(1) The
commissioner may suspend or revoke any certificate of authority issued to a
prepaid dental care plan organization pursuant to part 1 of this article and this part
5 if the commissioner finds that any of the following conditions exist:
(a) The prepaid dental care plan organization is operating significantly in
contravention of its basic organizational document or its prepaid dental care plan or
in a manner contrary to that described in and reasonably inferred from any other
information submitted pursuant to section 10-16-503, unless amendments to such
submissions have been filed with and approved by the commissioner;
(b) The prepaid dental care plan organization issues evidence of coverage or
uses a schedule of charges for prepaid dental care services which do not comply
with the requirements of section 10-16-507;
(c) The prepaid dental care plan does not provide or arrange for basic
prepaid dental care services;
(d) The prepaid dental care plan organization is unable to fulfill its
obligations to furnish prepaid dental care services as required under its care plan;
(e) The prepaid dental care plan organization is no longer financially
responsible and may reasonably be expected to be unable to meet its obligations to
enrollees or prospective enrollees;
(f) The prepaid dental care plan organization has failed to implement a
mechanism affording the enrollees an opportunity to participate in matters of
policy and operation pursuant to section 10-16-503 (1)(d);
(g) The prepaid dental care plan organization, or any person on its behalf, has
advertised or merchandised its prepaid dental care services in an untrue,
misrepresentative, misleading, deceptive, or unfair manner;
(h) The continued operation of the prepaid dental care plan organization
would be hazardous to its enrollees;
(i) The prepaid dental care plan organization has otherwise failed to
substantially comply with part 1 of this article or this part 5.
(2) When the commissioner has cause to believe that grounds for the
suspension or revocation of a certificate of authority exist, he shall notify the
prepaid dental care plan organization in writing specifically stating the grounds for
suspension or revocation and fixing a time of at least twenty days but not more than
sixty days thereafter for a hearing on the matter.
(3) After such hearing, or upon the failure of the prepaid dental care plan
organization to appear at such hearing, the commissioner shall take action as is
deemed advisable on written findings which shall be mailed to the prepaid dental
care plan organization.
(4) The provisions of article 4 of title 24, C.R.S., shall apply to proceedings
under this section to the extent they are not in conflict with subsections (2) and (3)
of this section.
(5) (a) The commissioner may, in lieu of suspension or revocation of a
certificate of authority and pursuant to the provisions of article 4 of title 24, C.R.S.,
levy an administrative penalty in an amount not less than one hundred dollars nor
more than five hundred dollars, if reasonable notice in writing is given of the intent
to levy the penalty and the prepaid dental care plan organization has a reasonable
time within which to remedy the defect in its operations which gave rise to the
penalty citation. The commissioner may augment this penalty by an amount equal
to the sum that the commissioner calculates to be the damages suffered by
enrollees or other members of the public.
(b) (I) If the commissioner, for any reason, has cause to believe that any
violation of part 1 of this article or this part 5 has occurred or is threatened, prior to
levy of a penalty or suspension or revocation of a certificate of authority, the
commissioner shall give notice to the prepaid dental care plan organization and to
the representatives, or other persons who appear to be involved in such suspected
violation, to arrange a conference with the alleged violators or their authorized
representatives for the purpose of attempting to ascertain the facts relating to
such suspected violation and, in the event it appears that any violation has occurred
or is threatened, to arrive at an adequate and effective means of correcting or
preventing such violation.
(II) Proceedings under this paragraph (b) shall not be governed by any formal
procedural requirements and may be conducted in such manner as the
commissioner may deem appropriate under the circumstances.
(c) (I) The commissioner may issue an order directing a prepaid dental care
plan organization or a representative of a prepaid dental care plan organization to
cease and desist from engaging in any act or practice in violation of the provisions
of part 1 of this article or this part 5.
(II) Within thirty days after service of the order of cease and desist, the
respondent may request a hearing on the question of whether acts or practices in
violation of part 1 of this article or this part 5 have occurred. Such hearings shall be
conducted pursuant to the provisions of article 4 of title 24, C.R.S.
(d) In the case of any violation of the provisions of part 1 of this article or this
part 5 if the commissioner elects not to issue a cease-and-desist order, or in the
event of noncompliance with a cease-and-desist order issued pursuant to
paragraph (c) of this subsection (5), the commissioner may institute a proceeding to
obtain injunctive relief or seek other appropriate relief through the attorney
general.
(6) When the certificate of authority of a prepaid dental care plan
organization is suspended, the prepaid dental care plan organization shall not,
during the period of such suspension, enroll any additional enrollees except
newborn children or other newly acquired dependents of existing enrollees and
shall not engage in any advertising or solicitation whatsoever.
(7) When the certificate of authority of a prepaid dental care plan
organization is revoked, such organization shall proceed, immediately following the
effective date of the order of revocation, to wind up its affairs and shall conduct no
further business except as may be essential to the orderly conclusion of the affairs
of such organization. It shall engage in no further advertising or solicitation
whatsoever. The commissioner may, by written order, permit such further operation
of the organization as the commissioner may find to be in the best interest of
enrollees, to the end that enrollees will be afforded the greatest practical
opportunity to obtain continuing prepaid dental care coverage.
(8) Any final action of the commissioner pursuant to this section shall be
subject to judicial review by the court of appeals pursuant to section 24-4-106 (11),
C.R.S.