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Bill S.808
Chapter 176X of the General Laws, as appearing in the 2020 Official Edition, are hereby amended by adding the following chapter:-
Chapter 176Y
SECTION 1.
DISCLOSURE OF BENEFIT TERMS.
(a)
An employee benefit plan or health insurance policy shall: (1)
if applicable, disclose that the benefit for dental care services offered is limited to the least costly treatment; and
(2)
specify in dollars and cents the amount of the
payment or reimbursement to be provided for dental care services or
define AND explain the standard on which payment of benefits or
reimbursement for the cost of dental care services is based, such
as:
(A)
"usual and customary" fees;
(B)
"reasonable and customary fees;
(C)
"usual, customary, and reasonable" fees; or (D)
preset fee schedule or (E) words of similar meaning.
(b)
A person or entity who provides or issues an employee benefit plan or health insurance policy or the employer or employee organization, if applicable, shall establish an Internet website to provide resources and accurate information to dentists, insureds, participants, employees, and members, including the standard on which reimbursement is based.
(c)
An employee benefit plan or health insurance policy shall make accessible on the Internet website established under subsection (b) information about the plan or policy sufficient for patients and dentists to determine the type of dental care services covered by the plan or policy and the amount of the payment or
reimbursement available for those services under the plan or
policy. Access to the Internet website must be at no charge to patients under the plan or policy and dentists providing dental care services to the patients whether in network or out of network.
SECTION 2.
(a)
The employee benefit plan or health insurance policy
shall:
(1)
provide:
(A) that payment or reimbursement for a
noncontracting provider dentist shall be the same or greater as payment or
reimbursement for a contracting provider dentist;
(B)
that the party to or beneficiary of the
plan or policy may assign the right to payment or reimbursement to
the dentist who provides the dental care services; and (C)
one or more methods of payment or
reimbursement that provide the dentist 100 percent of the contracted amount of the payment or reimbursement and that do not
require the dentist to incur a fee to access the payment or
reimbursement; and (2)
disclose on the Internet website required under and on request of a dentist or a party to or
beneficiary of the plan or policy the fees, if any, associated with
the methods of payment or reimbursement available under the plan or
policy.
SECTION 3.
(a)
An employee benefit plan or health insurance policy may
not:
(1)
interfere with or prevent an individual who is a
party to or beneficiary of the plan or policy from selecting a
dentist of the individual's choice to provide a dental care service
the plan or policy offers if the dentist selected is licensed in
this state to provide the service;
(2)
deny a dentist the right to participate as a
contracting provider under the plan or policy if the dentist is
licensed to provide the dental care services the plan or policy
offers;
(3)
authorize a person to regulate, interfere with, or
intervene in the provision of dental care services a dentist
provides a patient, including diagnosis, if the dentist practices
within the scope of the dentist's license;
(4)
require a dentist to make or obtain a dental x-ray
or other diagnostic aid in providing dental care services; or (5)
deduct the amount of an overpayment of a claim from
a payment or reimbursement of another claim unless both claims were
for dental services provided to the same patient by the same
dentist.
(b)
This section does not prohibit the predetermination of benefits for dental care expenses before the attending dentist provides treatment.
An employee benefit plan or health insurance policy that provides a written predetermination of benefits to a dentist with respect to a dental care service for a patient that
includes a specific benefit payment or reimbursement amount may not
pay or reimburse the dentist for providing that service to the
patient in an amount that is less than the amount set forth in the predetermination.
The information contained in this website is for general information purposes only. The General Court provides this information as a public service and while we endeavor to keep the data accurate and current to the best of our ability, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
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