuals do not need a Special Enrollment Period to Enroll in a Dental Plan outside of the Open Enrollment Period; (b) Where no APTC is applied to a Dental Plan, the delinquency, termination, and reinstatement rules applicable to Non-group Health Plans without Financial Assistance, found at 956 CMR 12.12(2), (3), and (6) shall apply to Dental Plans, even where an enrollee is eligible for Non-group Health Plans with Financial Assistance; (c) Dental Plans are not eligible for Premium waivers or reductions under 956 CMR 12.12(7); and (d) Dental Plans are not subject to the participation and contribution requirements applicable to Small Group Health Plans at 956 CMR 12.04(4)(a)5. (4) Dental Plan Waiting Periods. A Dental Carrier may impose waiting periods on certain services following the start date of coverage in the Dental Plan, as consistent with state and federal law. (5) Dental Plan Lockout Periods. A Dental Carrier may impose lockout periods on Dental Plans during which individuals and Employees cannot enroll, if the Eligible Individual or Employee is terminated from the Dental Plan because of failure to pay Dental Plan Premium or because of voluntary termination, as consistent with state and federal law.