Enrolled SB 258: 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.
00Enrolled 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.