2023 -- H 5683

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LC001427

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Casimiro, Noret, and Morales

     Date Introduced: February 17, 2023

     Referred To: House Health & Human Services

     (by request)

It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-91. Dental implant coverage.

     (a) As used in this section:

     (1) Cosmetic procedure means:

     (i) Enhancing the aesthetics of patient's smile;

     (ii) Underlying tooth or tissue is not injured, impaired, or decayed;

     (iii) No medically necessary reason for altering the tooth.

     (2) Medically necessary means:

     (i) Condition due to decay or disease;

     (ii) Resulting from an accident or injury;

     (iii) Replacing missing teeth;

     (iv) Altering mechanics of patient's bite.

     (b) Every individual or group health insurance contract or every individual or group

hospital or medical insurance policy, plan, or group policy delivered, issued for delivery, or

renewed in this state on or after July 1, 2024, shall provide coverage for the medically necessary

procedure of dental implants in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting.

     (c) Every individual or group health insurance contract or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover medically necessary dental implants, as defined in

subsection (a) of this section, shall report utilization and cost information related to dental implant

services to the office of the health insurance commissioner on or before July 1, 2024, and each July

1, thereafter. The office of the health insurance commissioner shall acquire the utilization and cost

information required to be reported.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-83. Dental implant coverage.

     (a) As used in this section:

     (1) Cosmetic procedure means:

     (i) Enhancing the aesthetics of patient's smile;

     (ii) Underlying tooth or tissue is not injured, impaired, or decayed;

     (iii) No medically necessary reason for altering the tooth.

     (2) Medically necessary means:

     (i) Condition due to decay or disease;

     (ii) Resulting from an accident or injury;

     (iii) Replacing missing teeth;

     (iv) Altering mechanics of patient's bite.

     (b) Every individual or group health insurance contract or every individual or group

hospital or medical insurance policy, plan, or group policy delivered, issued for delivery, or

renewed in this state on or after July 1, 2024, shall provide coverage for the medically necessary

procedure of dental implants in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting.

     (c) Every individual or group health insurance contract or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover medically necessary dental implants, as defined in

subsection (a) of this section, shall report utilization and cost information related to dental implant

services to the office of the health insurance commissioner on or before July 1, 2024, and each July

1, thereafter. The office of the health insurance commissioner shall acquire the utilization and cost

information required to be reported.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-79. Dental implant coverage.

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     (a) As used in this section:

     (1) Cosmetic procedure means:

     (i) Enhancing the aesthetics of patient's smile;

     (ii) Underlying tooth or tissue is not injured, impaired, or decayed;

     (iii) No medically necessary reason for altering the tooth.

     (2) Medically necessary means:

     (i) Condition due to decay or disease;

     (ii) Resulting from an accident or injury;

     (iii) Replacing missing teeth;

     (iv) Altering mechanics of patient's bite.

     (b) Every individual or group health insurance contract or every individual or group

hospital or medical insurance policy, plan, or group policy delivered, issued for delivery, or

renewed in this state on or after July 1, 2024, shall provide coverage for the medically necessary

procedure of dental implants in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting.

     (c) Every individual or group health insurance contract or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover medically necessary dental implants, as defined in

subsection (a) of this section, shall report utilization and cost information related to dental implant

services to the office of the health insurance commissioner on or before July 1, 2024, and each July

1, thereafter. The office of the health insurance commissioner shall acquire the utilization and cost

information required to be reported.

     SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

Corporations" is hereby amended by adding thereto the following section:

     27-20.1-23. Dental implant coverage.

     (a) As used in this section:

     (1) Cosmetic procedure means:

     (i) Enhancing the aesthetics of patient's smile;

     (ii) Underlying tooth or tissue is not injured, impaired, or decayed;

     (iii) No medically necessary reason for altering the tooth.

     (2) Medically necessary means:

     (i) Condition due to decay or disease;

     (ii) Resulting from an accident or injury;

     (iii) Replacing missing teeth;

LC001427 - Page 3 of 6

     (iv) Altering mechanics of patient's bite.

     (b) Every individual or group health insurance contract or every individual or group

hospital or medical insurance policy, plan, or group policy delivered, issued for delivery, or

renewed in this state on or after July 1, 2024, shall provide coverage for the medically necessary

procedure of dental implants in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting.

     (c) Every individual or group health insurance contract or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover medically necessary dental implants, as defined in

subsection (a) of this section, shall report utilization and cost information related to dental implant

services to the office of the health insurance commissioner on or before July 1, 2024, and each July

1, thereafter. The office of the health insurance commissioner shall acquire the utilization and cost

information required to be reported.

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-96. Dental implant coverage.

     (a) As used in this section:

     (1) Cosmetic procedure means:

     (i) Enhancing the aesthetics of patient's smile;

     (ii) Underlying tooth or tissue is not injured, impaired, or decayed;

     (iii) No medically necessary reason for altering the tooth.

     (2) Medically necessary means:

     (i) Condition due to decay or disease;

     (ii) Resulting from an accident or injury;

     (iii) Replacing missing teeth;

     (iv) Altering mechanics of patient's bite.

     (b) Every individual or group health insurance contract or every individual or group

hospital or medical insurance policy, plan, or group policy delivered, issued for delivery, or

renewed in this state on or after July 1, 2024, shall provide coverage for the medically necessary

procedure of dental implants in accordance with each health insurer's respective principles and

mechanisms of reimbursement, credentialing, and contracting.

     (c) Every individual or group health insurance contract or every individual or group

hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery,

or renewed in this state that is required to cover medically necessary dental implants, as defined in

LC001427 - Page 4 of 6

subsection (a) of this section, shall report utilization and cost information related to dental implant

services to the office of the health insurance commissioner on or before July 1, 2024, and each July

1, thereafter. The office of the health insurance commissioner shall acquire the utilization and cost

information required to be reported.

     SECTION 6. This act shall take effect upon passage.

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LC001427

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require individual or group health insurers to provide coverage for

medically necessary dental implants.

     This act would take effect upon passage.

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LC001427

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LC001427 - Page 6 of 6