Read the full stored bill text
PRINTER'S NO. 1814
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1378
Session of
2026
INTRODUCED BY ARGALL, JUNE 15, 2026
REFERRED TO BANKING AND INSURANCE, JUNE 15, 2026
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for third-party access to dental
insurance contracts; and promulgating regulations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 68
THIRD-PARTY ACCESS TO DENTAL INSURANCE CONTRACTS
Sec.
6801. Definitions.
6802. Leasing.
§ 6801. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Affiliate." A company that controls, is controlled by or is
under common control with another company.
"Children's Health Insurance Program." As defined under
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
section 9103 (relating to definitions).
"Contracting entity." A person or entity that enters into a
direct contract with a provider for the delivery of dental
services in the ordinary course of business, including a third-
party administrator or a dental carrier.
"Dental benefits plan." A benefits plan that pays or
provides dental expense benefits for covered dental services and
is delivered or issued for delivery in this Commonwealth by or
through a dental carrier or on a stand-alone basis.
"Dental carrier." A dental insurance company, dental service
corporation or dental plan organization authorized to provide a
dental benefits plan in this Commonwealth or a health benefits
plan in this Commonwealth that includes coverage for dental
services.
"Dental service." A service for the diagnosis, prevention,
treatment or cure of a dental condition, illness, injury or
disease. The term shall not include a service delivered by a
provider under a health benefits plan that is billed as a
medical service under the health benefits plan.
"Medical assistance." As defined under section 4802
(relating to definitions).
"Provider network contract." A contract between a
contracting entity and a provider specifying the rights and
responsibilities of the contracting entity and providing for the
delivery of and payment for dental services to covered persons.
"Third party." A person or entity that enters into a
contract with a contracting entity or with another third party
to gain access to the dental services or contractual discounts
of a provider network contract. The term shall not include an
employer or other group for which the contracting entity or
20260SB1378PN1814 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
dental carrier provides administrative services, including the
payment of claims.
§ 6802. Leasing.
(a) Access to provider network contract allowed.--A
contracting entity may grant a third party access to the
following, subject to the requirements of subsections (b) and
(c):
(1) A provider network contract.
(2) A provider's dental services or contractual
discounts provided pursuant to a provider network contract.
(b) Access not required.--At the time the contract is
entered into, sold, leased or renewed or when material
modifications are made to a contract relevant to granting access
to a provider network contract to a third party, the dental
carrier shall allow any provider that is part of the carrier's
provider network to choose not to participate in third-party
access to the contract or to enter into a contract directly with
the third party that acquired the provider network. If the
original dental carrier leases the provider network and a
provider chooses not to participate in third-party access to the
provider network, the provider may not be required to cancel or
otherwise end the contractual relationship with the original
dental carrier.
(c) Requirements for access.--A contracting entity may grant
a third party access to a provider network contract or a
provider's dental services or contractual discounts provided
pursuant to a provider network contract if:
(1) The contract specifically states:
(i) That the contracting entity may enter into an
agreement with a third party, allowing the third party to
20260SB1378PN1814 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
obtain the contracting entity's rights and
responsibilities as if the third party were the
contracting entity.
(ii) If the contracting entity is a dental carrier,
that the provider chose to participate in third-party
access at the time the provider network contract was
entered into or renewed.
(2) The third party accessing the contract agrees to
comply with all of the contract's terms, including the third
party's obligation concerning patient steerage.
(3) The contracting entity identifies to the provider,
in writing or electronic form, each third party in existence
as of the date the contract is entered into, sold, leased or
renewed.
(4) The contracting entity identifies all third parties
in existence in a list on the entity's publicly accessible
Internet website, which must be updated at least once every
90 days.
(5) The contracting entity requires each third party to
identify the source of the discount on all remittance advices
or explanations of payment under which a discount is taken.
This paragraph shall not apply to electronic transactions
mandated by The Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191, 110 Stat.
1936).
(6) The contracting entity notifies the third party of
termination of a provider network contract no later than 30
days from the termination date with the contracting entity.
(7) A third party's right to a provider's discounted
rate ceases as of the termination date of the provider
20260SB1378PN1814 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
network contract. The contracting entity shall make available
a copy of the provider network contract relied on in the
adjudication of a claim to a provider within 30 days of a
request from the provider.
(8) The third-party access provision of any provider
contract is clearly identified in the provider contract,
including notice that the contract grants third-party access
to the provider network and that the dentist has the right to
choose not to participate in third-party access.
(d) Discounted reimbursement not required.--A provider shall
not be bound by or required to perform dental services for
discounted reimbursement under a provider network contract that
has been granted to a third party in violation of subsection (c)
(1), (2), (3), (4) or (8).
(e) Waiver not permitted.--The provisions of this section
shall not be waived by contract. A contractual arrangement in
conflict with the provisions of this section or that purports to
waive any requirements of this section shall be null and void
and unenforceable.
(f) Rules and regulations.--The department shall adopt and
promulgate rules and regulations necessary to effectuate the
purposes of this chapter, which shall include penalty provisions
for violations of this chapter.
(g) Applicability.--
(1) The provisions of this section shall not apply to:
(i) Access to a provider network contract that is
granted to a dental carrier or an entity operating in
accordance with the same brand licensee program as the
contracting entity or to an entity that is an affiliate
of the contracting entity. A list of the contracting
20260SB1378PN1814 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
entity's affiliates must be made available to a provider
on the contracting entity's publicly accessible Internet
website.
(ii) A provider network contract for dental services
provided to beneficiaries of State-sponsored health
programs, including Medicare, medical assistance and the
Children's Health Insurance Program.
(2) This chapter shall apply to provider network
contracts delivered, issued, executed or renewed in this
Commonwealth on or after the effective date of this
paragraph.
Section 2. This act shall take effect in 60 days.
20260SB1378PN1814 - 6 -
1
2
3
4
5
6
7
8
9
10
11
12