Chapter 386
2004 -- S 2635
SUBSTITUTE A
Enacted 07/05/04
A N A C T
RELATING
TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced
By: Senators Tassoni, F Caprio, Polisena, Perry, and Roberts
Date
Introduced: February 11, 2004
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:
27-18-63.
Dental insurance assignment of benefits. - - Every entity providing
a policy
of
accident and sickness insurance as defined in chapter 27-18 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 direct, in writing, that benefits from a 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. 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. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service
Corporations"
is hereby amended by adding thereto the following section:
27-19-54.
Dental insurance assignment of benefits. - - Every entity providing
a contract
of
insurance subject to chapter 27-19 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
direct, in writing, that benefits from a 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
3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service
Corporations"
is hereby amended by adding thereto the following section:
27-20-49.
Dental insurance assignment of benefits. -- Every entity providing a
contract
of
insurance as defined in chapter 27-20 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 direct, in writing, that benefits from a 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. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service
Corporations
" is hereby amended by adding thereto the following section:
27-20.1-18.
Dental insurance assignment of benefits. -- Every entity providing
nonprofit
dental service plan as defined in chapter 27-20.1 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 direct, in writing, that benefits from a 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
5. Chapter 27-41 of the General Laws entitled "Health Maintenance
Organizations"
is hereby amended by adding thereto the following section:
27-41-66.
Dental insurance assignment of benefits. - - Every entity licensed
under
chapter
27-41 shall allow, as a provision of any evidence of coverage of dental
services, any
person
covered by such entity to direct, in writing, that benefits from a 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
6. Section 5-31.1-32 of the General Laws in Chapter 5-31.1 entitled
"Dentists
and
Dental Hygienists" is hereby amended to read as follows:
5-31.1-32.
Disclosure of nonparticipation in dental insurance plans. -- (a) Any
dentist
who is
not a participant in any a dental insurance plan and who, when
treating patients of that
plan,
elects to use the direction to pay procedure set forth in title 27 must post a notice, in
a
conspicuous
place in his or her offices where it can be read by his or her patients, which
reads, in
substance,
as follows:
"To my patients:"
"I do not participate in any the dental insurance plan. You
should know that you will be
responsible
for the payment of my dental fees."
(b) Any dentist who fails to post this notice is not entitled to charge his or
her patients
any
amount for dental fees in excess of that allowed had the dentist participated
in the patients'
dental
insurance plan.
SECTION
7. Expiration provision. – The requirement to allow direction to pay
in
sections
27-18-63, 27-19-54, 27-20-49,27-20.1-18, and 27-41-66 shall expire and be of no
further
force
or effect if before May 1, 2009, the director receives notification that shall:
(a)
be from either of the commercial dental insurers in Rhode Island that are the
two
largest
in terms of annual dental expenses paid; and
(b)
certify that, exclusive of those dentists retiring from practice, more than ten
percent
(10%)
of general practice dentists, twenty-five percent (25%) of oral surgeons,
twenty-five
percent
(25%) of endodontists, or twenty-five percent (25%) of periodontists, who were
participating
providers with such insurers as of May 1, 2004, have become nonparticipating.
Oral
surgeons,
endodontists, and periodontists shall be classified in accordance with the
council on
dental
education and licensure of the American Dental Association definitions.
SECTION
8. This act shall take effect on September 1, 2004.
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LC02279/SUB
A
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