Sec. 31.10.45.06. Dental Network Adequacy Executive Summary Form

A. For each provider panel used by a carrier for a dental plan, the carrier shall provide the network sufficiency results for the dental plan service area as follows:

(1) Travel Distance Standards.

(a) For each provider type listed in Regulation .03 of this chapter, list the percentage of enrollees for which the carrier met the travel distance standards, in the following format:

	Urban Area	Suburban Area	Rural Area
General dentist
Specialty provider

(b) List the total number of essential community providers in the carrier’s network.

(c) List the total percentage of essential community providers available in the dental benefit plan’s service area that are participating providers.

(2) Appointment Waiting Time Standards.

(a) For each appointment type listed in Regulation .04 of this chapter, list the percentage of enrollees in which the carrier met the appointment waiting time standards, in the following format:

Appointment Waiting Time Standard Results
Urgent care - within 3 calendar days
Routine dental services - within 45 calendar days
Nonurgent specialty care - within 60 calendar days

(b) List the total percentage of telehealth appointments counted as part of the appointment waiting time standard results.

B. Each carrier shall provide a description of how it will monitor, on an ongoing basis, the ability of participating providers to provide covered services to the carrier’s enrollees.

C. The dental network adequacy access plan executive summary form filed by a carrier pursuant to §A of this regulation is not confidential information.