SSB 1046 (LSB 1177XC (1) 87)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON ANDERSON)

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 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 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 issuer of such policy or contract of insurance on account of any payment the issuer makes or individual policy or contract the issuer issues before receiving notice of the assignment, provided that the issuer 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 designated beneficiary of the policy or contract of insurance. Nothing in this section shall be construed to prevent any person from reconciling duplicate payments.
    Sec. 2.  NEW SECTION.  514C.3D  Dental coverage —— uniform coordination of benefits.
   A policy or contract of insurance which provides for coverage of dental services shall provide for coordination of benefits in a manner so that the policy or contract pays the same amount for the dental services provided regardless of the existence of other coverage for the dental 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.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage for dental 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 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 issuer 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 services shall be made directly to the designated beneficiary of the policy or contract. 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 services shall provide for coordination of benefits in a manner so that the policy or contract pays the same amount for the dental 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.