S.F. _____ Section 1. NEW SECTION . 514C.3C Dental coverage —— 1 assignment of health insurance benefits. 2 A person who is the owner of any rights or benefits under a 3 policy or contract of insurance which provides for coverage of 4 dental care services shall be permitted to assign all or any 5 part of that person’s rights and privileges under the policy or 6 contract, including but not limited to the right to designate 7 a beneficiary and to have an individual policy or contract 8 issued in accordance with the terms of the policy or contract. 9 Such assignment shall be without prejudice to the insurer on 10 account of any payment the insurer makes or individual policy 11 or contract the insurer issues before receiving notice of the 12 assignment, provided that the insurer was acting in good faith. 13 If written proof of an assignment of benefits is presented to 14 an insurer, health maintenance organization, managed care plan, 15 health care plan, preferred provider organization, or other 16 third-party payor, then payment shall be made directly to the 17 health care professional or health care facility providing the 18 dental services. Nothing in this section shall be construed to 19 prevent any persons from reconciling duplicate payments. 20 Sec. 2. NEW SECTION . 514C.3D Uniform coordination of 21 benefits. 22 A policy or contract of insurance which provides for 23 coverage of dental care services shall provide for coordination 24 of benefits in a manner so that the policy or contract pays the 25 same amount for the dental care services provided regardless 26 of the existence of other coverage for the dental care 27 services, so long as the total amount paid does not exceed one 28 hundred percent of the amount of the applicable claim. Such 29 coordination of benefits shall be effected consistent with 30 rules adopted by the commissioner of insurance under chapter 31 17A, based upon similar model rules developed by the national 32 association of insurance commissioners. 33 Sec. 3. NEW SECTION . 514C.3E Freedom of choice of dentists 34 in dental plans. 35 -1- LSB 1343XC (2) 85 av/nh 1/ 4

S.F. _____ 1. A dental plan which is delivered, renewed, issued for 1 delivery, or otherwise contracted for in this state on or after 2 July 1, 2013, shall not do either of the following: 3 a. Prevent any person who is a party to or a beneficiary 4 of such dental plan from selecting the dentist of the person’s 5 choice to furnish the dental care services offered by the 6 dental plan, or interfere with such selection. 7 b. Deny any dentist the right to participate as a 8 contracting provider for the dental plan. 9 2. The payment or reimbursement for a noncontracting 10 provider by a dental plan shall be the same as or greater 11 than the payment or reimbursement for a contracting provider. 12 However, a dental plan is not required to make a payment or 13 reimbursement in an amount that is greater than the amount 14 specified in the dental plan or that is greater than the fee 15 charged by the dentist for the dental care services rendered. 16 3. Any provision in a dental plan which is delivered, 17 renewed, issued for delivery, or otherwise contracted for in 18 this state on or after July 1, 2013, which is contrary to this 19 section is, to the extent of the conflict, void. 20 4. For the purposes of this section: 21 a. “Contracting provider” means, with respect to any dental 22 plan, a dentist who has entered into a contract with the dental 23 plan for the provision of dental care services to covered 24 individuals under the dental plan. 25 b. “Dental care services” means any services furnished to a 26 person for the purpose of preventing, alleviating, curing, or 27 healing human dental abnormalities, accidents, or diseases. 28 c. “Dental plan” means any policy or contract of insurance 29 which provides for coverage of dental care services not in 30 connection with a medical plan that provides for the coverage 31 of medical services. 32 d. “Dentist” means any person who furnishes dental care 33 services and who is licensed as a dentist pursuant to chapter 34 153. 35 -2- LSB 1343XC (2) 85 av/nh 2/ 4

S.F. _____ e. “Noncontracting provider” means, with respect to any 1 dental plan, a dentist who has not entered into a contract with 2 the dental plan for the provision of dental care services to 3 covered individuals under the dental plan. 4 Sec. 4. Section 514J.103, subsection 1, Code 2013, is 5 amended to read as follows: 6 1. Except as provided in subsection 2 , this chapter shall 7 apply to all health carriers , including health carriers issuing 8 a policy or certificate that provides coverage for dental care . 9 Sec. 5. Section 514J.103, subsection 2, paragraph a, Code 10 2013, is amended to read as follows: 11 a. A policy or certificate that provides coverage only for a 12 specified disease, specified accident or accident-only, credit, 13 disability income, hospital indemnity, long-term care, dental 14 care, vision care, or any other limited supplemental benefit. 15 EXPLANATION 16 This bill relates to insurance coverage for dental care 17 services. 18 New Code section 514C.3C provides that a person who owns 19 rights or benefits under a policy or contract of insurance 20 which provides for coverage of dental care services must be 21 allowed to assign any or part of that person’s rights and 22 privileges under the policy or contract, including the right 23 to designate a beneficiary and to have an individual policy or 24 contract issued. The assignment is without prejudice to an 25 insurer that makes a payment in good faith under the policy 26 or contract before receiving notice of the assignment. If 27 written proof of the assignment of benefits is presented to an 28 insurer, health maintenance organization, managed care plan, 29 health care plan, preferred provider organization, or other 30 third-party payor, the payment for coverage of dental care 31 services shall be made directly to the health care provider 32 providing the services. The section shall not be construed to 33 prevent reconciliation of duplicate payments. 34 New Code section 514C.3D provides that a policy or contract 35 -3- LSB 1343XC (2) 85 av/nh 3/ 4

S.F. _____ of insurance which provides for coverage of dental care 1 services shall provide for coordination of benefits in a 2 manner so that the policy or contract pays the same amount 3 for the dental care services provided regardless of whether 4 there is other coverage for the services, so long as the total 5 amount paid does not exceed 100 percent of the amount of the 6 claim. The commissioner of insurance shall adopt rules to 7 provide for such coordination of benefits, based on similar 8 model rules developed by the national association of insurance 9 commissioners. 10 New Code section 514C.3E provides that a policy or contract 11 of insurance which provides for coverage of dental care 12 services not in connection with a medical plan that covers 13 medical services, shall not prevent a party or beneficiary 14 of the dental plan from selecting a dentist of the person’s 15 choice to furnish dental care services provided by the plan 16 or deny any dentist the right to participate as a contracting 17 dentist for the dental plan. The payment or reimbursement for 18 a noncontracting dentist by a dental plan must be the same or 19 greater than the payment or reimbursement for a contracting 20 dentist. However, a dental plan is not required to make a 21 payment or reimbursement in an amount greater than the amount 22 specified in the plan or that is greater than the fee charged 23 by the dentist. A provision in a dental plan that is contrary 24 to the new Code section is void. New Code section 514C.3E is 25 applicable to a dental plan that is delivered, renewed, issued 26 for delivery, or otherwise contracted for in this state on or 27 after July 1, 2013. 28 Code section 514J.103 is amended to provide that decisions 29 of health carriers issuing a policy or certificate that 30 provides coverage for dental care are subject to the external 31 review provisions of Code chapter 514J, and the chapter is also 32 applicable to a policy or certificate that provides coverage 33 only for dental care. 34 -4- LSB 1343XC (2) 85 av/nh 4/ 4