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A4166
ASSEMBLY, No. 4166
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 19, 2026
Sponsored by:
Assemblywoman� CAROL A. MURPHY
District 7 (Burlington)
SYNOPSIS
���� Requires insurance carriers offering dental benefit
plans to provide certain level of coverage and reimbursement.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning certain dental benefit plans and
supplementing P.L.2014, c.70 (C.26:2S-26 et seq.).
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� a.� A dental plan
offered by a carrier in this State shall provide for a level of coverage that
is designed to provide benefits that are actuarially equivalent to an amount of
the full actuarial value of the benefits provided under the plan that shall be
determined by the Commissioner of Banking and Insurance.
���� b.��� The level of coverage of
a dental plan shall be determined on the basis that the covered services are
provided to a standard population, and without regard to the actual population
to which the plan may provide benefits.
���� c.���� The commissioner shall
develop guidelines to provide for a de minimis variation in the actuarial
calculations used in determining the level of coverage of a dental plan to
account for differences in actuarial estimates.
���� 2.��� a.�� A dental plan
offered by a carrier in this State shall provide for reimbursement to a
provider for a covered service at a level that is at least 75 percent of the
usual and customary charge for the service provided, as determined pursuant to
subsection b. of this section.
���� b.��� The commissioner shall
develop procedures for the determination of the usual and customary charges for
dental services on a regional basis within the State.� Determinations for the
usual and customary charges for dental services shall be made, at a minimum,
for three areas within the State, including the northern, central, and southern
portions of the State.
���� 3.��� This act shall take
effect on the first day of the third month next following the date of
enactment, and shall apply to dental plans delivered, issued, executed, or
renewed after that date.
STATEMENT
���� This bill requires insurance
carriers offering dental benefit plans to provide covered persons with a
certain level of coverage for covered services.� Specifically, the bill
requires dental plans offered by insurance carriers in this State to provide
for a level of coverage that is designed to provide benefits that are
actuarially equivalent to an amount of the full actuarial value of the benefits
provided under the plan that shall be determined by the Commissioner of Banking
and Insurance.
���� The bill provides that the
level of coverage of a dental plan is to be determined on the basis that the
covered services are provided to a standard population, and without regard to
the actual population to which the plan may provide benefits.
���� The bill requires the
Commissioner of Banking and Insurance to develop guidelines to provide for a de
minimis variation in the actuarial calculations used in determining the level
of coverage of a plan to account for differences in actuarial estimates.
���� The bill also requires a
dental plan offered by a carrier in this State to provide for reimbursement to
a provider for a covered service at a level that is at least 75 percent of the
usual and customary charge for the service provided.
���� The bill requires the
Commissioner of Banking and Insurance to develop procedures for the
determination of the usual and customary charge for dental services on a
regional basis within the State.� Determinations for reimbursement of dental
services are required to be made, at a minimum, for three areas within the
State, including the northern, central, and southern portions of the State.�