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*sb0813*
SENATE BILL 813
J5 (6lr2133)
ENROLLED BILL
— Finance/Health —
Introduced by Senator Hayes
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at _________________ _______ o’clock, ________M.
______________________________________________
President.
CHAPTER ______
AN ACT concerning 1
Health Insurance and Dental Plan Organizations – Dentists – Assignment of 2
Benefits and Reimbursement of Nonpreferred Providers 3
FOR the purpose of prohibiting certain insurers and dental plan organizations from 4
prohibiting an assignment of benefits to a provider who is a dentist by an insured or 5
refusing to directly reimburse a nonpreferred provider who is a dentist; requiring a 6
nonpreferred provider who is a dentist and who seeks an assignment of benefits from 7
an insured or enrollee to provide certain information to the insured or enrollee before 8
performing a health care service and submit a disclosure form to document the 9
assignment of benefits; authorizing certain insurers and dental plan organizations 10
to refuse to directly reimburse a nonparticipating provider who is a dentist under 11
certain circumstances; and generally relating to insurance coverage for dental 12
services. 13
BY repealing and reenacting, without amendments, 14
2 SENATE BILL 813
Article – Insurance 1
Section 14–201(a) 2
Annotated Code of Maryland 3
(2017 Replacement Volume and 2025 Supplement) 4
BY repealing and reenacting, with amendments, 5
Article – Insurance 6
Section 14–201(p) and (r) and 14–205.3 7
Annotated Code of Maryland 8
(2017 Replacement Volume and 2025 Supplement) 9
BY adding to 10
Article – Insurance 11
Section 14–410.1 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2025 Supplement) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Insurance 17
14–201. 18
(a) In this subtitle the following words have the meanings indicated. 19
(p) “Provider” means a physician, DENTIST, hospital, or other person that is 20
licensed or otherwise authorized to provide health care services. 21
(r) “Similarly licensed provider” means: 22
(1) for a physician: 23
(i) a physician who is board certified or eligible in the same practice 24
specialty; or 25
(ii) a group physician practice that contains board certified or 26
eligible physicians in the same practice specialty; [or] 27
(2) FOR A DENTIST: 28
(I) A DENTIST LICENSED T O PRACTICE DENTISTRY IN THE 29
STATE UNDER TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE WHO PERFORMS 30
THE SAME OR SIMILAR DENTAL SERVICES; OR 31
SENATE BILL 813 3
(II) A GROUP DENTAL PRACT ICE THAT CONSISTS OF DENTISTS 1
LICENSED IN THE STATE UNDER TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE 2
WHO PERFORM THE SAME OR SIMILAR DENTAL SERVICES; OR 3
[(2)] (3) for a health care provider OR DENTIST who is not a physician 4
OR DENTIST, a health care provider OR DENTIST who holds the same type of license or 5
certification. 6
14–205.3. 7
(a) This section does not apply to on–call physicians or hospital–based physicians. 8
(b) An insurer may not: 9
(1) prohibit the assignment of benefits to a provider who is a physician OR 10
DENTIST by an insured; or 11
(2) refuse to directly reimburse a nonpreferred provider who is a physician 12
OR DENTIST under an assignment of benefits. 13
(c) If an insured has not provided a n assignment of benefits, the insurer shall 14
include the following information with the payment to the insured for health care services 15
rendered by the nonpreferred provider who is a physician OR DENTIST: 16
(1) the specific claim covered by the payment; 17
(2) the amount paid for the claim; 18
(3) the amount that is the insured’s responsibility; and 19
(4) a statement instructing the insured to use the payment to pay the 20
nonpreferred provider in the event the insured has not paid the nonpreferred provider i n 21
full for the health care services rendered by the nonpreferred provider. 22
(d) If a physician OR DENTIST who is a nonpreferred provider seeks an 23
assignment of benefits from an insured, the physician OR DENTIST shall provide the 24
following information to the insured, prior to performing a health care service: 25
(1) a statement informing the insured that the physician OR DENTIST is a 26
nonpreferred provider; 27
(2) a statement informing the insured that the physician OR DENTIST may 28
charge the insured for noncovered services; 29
(3) a statement informing the insured that the physician OR DENTIST may 30
charge the insured the balance bill for covered services; 31
4 SENATE BILL 813
(4) an estimate of the cost of services that the physician OR DENTIST will 1
provide to the insured; 2
(5) any terms of payment that may apply; and 3
(6) whether interest will apply and, if so, the amount of interest charged 4
by the physician OR DENTIST. 5
(e) A ph ysician OR DENTIST who is a nonpreferred provider shall submit the 6
disclosure form developed by the Commissioner under subsection (f) of this section to 7
document to the insurer the assignment of benefits by an insured. 8
(f) The Commissioner shall develop disclosure forms to implement the 9
requirements under subsections (c) and (d) of this section. 10
(g) Notwithstanding the provisions of subsection (b) of this section, an insurer 11
may refuse to directly reimburse a nonpreferred provider under an assignment of benefits 12
if: 13
(1) the insurer receives notice of the assignment of benefits after the time 14
the insurer has paid the benefits to the insured; 15
(2) the insurer, due to an inadvertent administrative error, has previously 16
paid the insured; 17
(3) the insu red withdraws the assignment of benefits before the insurer 18
has paid the benefits to the nonpreferred provider; or 19
(4) the insured paid the nonpreferred provider the full amount due at the 20
time of service. 21
14–410.1. 22
(A) IN THIS SECTION, “DENTIST” MEANS AN INDIVIDUAL LICENSED UNDER 23
TITLE 4 OF THE HEALTH OCCUPATIONS ARTICLE. 24
(B) EXCEPT AS PROVIDED IN SUBSECTION (G) OF THIS SECTION, A DENTAL 25
PLAN ORGANIZATION MAY NOT: 26
(1) PROHIBIT THE ASSIGNM ENT OF BENEFITS TO A DENTIST BY AN 27
ENROLLEE; OR 28
(2) REFUSE TO DIRECTLY R EIMBURSE A NONPREFER RED DENTIST 29
UNDER AN ASSIGNMENT OF BENEFITS. 30
SENATE BILL 813 5
(C) IF AN ENROLLEE HAS NO T PROVIDED AN ASSIGN MENT OF BENEFITS , 1
THE DENTAL PLAN ORGANIZATION SHALL INCLUDE THE FOLLOWING INFORMATION 2
WITH THE PAYMENT TO THE ENROLLEE FOR DENTAL SERVICES RENDERED BY THE 3
NONPREFERRED DENTIST: 4
(1) THE SPECIFIC CLAIM COVERED BY THE PAYMENT; 5
(2) THE AMOUNT PAID FOR THE CLAIM; 6
(3) THE AMOUNT THAT IS T HE ENROLLEE’S RESPONSIBILITY OF THE 7
DENTAL PLAN ORGANIZATION; AND 8
(4) A STATEMENT INSTRUCT ING THE ENROLLEE TO USE THE 9
PAYMENT TO PAY THE NONPREFERRED DENTIST IN THE EVENT THAT THE ENROLLEE 10
HAS NOT PAID THE NON PREFERRED DENTIST IN FULL FOR DENTAL SERV ICES 11
RENDERED BY THE NONPREFERRED DENTIST. 12
(D) IF A NONPREFERRED DEN TIST S EEKS AN ASSIGNMENT O F BENEFITS 13
FROM AN ENROLLEE, THE DENTIST SHALL PROVIDE THE FOLLOWING INFORMATION 14
TO THE ENROLLEE BEFORE PERFORMING A DENTAL SERVICE: 15
(1) A STATEMENT INFORMING THE ENROLLEE THAT THE DENTIST IS 16
A NONPREFERRED DENTIST; 17
(2) A STATEMEN T INFORMING THE ENRO LLEE THAT THE DENTIS T 18
MAY CHARGE THE ENROLLEE FOR NONCOVERED SERVICES; 19
(3) A STATEMENT INFORMIN G THE ENROLLEE THAT THE DENTIST 20
MAY CHARGE THE ENROLLEE THE BALANCE BILL FOR COVERED SERVICES; 21
(4) AN ESTIMATE OF THE COST OF SERVICES THAT THE DENTIST WILL 22
PROVIDE TO THE ENROLLEE; 23
(5) ANY TERMS OF PAYMENT THAT MAY APPLY; AND 24
(6) WHETHER INTEREST WIL L APPLY AND , IF SO , THE AMOUNT OF 25
INTEREST CHARGED BY THE DENTIST. 26
(E) A NONPREFERRED DENTIST SHALL SUBMIT THE DIS CLOSURE FORM 27
DEVELOPED BY THE COMMISSIONER UNDER SUBSECTION (F) OF THIS SECTION TO 28
DOCUMENT TO THE DENT AL PLAN ORGANIZATION THE ASSIGNMENT OF BE NEFITS 29
BY THE ENROLLEE. 30
6 SENATE BILL 813
(F) THE COMMISSIONER SHALL DE VELOP THE FORMS NECE SSARY TO 1
IMPLEMENT THIS SUBSECTION SECTION. 2
(G) A DENTAL PLAN ORGANIZATION MAY REFUSE TO DIRECTLY REIMBURSE 3
A NONPREFERRED DENTIST UNDER AN ASSIGNMENT OF BENEFITS IF: 4
(1) THE DENTAL PLAN ORGA NIZATION RECEIVES NO TICE OF THE 5
ASSIGNMENT OF BENEFITS AFTER THE TIME THE DENTAL PLAN ORGANIZATION HAS 6
PAID THE BENEFITS TO THE ENROLLEE; 7
(2) THE ENROLLEE WITHDRA WS THE ASSIGNMENT OF BENEFITS 8
BEFORE THE DENTAL PL AN ORGANIZATION HAS PAID THE BENEFITS TO THE 9
NONPREFERRED DENTIST; OR 10
(3) THE ENROLLEE PAID TH E NONPREFERRED DENTI ST THE FULL 11
AMOUNT DUE AT THE TIME OF SERVICE. 12
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 13
January 1, 2027. 14
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.