SSB 1078 (LSB 1343XC (2) 85)

SENATE FILE _____

BY  (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON McCOY)

A BILL FOR

An Act relating to insurance coverage for dental care services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.3C  Dental coverage —— assignment of health insurance benefits.
   A person who is the owner of any rights or benefits under a policy or contract of insurance which provides for coverage of dental care services shall be permitted to assign all or any part of that person’s rights and privileges under the policy or contract, including but not limited to the right to designate a beneficiary and to have an individual policy or contract issued in accordance with the terms of the policy or contract. Such assignment shall be without prejudice to the insurer on account of any payment the insurer makes or individual policy or contract the insurer issues before receiving notice of the assignment, provided that the insurer was acting in good faith. If written proof of an assignment of benefits is presented to an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, or other third-party payor, then payment shall be made directly to the health care professional or health care facility providing the dental services. Nothing in this section shall be construed to prevent any persons from reconciling duplicate payments.
    Sec. 2.  NEW SECTION.  514C.3D  Uniform coordination of benefits.
   A policy or contract of insurance which provides for coverage of dental care services shall provide for coordination of benefits in a manner so that the policy or contract pays the same amount for the dental care services provided regardless of the existence of other coverage for the dental care services, so long as the total amount paid does not exceed one hundred percent of the amount of the applicable claim. Such coordination of benefits shall be effected consistent with rules adopted by the commissioner of insurance under chapter 17A, based upon similar model rules developed by the national association of insurance commissioners.
    Sec. 3.  NEW SECTION.  514C.3E  Freedom of choice of dentists in dental plans.
   1.  A dental plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state on or after July 1, 2013, shall not do either of the following:
   a.  Prevent any person who is a party to or a beneficiary of such dental plan from selecting the dentist of the person’s choice to furnish the dental care services offered by the dental plan, or interfere with such selection.
   b.  Deny any dentist the right to participate as a contracting provider for the dental plan.
   2.  The payment or reimbursement for a noncontracting provider by a dental plan shall be the same as or greater than the payment or reimbursement for a contracting provider. However, a dental plan is not required to make a payment or reimbursement in an amount that is greater than the amount specified in the dental plan or that is greater than the fee charged by the dentist for the dental care services rendered.
   3.  Any provision in a dental plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state on or after July 1, 2013, which is contrary to this section is, to the extent of the conflict, void.
   4.  For the purposes of this section:
   a.  “Contracting provider” means, with respect to any dental plan, a dentist who has entered into a contract with the dental plan for the provision of dental care services to covered individuals under the dental plan.
   b.  “Dental care services” means any services furnished to a person for the purpose of preventing, alleviating, curing, or healing human dental abnormalities, accidents, or diseases.
   c.  “Dental plan” means any policy or contract of insurance which provides for coverage of dental care services not in connection with a medical plan that provides for the coverage of medical services.
   d.  “Dentist” means any person who furnishes dental care services and who is licensed as a dentist pursuant to chapter 153.

   e.  “Noncontracting provider” means, with respect to any dental plan, a dentist who has not entered into a contract with the dental plan for the provision of dental care services to covered individuals under the dental plan.
    Sec. 4.  Section 514J.103, subsection 1, Code 2013, is amended to read as follows:
   1.  Except as provided in subsection 2, this chapter shall apply to all health carriers, including health carriers issuing a policy or certificate that provides coverage for dental care.
    Sec. 5.  Section 514J.103, subsection 2, paragraph a, Code 2013, is amended to read as follows:
   a.  A policy or certificate that provides coverage only for a specified disease, specified accident or accident-only, credit, disability income, hospital indemnity, long-term care, dental care, vision care, or any other limited supplemental benefit.
EXPLANATION
   This bill relates to insurance coverage for dental care services.
   New Code section 514C.3C provides that a person who owns rights or benefits under a policy or contract of insurance which provides for coverage of dental care services must be allowed to assign any or part of that person’s rights and privileges under the policy or contract, including the right to designate a beneficiary and to have an individual policy or contract issued. The assignment is without prejudice to an insurer that makes a payment in good faith under the policy or contract before receiving notice of the assignment. If written proof of the assignment of benefits is presented to an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, or other third-party payor, the payment for coverage of dental care services shall be made directly to the health care provider providing the services. The section shall not be construed to prevent reconciliation of duplicate payments.
   New Code section 514C.3D provides that a policy or contract of insurance which provides for coverage of dental care services shall provide for coordination of benefits in a manner so that the policy or contract pays the same amount for the dental care services provided regardless of whether there is other coverage for the services, so long as the total amount paid does not exceed 100 percent of the amount of the claim. The commissioner of insurance shall adopt rules to provide for such coordination of benefits, based on similar model rules developed by the national association of insurance commissioners.
   New Code section 514C.3E provides that a policy or contract of insurance which provides for coverage of dental care services not in connection with a medical plan that covers medical services, shall not prevent a party or beneficiary of the dental plan from selecting a dentist of the person’s choice to furnish dental care services provided by the plan or deny any dentist the right to participate as a contracting dentist for the dental plan. The payment or reimbursement for a noncontracting dentist by a dental plan must be the same or greater than the payment or reimbursement for a contracting dentist. However, a dental plan is not required to make a payment or reimbursement in an amount greater than the amount specified in the plan or that is greater than the fee charged by the dentist. A provision in a dental plan that is contrary to the new Code section is void. New Code section 514C.3E is applicable to a dental plan that is delivered, renewed, issued for delivery, or otherwise contracted for in this state on or after July 1, 2013.
   Code section 514J.103 is amended to provide that decisions of health carriers issuing a policy or certificate that provides coverage for dental care are subject to the external review provisions of Code chapter 514J, and the chapter is also applicable to a policy or certificate that provides coverage only for dental care.