SB169 (2014) Detail

Relative to non-covered services under dental insurance plans.


SB 169 – AS AMENDED BY THE SENATE

03/28/13 1051s

03/28/13 1144s

2013 SESSION

13-1003

01/10

SENATE BILL 169

AN ACT relative to non-covered services under dental insurance plans.

SPONSORS: Sen. Sanborn, Dist 9; Sen. Rausch, Dist 19; Sen. Soucy, Dist 18; Rep. Hammond, Hills 24

COMMITTEE: Commerce

ANALYSIS

This bill declares that no insurer offering a dental plan shall require a participating dentist to provide services to an enrolled participant at a fee set by the insurer unless such dental services are covered services.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/28/13 1051s

03/28/13 1144s

13-1003

01/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Thirteen

AN ACT relative to non-covered services under dental insurance plans.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Findings and Purpose. This act is intended to prohibit the practice where dental and healthcare plans establish fees for services to be provided by a dental provider that are not covered by the plan. For a dental or healthcare plan to require a discount, the service has to be covered by the plan at a rate that is determined in good faith and not nominal. The prohibition in this act is intended to be broadly construed to apply to all dental and healthcare plans available in New Hampshire.

2 New Section; Dental Services; Individual. Amend RSA 415 by inserting after section 6-r the following new section:

415:6-s Dental Services.

I. No insurer, health maintenance organization, health service corporation, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire, Inc., offering an accident or sickness policy that covers dental services, subject to regulation by the department of insurance, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available under an enrollee’s plan contract, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. Carriers offering dental coverage shall inform covered persons in the plan description that no in-network discount is available under the plan contract for services that are not covered dental services.

3 New Section; Dental Services; Group. Amend RSA 415 by inserting after section 18-w the following new section:

415:18-x Dental Services.

I. No insurer, health maintenance organization, health service corporation, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire, Inc., offering a general blanket or group policy that covers dental services, subject to regulation by the department of insurance, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available under an enrollee’s plan contract, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. Carriers offering dental coverage shall inform covered persons in the plan description that no in-network discount is available under the plan contract for services that are not covered dental services.

4 New Section; Dental Services; Discount Medical Plan Organizations. Amend RSA 415-I by inserting after section 5 the following new section:

415-I:5-a Dental Services.

I. No entity subject to regulation by or registration with the department of insurance under this chapter, that covers dental services, and no contract or participating provider agreement between any such entity and a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to a plan member at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available to a plan member, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. An entity offering a discount medical plan subject to this chapter with dental coverage shall inform covered persons in the plan description that no in-network discount is available under the plan contract for services that are not covered dental services.

5 New Section; Dental Services; Health Service Corporations. Amend RSA 420-A by inserting after section 17-g the following new section:

420-A:17-h Dental Services.

I. No health service corporation subject to regulation by the department of insurance, or any similar corporation licensed under the laws of another state, that issues or renews any policy of accident or health insurance that covers dental services, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to a certificate holder at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available under a certificate holders insurance contract, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. Health service corporations offering dental coverage shall inform certificate holders in the plan description that no in-network discount is available under the insurance contract for services that are not covered dental services.

6 New Section; Dental Services; Health Maintenance Organizations. Amend RSA 420-B by inserting after section 12 the following new section:

420-B:12-a Dental Services.

I. No health maintenance organization subject to regulation by the department of insurance, that covers dental services, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available under an enrollee’s policy or plan contract, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. Health maintenance organizations offering dental coverage shall inform enrolled participants in the evidence of coverage that no in-network discount is available under the policy or plan contract for services that are not covered dental services.

7 New Section; Dental Services; Managed Care. Amend RSA 420-J by inserting after section 8-d the following new section:

420-J:8-e Dental Services.

I. No health carrier subject to regulation by the department of insurance, that covers dental services, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to a covered person at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered dental services.

II. In this section “covered dental services” means dental services for which reimbursement is available under a covered person’s health benefit plan, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.

III. Health carriers offering dental coverage shall inform covered persons in the evidence of coverage that no in-network discount is available under the plan contract for services that are not covered dental services.

8 Delta Dental; Dental Services. Amend RSA 420-F:1, III to read as follows:

III. Delta shall be governed by this chapter and shall be exempt from this title, except for the provisions of RSA 400-A:39, RSA 402-C, RSA 404-F, RSA 415:18, XVI, relative to continuation of coverage, RSA 415:6-s, RSA 415:18-x, RSA 415-I:5-a, RSA 420-A:17-h, RSA 420-B:12-a, RSA 420-G:11, II, II-a and III, RSA 420-J:8-e, and 1961, 345; provided, however, if any of the provisions of 1961, 345 are inconsistent with this chapter the provisions of this chapter shall prevail. Delta and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.

9 Effective Date. This act shall take effect July 1, 2014.

Links

SB169 at GenCourtMobile

Action Dates

Date Body Type

Bill Text Revisions

SB169 Revision: 27117 Date: March 27, 2014, midnight

Docket