Enclosed is the Actuarial Memorandum for the Group Dental Insurance Policy Rider DTPR PPO 2015 and Group Dental Insurance Certificate Rider DTCR PPO 2015 forms filed under SERFF ICCI-129613856. The forms are new and are not intended to replace any forms previously approved by the Department. These riders are intended to be attached to Group Dental Policy form 515 and Group Dental Certificate form 514, both previously approved by your Department on March 2, 1995.
These forms are to be exchanged certified to be offered off the exchange only.
These forms will be offered to both existing insured groups and new applicants and will be marketed through independent agents.
The forms also provide the pediatric oral health benefits for children up to page 19. Hence, we respectfully request that the Policy and Certificate Riders receive exchange certification for use off the exchange in DC.
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