Senate File 2384 S-5021 Amend Senate File 2384 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. NEW SECTION . 514C.3C Dental care service plan 4 contracts. 5 1. Definitions. As used in this section unless the context 6 otherwise provides: 7 a. “Commissioner” means the commissioner of insurance. 8 b. “Contracting entity” means any person, third-party 9 administrator, health carrier, or dental carrier that enters 10 into a contract with a dental care provider for the delivery 11 of dental care services. 12 c. “Covered person” means a policyholder, subscriber, 13 enrollee, or other individual participating in a dental care 14 service plan or health benefit plan that provides for dental 15 care services. 16 d. “Dental care provider” means any person licensed to 17 practice dentistry pursuant to chapter 153, and who provides 18 dental care services pursuant to a dental care service plan or 19 health benefit plan. 20 e. “Dental care service plan” means a policy, contract, 21 plan, certificate, or agreement that provides for third-party 22 payment or prepayment of dental care services and that is 23 delivered or issued for delivery by or through a dental carrier 24 on a stand-alone basis. “Dental care service plan” includes a 25 health benefit plan that provides for dental care services. 26 f. “Dental care services” means the same as defined in 27 section 514J.102. “Dental care services” does not include 28 services that are billed as medical expenses under a health 29 benefit plan. 30 g. “Dental carrier” means an entity subject to the 31 insurance laws and regulations of this state, or subject to 32 the jurisdiction of the commissioner, including an insurance 33 company offering dental care service plans, or any other entity 34 that provides a dental care service plan. 35 -1- SF 2384.3223 (2) 90 (amending this SF 2384 to CONFORM to HF 2400) nls/ko 1/ 5 #1.

h. “Dental service contractor” means any person who accepts 1 a prepayment from, or for the benefit of, another person as 2 consideration for the provision of future dental care services. 3 “Dental service contractor” does not include a dental care 4 provider that accepts prepayment on a fee-for-service basis for 5 providing specific dental services to individual patients for 6 whom such services have been prediagnosed. 7 i. “Dentist agent” means a person that contracts with 8 a dental care provider to establish an agency relationship 9 for purposes of processing bills for services provided by 10 the dental care provider under the terms and conditions 11 of a contract between the dentist agent and a health care 12 provider. A contract between a dentist agent and a health care 13 provider may permit the dentist agent to submit bills, request 14 reconsideration, and receive reimbursement. 15 j. “Health benefit plan” means the same as defined in 16 section 514J.102. 17 k. “Health carrier” means the same as defined in section 18 514J.102. 19 l. “Network contract” means a contract between a contracting 20 entity and a dental care provider that specifies the rights and 21 responsibilities of the contracting entity and provides for the 22 delivery and payment of dental services to a covered person. 23 m. “Third party” means a person, not including a covered 24 person, that enters into a contract with a contracting entity 25 to access the dental services or contractual discounts of a 26 network contract. “Third party” does not include an employer or 27 other group for whom the dental carrier or contracting entity 28 provides administrative services. 29 n. “Virtual credit card payment” means an electronic funds 30 transfer in which a dental care service plan, or a contracted 31 vendor, issues a single-use series of numbers associated with 32 the payment of dental care services performed by a dental care 33 provider and chargeable to a predetermined dollar amount, where 34 the dental care provider is responsible for processing the 35 -2- SF 2384.3223 (2) 90 (amending this SF 2384 to CONFORM to HF 2400) nls/ko 2/ 5

payment by a credit card terminal or internet portal. “Virtual 1 credit card payment” includes only electronic or virtual credit 2 card payments, where no physical credit card is used and 3 the single-use electronic credit card expires upon payment 4 processing. 5 2. Third-party access to network contracts. 6 a. A contracting entity may grant a third party access 7 to a network contract, or to a dental care provider’s dental 8 care services or contractual discounts provided pursuant to a 9 network contract, if all of the following requirements are met: 10 (1) If the contracting entity is a dental carrier or health 11 carrier, at the time the network contract is entered into, 12 renewed, or material modifications relevant to granting access 13 to a third party are made, the contracting entity allows any 14 dental care provider that is part of the contracting entity’s 15 network contract to choose not to participate in third-party 16 access to the network contract, or to enter into a contract 17 directly with the third party. If a dental care provider opts 18 out of lease arrangements, a contracting entity shall not 19 cancel or terminate a contractual relationship with, or refuse 20 to contract with, the dental care provider. 21 (2) The network contract specifically states that the 22 contracting entity may enter into an agreement with a third 23 party to allow the third party to obtain the contracting 24 entity’s rights and responsibilities under the network 25 contract as if the third party were the contracting entity. 26 If the contracting entity is a dental carrier, the network 27 contract must specifically state that the dental care provider 28 may choose not to participate in third-party access to the 29 network contract, and that the dental care provider chose to 30 participate in third-party access at the time the network 31 contract was entered into or renewed. 32 (3) The third party accessing the network contract agrees to 33 comply with all of the network contract’s terms. 34 (4) The contracting entity identifies to the dental care 35 -3- SF 2384.3223 (2) 90 (amending this SF 2384 to CONFORM to HF 2400) nls/ko 3/ 5

provider, in writing, all third parties participating in the 1 network contract as of the date the network contract is entered 2 into or renewed. 3 (5) The contracting entity provides a list of all 4 third parties participating in the network contract on the 5 contracting entity’s internet site and the list of third 6 parties is updated at least once every ninety days. 7 (6) The contracting entity notifies a dental care provider 8 under the network contract at least thirty days prior to a new 9 third party leasing or purchasing the network contract. 10 (7) The contracting entity requires a third party to 11 identify, for all remittance advice or explanations of payment 12 under which a discount applies, the source of the discount. 13 This subparagraph does not apply to an electronic transaction 14 mandated by the federal Health Insurance Portability and 15 Accountability Act of 1996, Pub. L. No. 104-191. 16 (8) The contracting entity notifies a third party of the 17 termination of a network contract no later than thirty days 18 from the termination date of the network contract. 19 (9) A third party’s right to a dental care provider’s 20 discounted rate is terminated as of the termination date of the 21 network contract. 22 (10) In the adjudication of a claim under the network 23 contract, the contracting entity makes available to the 24 dental care provider a copy of the network contract no later 25 than thirty days after a request for the network contract is 26 received. 27 b. This section shall not apply to access to a network 28 contract provided to a third party that is either an affiliate 29 of, or operating under the same brand licensing as, the 30 contracting entity. A contracting entity shall provide a list 31 of all affiliates on the contracting entity’s internet site. 32 c. No dental care provider shall be bound by, or required to 33 perform, dental care services under a network contract that has 34 been granted to a third party in violation of this section. 35 -4- SF 2384.3223 (2) 90 (amending this SF 2384 to CONFORM to HF 2400) nls/ko 4/ 5

3. Dental care service plans —— method of payment. 1 a. A dental care service plan shall not require payments 2 to be made to dental care providers by virtual credit card 3 payment. 4 b. A dental care service plan, when initiating payments to 5 a dental care provider via virtual credit card payment, or when 6 changing the method of payment for a dental care provider to 7 virtual credit card payments, shall do all of the following: 8 (1) Notify the dental care provider of any fees associated 9 with each payment method. 10 (2) Inform the dental care provider of the available options 11 for methods of payment and provide clear instructions to the 12 dental care provider for the selection of an alternative 13 payment method. 14 c. A dental care service plan that transmits payments to 15 a dental care provider in accordance with the standards of 45 16 C.F.R. §162.1601 and 162.1602 shall not charge a fee solely for 17 the transmission of the payment to the dental care provider 18 unless the dental care provider has consented to payment of 19 the fee. When transmitting a national automated clearinghouse 20 payment, a dentist agent may charge a reasonable fee related 21 to bank transmittal, transaction management, data management, 22 portal services, and other value-added services. 23 4. Waiver prohibited. The requirements of this section 24 shall not be waived by contract. Any contractual arrangement 25 contrary to this section shall be null and void. 26 5. Rules. The commissioner may adopt rules pursuant to 27 chapter 17A to administer this chapter. > 28 ______________________________ DAN DAWSON -5- SF 2384.3223 (2) 90 (amending this SF 2384 to CONFORM to HF 2400) nls/ko 5/ 5