00CS FOR HOUSE BILL NO. 121(L&C) am                                                                                     
01 "An Act relating to patients' rights under a health care insurance plan or                                              
02 contract providing coverage for dental care, and prohibiting certain practices by                                       
03 health care insurers relating to dental care."                                                                          
04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                               
05    * Section 1.   AS 21.42 is amended by adding a new section to read:                                                
06  Sec 21.42.390.  Requirements relating to dental care coverage provisions.                                            
07 (a)  A health care insurer who provides coverage for dental care may not include in                                    
08 the health care insurance plan or contract a provision that                                                             
09   (1)  prohibits a covered person from obtaining dental care services from                                             
10 a dentist of the person's choice, including a specialist;                                                               
11   (2)  restricts a covered person's right to receive full information from                                             
12 the person's dentist regarding the care or treatment options that the dentist believes are                              
13 in the best interests of the person.                                                                                    
14  (b)  A health care insurance plan or contract that provides coverage for dental                                       

01 services that allows the health care insurer to review a treatment plan or conduct a                                    
02 utilization review must contain a provision that a treatment plan review or utilization                                 
03 review relating to dental care for a covered person receiving treatment in this state                                   
04 must be conducted by a dentist if the claim for reimbursement or payment is denied.                                     
05  (c)  A health care insurer may reimburse a covered person at a different rate                                         
06 because of the person's choice of a dentist if the dentist is not a part of the covered                                 
07 person's dental network or preferred provider organization agreement.  The covered                                      
08 expense for non-network providers may not be less than that allowed to a network                                        
09 provider, although the covered expense may be reimbursed at a lower percentage or                                       
10 with higher deductibles than if the service had been provided within the network.                                       
11  (d)  A health care insurer may not deny                                                                               
12   (1)  dental coverage, cancel a health care insurance plan or contract, or                                            
13 otherwise take action against a covered person or a dentist because the person has                                      
14 asserted a right described in this section;                                                                             
15   (2)  dental coverage or eligibility for dental coverage because the                                                  
16 covered person chooses a dentist outside of a preferred provider organization                                           
17 agreement.                                                                                                              
18  (e)  A covered person may bring a civil action against a health care insurer to                                       
19 enforce the person's rights under this section if the covered person has completed                                      
20 arbitration of the dispute.                                                                                             
21  (f)  A dentist who treats a covered person may not waive uncovered dental                                             
22 expenses for which the covered person has liability because a covered person chose                                      
23 the dentist outside of a dental network or a preferred provider organization agreement.                                 
24  (g)  In this section,                                                                                                 
25   (1)  "covered expense" means charges that are payable under plan                                                     
26 provisions;                                                                                                             
27   (2)  "dentist" means a person licensed in this state to practice dentistry;                                          
28   (3)  "preferred provider" means a dental provider who has signed an                                                  
29 agreement with a dental care plan to provide services to plan participants at a specific                                
30 rate.