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:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

     (5) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

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

     (9) Other limited benefit policies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

determine that the service in question was rendered.

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

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

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

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

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

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

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

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

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

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

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

LC001627 - Page 3 of 6

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

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

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

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

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

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

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

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

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

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

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

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

Maintenance Organizations" is hereby amended to read as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

benefits to a dentist of their choice.

     This act would take effect upon passage.

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LC001627

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