What Dentists Need To Know About In-House Membership Plan Compliance

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Whether your offices currently have an In-House Dental Plan in place – or you’re considering implementing one in the future – it’s important you understand the rules & regulations governing  discount health care plans and how your plan can maintain regulatory compliance.

In-House Dental Plan Compliance

If you’re a dentist or office manager you’re probably already aware of some of today’s most frequently discussed compliance issues facing 21st century dental providers   – including OSHA, HIPAA, PPO and Medicaid related compliance matters. Well, times are changing and if it’s officially now time to add one more to that list: In-House Dental Plan compliance.

The nature of In-House Dental Plans and there growing popularity amongst dentists and patients alike has fostered a lot of systemic abuse resulting in a increase of rules and regulations.

As a result of this, there’s now 25+ states that require program operators to register their discount plan with appropriate state government agencies, and an additional 12 states have enacted state-specific laws regulating In-House Dental Plans in some fashion.

State-Specific Rules & Regulations

The most cumbersome – and important – rules and regulations affecting today’s In-House Dental Plans are illustrated in state-specific Discount Medical Plan Organization (DMPO) licensing statutes and laws.

According to the National Association of Insurance Commissioners, a “Discount Medical Plan Organization (DMPO)” is an entity that, in exchange for fees, dues, charges or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount.

While exact DMPO licensing requirements vary by state, most states require the program operator to attain and maintain DMPO compliance.

Here are some examples of those DMPO compliance-related tasks required by states:

  • Program operator (dental office) must submit a DMPO license application for review. A DMPO application typically requires the operator to pay an annual licensing fee, attain a surety bond, and get approval for their plan’s enrollment rates, member discounts and marketing materials.
  • Once approved, the program operator (dental office) must follow DMPO guidelines to maintain ongoing compliance with their state’s DMPO statues. Maintaining a license typically involves the operator to continue paying licensing and surety bond fees as well as provide detailed periodic reports (usually quarterly).

How can I assure my In-House Dental Plan is compliant?

In order for your In-House Dental Plan to be regulatory compliant you can either go through the cumbersome process of attaining and maintaining a DMPO license yourself – or you can take a much smarter, less cumbersome approach – and partner with a reputable company that’s already a licensed plan operator like Ascension Dental, the parent company of My Loyal Dental Plan.

In short, if you choose to create and manage your In-House Dental Plan with a licensed DMPO like a My Loyal Dental Plan you’re guaranteed to have an In-House Membership Plan that’s compliant with your state’s applicable rules & regulations governing discount health care plans.

If you have further questions about your states In-House Membership Plan compliance statutes or In-House Memberhsip Plans in general, please don’t hesitate to contact us. We’d be happy to assist!