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7 LONG TITLE
8 General Description:
9 This bill regulates certain contract provisions for dental services.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms;
13 ▸ prohibits a dental insurer from setting fees for dental services that are not covered
14 services under the dental insurance; and
15 ▸ applies to dental plans entered into or renewed on or after January 1, 2018.
16 Money Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 ENACTS:
22 31A-22-645, Utah Code Annotated 1953
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24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-645 is enacted to read:
26 31A-22-645. Dental insurance -- Contract provision for noncovered services.
27 (1) For purposes of this section:
28 (a) "Covered services" means dental services for which reimbursement:
29 (i) (A) is available under an enrollee's dental plan; or
30 (B) would be available but for the application of contractual limitations such as
31 deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
32 frequency limitations, alternative benefit payments, or any other limitation; and
33 (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
34 (b) "Dental plan"means:
35 (i) a health benefit plan that includes coverage for dental services; and
36 (ii) a policy or certificate that provides coverage solely for dental services.
37 (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and
38 Dental Hygienist Practice Act.
39 (2) (a) This section applies to:
40 (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
41 (ii) an administrator providing third-party administration services or a provider
42 network for a dental plan.
43 (b) This section does not apply to a self-insured dental plan that is regulated by federal
44 law.
45 (3) A contract between a dental plan and a dentist to provide contracted services may
46 not:
47 (a) require, directly or indirectly, that a dentist provide dental services to a covered
48 individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
49 (i) the dental services are covered services under the dental plan; or
50 (ii) (A) the dental services are not reimbursed by the dental plan;
51 (B) the dental services are discounted for individuals who are part of a discount dental
52 rates plan; and
53 (C) the dentist who provided the dental services has elected to participate in the
54 discount dental rates plan; and
55 (b) prohibit a dentist from offering or providing noncovered dental services to a
56 covered individual at a fee determined by the dentist and the individual who will receive the
57 noncovered services.