Effective 5/9/2017
31A-22-646. Dental insurance — Contract provision for noncovered services.
31A-22-646. Dental insurance — Contract provision for noncovered services.
- (1) For purposes of this section:
- (a) “Covered services” means dental services for which reimbursement:
- (i) is available or would be reimbursable under an enrollee’s dental plan but for the application of one or more of the following contractual provisions:
- (A) deductibles;
- (B) copayments;
- (C) coinsurance;
- (D) waiting periods;
- (E) annual or lifetime maximums;
- (F) frequency limitations; or
- (G) alternative benefit payments; and
- (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (i) is available or would be reimbursable under an enrollee’s dental plan but for the application of one or more of the following contractual provisions:
- (b) “Dental plan”means:
- (i) a health benefit plan that includes coverage for dental services; and
- (ii) a policy or certificate that provides coverage solely for dental services.
- (c) “Dentist” means an individual licensed under Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
- (a) “Covered services” means dental services for which reimbursement:
- (2)
- (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
- (a) This section applies to:
- (3) A contract between a dental plan and a dentist to provide covered services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
- (i) the dental services are covered services under the dental plan; or
- (ii)
- (A) the dental services are not reimbursed by the dental plan;
- (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
- (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the noncovered services.
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
Enacted by Chapter 101, 2017 General Session
Technically renumbered to avoid duplication of section number also enacted in HB42, Chapter 168.