CSSB 258(L&C): "An Act prohibiting health care insurers that provide dental care coverage from setting fees that a dentist may charge under a preferred provider contract for dental services not covered under the insurer's policy, and relating to preferred provider contracts between insurers and dentists."
00 CS FOR SENATE BILL NO. 258(L&C) 01 "An Act prohibiting health care insurers that provide dental care coverage from setting 02 fees that a dentist may charge under a preferred provider contract for dental services 03 not covered under the insurer's policy, and relating to preferred provider contracts 04 between insurers and dentists." 05 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 06 * Section 1. AS 21.42.392(c) is amended to read: 07 (c) A health care insurer that provides coverage for dental care may 08 (1) reimburse a covered person at a different rate because of the 09 person's choice of a dentist if the dentist is not a part of the covered person's dental 10 network or preferred provider organization agreement; the [. THE] covered expense 11 for non-network providers may not be less than that allowed to a network provider, 12 although the covered expense may be reimbursed at a lower percentage or with higher 13 deductibles than if the service had been provided within the network; 14 (2) not limit a fee set by a dentist for a service unless the service is
01 covered under the insurer's plan or contract; and 02 (3) offer a dentist the option of entering into a preferred provider 03 contract with the insurer that provides a fee schedule for covered services only or 04 a fee schedule for both covered and uncovered services; under this paragraph, 05 (A) the health care insurer may not 06 (i) take an action against the dentist based on the 07 dentist's refusal to enter into a contract with an insurer; 08 (ii) fail to list a dentist who does not enter into a 09 contract with an insurer in the insurer's marketing materials; or 10 (iii) take action against the dentist during the 11 management or administration of a contract based on the dentist's 12 choice of contract; 13 (B) the terms or provisions of the contract 14 (i) may not violate AS 45.50.562 - 45.50.566; and 15 (ii) may authorize the insurer to provide information 16 to the insured describing the dentist's choice of contract and fee 17 schedules; 18 (C) "covered service" means a health care service for which 19 a health care insurer pays a benefit for all or part of the service, including 20 a benefit that is available but limited by deductible, coinsurance, or 21 frequency terms under the contract between the insurer and the insured.