H.F. 2034 Section 1. NEW SECTION . 514C.3B Dental coverage —— fee 1 schedules. 2 1. A contract between a dental plan and a dentist for the 3 provision of services to covered individuals under the plan 4 shall not require that a dentist provide services to those 5 covered individuals at a fee set by the dental plan unless such 6 services are covered services under the dental plan. 7 2. A person or entity providing third-party administrator 8 services shall not make available any dentists in its dentist 9 network to a dental plan that does any of the following: 10 a. Sets fees for dental services that are not covered 11 services. 12 b. Sets fees for dental services that exceed the maximum fee 13 for dental services covered by the dental plan. 14 3. For the purposes of this section: 15 a. “Covered services” means services reimbursed under the 16 dental plan. 17 b. “Dental plan” means any policy or contract of insurance 18 which provides for coverage of dental services not in 19 connection with a medical plan that provides for the coverage 20 of medical services. 21 EXPLANATION 22 This bill creates new Code section 514C.3B which prohibits 23 a dental plan from setting fee schedules for participating 24 dentists for the provision of dental services that are not 25 covered by the plan. The bill also prohibits a third-party 26 administrator from making a dentist in its provider network 27 available to a dental plan that sets fees for services that are 28 not covered or sets fees for dental services that exceed the 29 maximum fee for dental services covered by the dental plan. 30 For the purposes of the bill, a “covered service” is a 31 service reimbursed under the applicable dental plan. A “dental 32 plan” is any policy or contract of insurance which provides for 33 coverage of dental services not in connection with a medical 34 plan which provides for the coverage of medical services. 35 -1- LSB 5299YH (4) 83 av/rj 1/ 1