CSHB 309(HSS): "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 HOUSE BILL NO. 309(HSS) 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 08 (1) may 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) may not limit a fee set by a dentist for a service unless the 15 service is covered under the insurer's plan or contract, except as provided under
01 (3) of this subsection; 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) must require both the insurer and the dentist to 17 provide information to the insured describing the dentist's choice 18 of contract and fee 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.