Text: SF00182 Text: SF00184 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.3A DENTAL COVERAGE
1 2 REIMBURSEMENT RATES.
1 3 1. An individual or group policy of accident or health
1 4 insurance or individual or group hospital or health care
1 5 service contract issued pursuant to chapter 509, 514, or 514A,
1 6 and delivered, amended, or renewed on or after July 1, 1996,
1 7 that provides dental care benefits with a base payment for
1 8 those benefits determined upon a usual and customary fee
1 9 charged by licensed dentists, shall disclose all of the
1 10 following:
1 11 a. The frequency of the determination of the usual and
1 12 customary fee.
1 13 b. A general description of the methodology used to deter-
1 14 mine usual and customary fees, including geographic
1 15 considerations.
1 16 c. The percentile that determines the maximum benefit that
1 17 the insurer or nonprofit health service corporation will pay
1 18 for any dental procedure, if the usual and customary fee is
1 19 determined by taking a sample of fees submitted on actual
1 20 claims from licensed dentists and then determining the benefit
1 21 by selecting a percentile of those fees.
1 22 2. The disclosure shall be provided upon request to all
1 23 group and individual policyholders and subscribers. All
1 24 proposals for dental care benefits shall inform the
1 25 prospective policyholder or subscriber that information
1 26 regarding usual and customary fee determinations is available
1 27 from the insurer or nonprofit health service corporation. All
1 28 employee benefit descriptions or supplemental documents shall
1 29 notify the employee that information regarding reimbursement
1 30 rates is available from the employer.
1 31 EXPLANATION
1 32 This bill requires insurance companies and nonprofit health
1 33 service corporations that issue individual or group policies
1 34 of accident or health insurance or hospital or health care
1 35 service contracts, to disclose the methods used to determine
2 1 usual and customary fees for all dental care benefit coverages
2 2 written in the state.
2 3 LSB 1290SS 76
2 4 pf/cf/24
Text: SF00182 Text: SF00184 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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