(215 ILCS 5/355.2)
(from Ch. 73, par. 967.2)
Dental coverage reimbursement rates.
(a) Every company that issues, delivers, amends, or renews any
individual or group policy of accident and health insurance on or after the
effective date of this amendatory Act of 1991 that provides
dental insurance and bases payment for those benefits upon a
usual and customary fee charged by licensed dentists
must disclose all of the following:
(1) The frequency of the determination of the usual
(2) A general description of the methodology used to
determine usual and customary fees.
(3) The percentile that determines the maximum
benefit that the company will pay for any dental procedure, if the usual and customary fee is determined by taking a sample of fees submitted on actual claims from licensed dentists and then determining the benefit by selecting a percentile of those fees.
(b) The disclosure must be provided upon request to all group and
individual policy holders and group certificate holders. All proposals for
dental insurance must notify the prospective policy holder that information
regarding usual and customary fee determinations is available from the
insurer. All employee benefit descriptions or supplemental documents must
notify the employee that information regarding reimbursement rates is
available from the employer.
(Source: P.A. 87-587.)