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.