2017 -- H 5627

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LC001627

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO INSURANCE - DENTAL HEALTH COVERAGE

     

     Introduced By: Representatives Lima, Carson, Vella-Wilkinson, and Fellela

     Date Introduced: March 01, 2017

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-63 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

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     27-18-63. Dental insurance assignment of benefits.

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     Every entity providing a policy of accident and sickness insurance as defined in this

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chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan

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for coverage of dental services, any person insured by such entity to receive benefits no more

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than five percent (5%) less than the benefits paid to participating dentists or dental specialists if

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the service is provided by a dental care provider who has not contracted with the entity to provide

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dental services to persons covered by the entity but otherwise meets the credentialing criteria of

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the entity and has not previously been terminated by such entity as a participating provider, and

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shall allow any person insured by such entity to direct, in writing, that those benefits from a

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health benefit plan, policy or contract, be paid directly to a that dental care provider who has not

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contracted with the entity to provide dental services to persons covered by the entity but

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otherwise meets the credentialing criteria of the entity and has not previously been terminated by

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such entity as a participating provider. If written direction to pay is executed and written notice of

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the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to

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the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental

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care provider under this section may include a reduction in benefits paid of no more than five

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percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist,

 

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pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the

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records of the dentist receiving such payment that relate exclusively to that particular

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subscriber/patient to determine that the service in question was rendered. Provided, however, this

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section shall not apply to insurance coverage providing benefits for:

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     (1) Hospital confinement indemnity;

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     (2) Disability income;

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     (3) Accident only;

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     (4) Long-term care;

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     (5) Medicare supplement;

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     (6) Limited benefit health;

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     (7) Specified disease indemnity;

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     (8) Sickness or bodily injury or death by accident or both; and

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     (9) Other limited benefit policies.

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     SECTION 2. Section 27-19-54 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-54. Dental insurance assignment of benefits.

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     Every entity providing a contract of insurance subject to this chapter shall allow, as a

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provision in a group or individual policy, contract or health benefit plan for coverage of dental

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services, any person insured by such entity to receive benefits no more than five percent (5%) less

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than the benefits paid to participating dentists or dental specialists if the service is provided by a

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dental care provider who has not contracted with the entity to provide dental services to persons

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covered by the entity but otherwise meets the credentialing criteria of the entity and has not

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previously been terminated by such entity as a participating provider, and shall allow any person

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insured by such entity to direct, in writing, that those benefits from a health benefit plan, policy or

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contract, be paid directly to a that dental care provider who has not contracted with the entity to

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provide dental services to persons covered by the entity but otherwise meets the credentialing

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criteria of the entity and has not previously been terminated by such entity as a participating

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provider. If written direction to pay is executed and written notice of the direction to pay is

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provided to such entity, the insuring entity shall pay the benefits directly to the dental care

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provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

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under this section may include a reduction in benefits paid of no more than five percent (5%) less

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than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a

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direction to pay duly executed by the subscriber, shall have the right to review the records of the

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dentist receiving such payment that relate exclusively to that particular subscriber/patient to

 

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determine that the service in question was rendered.

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     SECTION 3. Section 27-20-49 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

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     27-20-49. Dental insurance assignment of benefits.

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     Every entity providing a contract of insurance as defined in this chapter shall allow, as a

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provision in a group or individual policy, contract or health benefit plan for coverage of dental

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services, any person insured by such entity to receive benefits no more than five percent (5%) less

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than the benefits paid to participating dentists or dental specialists if the service is provided by a

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dental care provider who has not contracted with the entity to provide dental services to persons

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covered by the entity but otherwise meets the credentialing criteria of the entity and has not

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previously been terminated by such entity as a participating provider, and shall allow any person

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insured by such entity to direct, in writing, that those benefits from a that health benefit plan,

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policy or contract, be paid directly to a dental care provider who has not contracted with the entity

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to provide dental services to persons covered by the entity but otherwise meets the credentialing

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criteria of the entity and has not previously been terminated by such entity as a participating

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provider. If written direction to pay is executed and written notice of the direction to pay is

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provided to such entity, the insuring entity shall pay the benefits directly to the dental care

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provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

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under this section may include a reduction in benefits paid of no more than five percent (5%) less

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than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a

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direction to pay duly executed by the subscriber, shall have the right to review the records of the

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dentist receiving such payment that relate exclusively to that particular subscriber/patient to

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determine that the service in question was rendered.

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     SECTION 4. Section 27-20.1-18 of the General Laws in Chapter 27-20.1 entitled

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"Nonprofit Dental Service Corporations" is hereby amended to read as follows:

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     27-20.1-18. Dental insurance assignment of benefits.

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     Every entity providing nonprofit dental service plan as defined in this chapter shall allow,

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as a provision in a group or individual policy, contract or health benefit plan for coverage of

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dental services, any person insured by such entity to receive benefits no more than five percent

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(5%) less than the benefits paid to participating dentists or dental specialists if the service is

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provided by a dental care provider who has not contracted with the entity to provide dental

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services to persons covered by the entity but otherwise meets the credentialing criteria of the

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entity and has not previously been terminated by such entity as a participating provider, and shall

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allow any person insured by such entity to direct, in writing, that those benefits from a health

 

LC001627 - Page 3 of 6

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benefit plan, policy or contract, be paid directly to a that dental care provider who has not

2

contracted with the entity to provide dental services to persons covered by the entity but

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otherwise meets the credentialing criteria of the entity and has not previously been terminated by

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such entity as a participating provider. If written direction to pay is executed and written notice of

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the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to

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the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental

7

care provider under this section may include a reduction in benefits paid of no more than five

8

percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist,

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pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the

10

records of the dentist receiving such payment that relate exclusively to that particular

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subscriber/patient to determine that the service in question was rendered.

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     SECTION 5. Section 27-41-66 of the General Laws in Chapter 27-41 entitled "Health

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Maintenance Organizations" is hereby amended to read as follows:

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     27-41-66. Dental insurance assignment of benefits.

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     Every entity licensed under this chapter shall allow, as a provision of any evidence of

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coverage of dental services, any person covered by such entity to receive benefits no more than

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five percent (5%) less than the benefits paid to participating dentists or dental specialists if the

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service is provided by a dental care provider who has not contracted with the entity to provide

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dental services to persons covered by the entity but otherwise meets the credentialing criteria of

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the entity and has not previously been terminated by such entity as a participating provider, and

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shall allow any person insured by such entity to direct, in writing, that those benefits from a

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health benefit plan, policy or contract, be paid directly to a that dental care provider who has not

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contracted with the entity to provide dental services to persons covered by the entity but

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otherwise meets the credentialing criteria of the entity and has not previously been terminated by

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such entity as a participating provider. If written direction to pay is executed and written notice of

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the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to

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the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental

28

care provider under this section may include a reduction in benefits paid of no more than five

29

percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist,

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pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the

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records of the dentist receiving such payment that relate exclusively to that particular

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subscriber/patient to determine that the service in question was rendered.

 

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     SECTION 6. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - DENTAL HEALTH COVERAGE

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     This act would permit dental patients of health care providers to assign their dental

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benefits to a dentist of their choice.

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     This act would take effect upon passage.

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