An Act relative to financial services contracts for dental benefits corporations
Generates a plain-language summary of the bill text and history.
| Committee | Recommendation | Vote |
|---|---|---|
| J11 | Accompanied | — |
| Bill | Title | Status |
|---|---|---|
| H5044 | An Act relative to financial services contracts for dental benefits corporations | Active |
Section 1 of Chapter 175 of the General Laws as most recently appearing, is hereby amended by inserting at the end of said section the following sentence "Covered services" means dental care services for which a reimbursement is available under an enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation
Section 1 of Chapter 175 of the General Laws as most recently appearing, is hereby amended by inserting at the end of said section the following sentence "Dental plan" shall include any policy of insurance which is issued by a health care service contractor which provides for coverage of dental services not in connection with a medical plan.
Section 108B of Chapter 175 of the General Laws, as most recently appearing, is hereby amended by inserting at the end of said section the following sentence:-“No contract of any health care service contractor that covers any dental services, and no contract or participating provider agreement with a dentist may require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the health care service contractor unless the dental services are covered services. A health care service contractor or other person providing third party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services. “
Section 7 of chapter 176B of the General Laws, as most recently appearing, is hereby amended by inserting after the second paragraph the following paragraph: - “No such agreement may require that a dentist provide dental services to subscribers or their covered dependents at a particular fee unless the dental services are covered services.”
Section 7 of chapter 176E of the General Laws, as most recently appearing, is hereby amended by inserting after the second paragraph the following paragraph: - “No written agreement between a dental service corporation and a participating dentist may require that the dentist provide dental services to subscribers or their covered dependents at a particular fee unless the dental services are covered services.”
Section 21 of chapter 176G of the General Laws, as most recently appearing, is hereby amended by inserting after subsection (d) the following sub-section:- “(e) No contract between a health maintenance organization and a participating provider who is a registered dentist may require that such dentist provide dental services to a member at a particular fee unless the dental services are covered services.”
Section 2 of chapter 176I of the General Laws, as most recently appearing, is hereby amended by inserting after the first paragraph the following paragraph: - “No preferred provider arrangement with a health care provider who is a registered dentist may require that such dentist provide dental service to a covered person at a particular fee unless the dental services are covered services.”
SECTION 1.Section 1 of Chapter 175 of the General Laws as most recently appearing, is hereby amended by inserting at the end of said section the following sentence "Covered services" means dental care services for which a reimbursement is available under an enrollee’s plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation SECTION 2. Section 1 of Chapter 175 of the General Laws as most recently appearing, is hereby amended by inserting at the end of said section the following sentence "Dental plan" shall include any policy of insurance which is issued by a health care service contractor which provides for coverage of dental services not in connection with a medical plan. SECTION 3. Section 108B of Chapter 175 of the General Laws, as most recently appearing, is hereby amended by inserting at the end of said section the following sentence:-“No contract of any health care service contractor that covers any dental services, and no contract or participating provider agreement with a dentist may require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the health care service contractor unless the dental services are covered services. A health care service contractor or other person providing third party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services. “ SECTION 4. Section 7 of chapter 176B of the General Laws, as most recently appearing, is hereby amended by inserting after the second paragraph the following paragraph: - “No such agreement may require that a dentist provide dental services to subscribers or their covered dependents at a particular fee unless the dental services are covered services.” SECTION 5. Section 7 of chapter 176E of the General Laws, as most recently appearing, is hereby amended by inserting after the second paragraph the following paragraph: - “No written agreement between a dental service corporation and a participating dentist may require that the dentist provide dental services to subscribers or their covered dependents at a particular fee unless the dental services are covered services.” SECTION 6. Section 21 of chapter 176G of the General Laws, as most recently appearing, is hereby amended by inserting after subsection (d) the following sub-section:- “(e) No contract between a health maintenance organization and a participating provider who is a registered dentist may require that such dentist provide dental services to a member at a particular fee unless the dental services are covered services.” SECTION 6. Section 2 of chapter 176I of the General Laws, as most recently appearing, is hereby amended by inserting after the first paragraph the following paragraph: - “No preferred provider arrangement with a health care provider who is a registered dentist may require that such dentist provide dental service to a covered person at a particular fee unless the dental services are covered services.”