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1 New Paragraph; Unfair Insurance Trade Practices; Non-Covered Services Under Dental Insurance Plans. Amend RSA 417:4 by inserting after paragraph XXIII the following new paragraph:
XXIV. Non-Covered Dental Services.
(a) No insurer, health care service contractor, health maintenance organization, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire Inc., subject to regulation by the insurance department 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 services.
(b) No person providing third party administrator services shall make available for any customers a plan that sets dental fees for providers in its provider network for any services except covered services.
(c) In this paragraph "covered services" means dental care service 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.
(d) Fees for covered services shall be set in good faith and shall not be nominal.
2 Effective Date. This act shall take effect January 1, 2021.
Text to be added highlighted in green.
1 New Paragraph; Unfair Insurance Trade Practices; Non-Covered Services Under Dental Insurance Plans. Amend RSA 417:4 by inserting after paragraph XXIII the following new paragraph:
XXIV. Non-Covered Dental Services.
(a) No insurer, health care service contractor, health maintenance organization, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire Inc., subject to regulation by the insurance department 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 services.
(b) No person providing third party administrator services shall make available for any customers a plan that sets dental fees for providers in its provider network for any services except covered services.
(c) In this paragraph "covered services" means dental care service 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.
(d) Fees for covered services shall be set in good faith and shall not be nominal.
2 Effective Date. This act shall take effect January 1, 2021.