00 Enrolled SB 258                                                                                                         
01 Prohibiting health care insurers that provide dental care coverage from setting fees that a                             
02 dentist may charge under a preferred provider contract for dental services not covered under                            
03 the insurer's policy, and relating to preferred provider contracts between insurers and dentists.                       
04                           _______________                                                                               
05    * Section 1. AS 21.42.392(c) is amended to read:                                                                 
06            (c)  A health care insurer that provides coverage for dental care                                        
07                 (1)  may reimburse a covered person at a different rate because of the                            
08       person's choice of a dentist if the dentist is not a part of the covered person's dental                          
09       network or preferred provider organization agreement; the [. THE] covered expense                             
10       for non-network providers may not be less than that allowed to a network provider,                                
11       although the covered expense may be reimbursed at a lower percentage or with higher                               
12       deductibles than if the service had been provided within the network;                                         
13                 (2)  may not limit a fee set by a dentist for a service unless the                                  
01       service is covered under the insurer's plan or contract; and                                                  
02                 (3)  may offer a dentist the option of entering into a preferred                                    
03       provider contract with the insurer that provides a fee schedule for covered                                   
04       services only or a fee schedule for both covered and uncovered services; under                                
05       this paragraph,                                                                                               
06                      (A)  the health care insurer may not                                                           
07                           (i)  take an action against the dentist based on the                                      
08                 dentist's refusal to enter into a contract with an insurer;                                         
09                           (ii)  fail to list a dentist who does not enter into a                                    
10                 contract with an insurer in the insurer's marketing materials; or                                   
11                           (iii)  take action against the dentist during the                                         
12                 management or administration of a contract based on the dentist's                                   
13                 choice of contract;                                                                                 
14                      (B)  the terms or provisions of the contract                                                   
15                           (i)  may not violate AS 45.50.562 - 45.50.566; and                                        
16                           (ii)  may authorize the insurer to provide information                                    
17                 to the insured describing the dentist's choice of contract and fee                                  
18                 schedules;                                                                                          
19                      (C)  "covered service" means a health care service for which                                   
20            a health care insurer pays a benefit for all or part of the service, including                           
21            a benefit that is available but limited by deductible, coinsurance, or                                   
22            frequency terms under the contract between the insurer and the insured.