HB 1351

Bill Subjects

Agencies; Department Of Insurance (Idoi) Civil Law And Procedure; Contracts And Legal Documents Civil Law And Procedure; Liabilities, Damages, And Penalties Health Care Professionals; Dentistry Health; Dental And Vision Insurance; Health Insurance

Abstract

Provides that if an insured assigns the insured's rights to benefits for dental services to the provider of the dental services, the insurer shall pay the benefits assigned by the insured to the provider of the dental services. Prohibits a third party administrator or another person from arranging for a dental provider to provide dental services for a dental plan that sets the amount of the fee for any dental services unless the dental services are covered services under the dental plan. Provides that a contracting entity (a dental carrier, a third party administrator, or another person that enters into a provider network contract with providers of dental services) may not grant a third party access to the provider network contract or to dental services or contractual discounts provided pursuant to the provider network contract unless certain conditions are satisfied. Provides that when a dental provider network contract is entered into, renewed, or materially modified, any provider that is a party to the network contract must be allowed to choose not to participate in the third party access. Prohibits a contracting entity from: (1) altering the rights or status under a provider network contract of a dental provider that chooses not to participate in third party access; or (2) rejecting a provider as a party to a provider network contract because the provider chose not to participate in third party access. Authorizes the insurance commissioner to issue a cease and desist order against a person that violates any of these prohibitions and, if the person violates the cease and desist order, to impose a civil penalty upon the person and suspend or revoke the person's certificate of authority.