AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-DENTAL INSURANCE COVERAGE (Clarifies the manner in which certain dental insurance benefits are paid directly to the provider.)

H7722

2026 -- H 7722
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LC005036
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STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-
DENTAL INSURANCE COVERAGE

Introduced By:
Representative Joseph M. McNamara

Date Introduced:
February 12, 2026

Referred To:
House Corporations
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 27-18-63 of the General Laws in Chapter 27-18 entitled "Accident
2
and Sickness Insurance Policies" is hereby amended to read as follows:
3

27-18-63. Dental insurance assignment of benefits.
4

(a)

Every entity providing a policy of accident and sickness insurance as defined in this
5
chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan
6
for coverage of dental services, any person insured by such entity to direct, in writing, that benefits
7
from a health benefit plan, policy, or contract, be paid directly to a dental care provider who has
8
not contracted with the entity to provide dental services to persons covered by the entity but
9
otherwise meets the credentialing criteria of the entity and has not previously been terminated by
10
such entity as a participating provider. If written direction to pay is executed and written notice of
11
the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to
12
the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental
13
care provider under this section may include a reduction in benefits paid of no more than five
14
percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist,
15
pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the
16
records of the dentist receiving such payment that relate exclusively to that particular
17
subscriber/patient to determine that the service in question was rendered.

Any entity as defined and
18
licensed in this chapter shall allow, as a provision in any group or individual policy, contract, or

1
health benefit plan for coverage of dental services, any person insured by the entity to direct, in
2
writing, that their benefits, and the corresponding reimbursement to the dental care provider for
3
covered services, from a health benefit plan, policy, or contract be paid directly to any dental care
4
provider who has or has not contracted with the entity.
5

(b) Upon receipt of a duly executed written direction to pay and written notice thereof, the
6
entity shall pay the benefits and compensation directly to the dental care provider. The amount of
7
benefits paid under this section shall be no less than the highest reimbursement amount actually
8
paid to any participating provider for the same covered dental service, as listed in the entity's benefit
9
allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.
10

(c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the
11
highest reimbursement amount listed for that procedure code among all participating provider
12
categories.
13

(d) The entity shall not use tiered reimbursement structures, geographic modifiers, or
14
network classifications to reduce the benchmark amount for purposes of calculating payment under
15
this section. The entity shall not create or designate new provider categories or reimbursement tiers
16
for the purpose of reducing the benchmark amount under this section.
17

(e) The entity shall not reduce, modify, or condition the benefit amount based on the
18
provider's non-participation. The entity may review the provider's records related exclusively to the
19
subscriber/patient to verify that the service was rendered and to verify such treatment meets the
20
entity's criteria for benefit payment.
21

(f)
Provided, however, this section shall not apply to insurance coverage providing benefits
22
for:
23
(1) Hospital confinement indemnity;
24
(2) Disability income;
25
(3) Accident only;
26
(4) Long-term care;
27
(5) Medicare supplement;
28
(6) Limited benefit health;
29
(7) Specified disease indemnity;
30
(8) Sickness or bodily injury or death by accident or both; and
31
(9) Other limited benefit policies.
32
SECTION 2. Section 27-19-54 of the General Laws in Chapter 27-19 entitled "Nonprofit
33
Hospital Service Corporations" is hereby amended to read as follows:
34

27-19-54. Dental insurance assignment of benefits.

LC005036 - Page 2 of 6
1

(a)

Every entity providing a contract of insurance subject to this chapter shall allow, as a
2
provision in a group or individual policy, contract, or health benefit plan for coverage of dental
3
services, any person insured by the entity to direct, in writing, that benefits from a health benefit
4
plan, policy, or contract be paid directly to a dental care provider who has not contracted with the
5
entity to provide dental services to persons covered by the entity but otherwise meets the
6
credentialing criteria of the entity and has not previously been terminated by the entity as a
7
participating provider. If written direction to pay is executed and written notice of the direction to
8
pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care
9
provider. Any efforts to modify the amount of benefits paid directly to the dental care provider
10
under this section may include a reduction in benefits paid of no more than five percent (5%) less
11
than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction
12
to pay duly executed by the subscriber, shall have the right to review the records of the dentist
13
receiving the payment that relate exclusively to that particular subscriber/patient to determine that
14
the service in question was rendered.

Any entity as defined and licensed in this chapter shall allow,
15
as a provision in any group or individual policy, contract, or health benefit plan for coverage of
16
dental services, any person insured by the entity to direct, in writing, that their benefits, and the
17
corresponding reimbursement to the dental care provider for covered services, from a health benefit
18
plan, policy, or contract be paid directly to any dental care provider who has or has not contracted
19
with the entity.
20

(b) Upon receipt of a duly executed written direction to pay and written notice thereof, the
21
entity shall pay the benefits and compensation directly to the dental care provider. The amount of
22
benefits paid under this section shall be no less than the highest reimbursement amount actually
23
paid to any participating provider for the same covered dental service, as listed in the entity's benefit
24
allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.
25

(c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the
26
highest reimbursement amount listed for that procedure code among all participating provider
27
categories.
28

(d) The entity shall not use tiered reimbursement structures, geographic modifiers, or
29
network classifications to reduce the benchmark amount for purposes of calculating payment under
30
this section. The entity shall not create or designate new provider categories or reimbursement tiers
31
for the purpose of reducing the benchmark amount under this section.
32

(e) The entity shall not reduce, modify, or condition the benefit amount based on the
33
provider's non-participation. The entity may review the provider's records related exclusively to the
34
subscriber/patient to verify that the service was rendered and to verify such treatment meets the

LC005036 - Page 3 of 6
1
entity's criteria for benefit payment.
2
SECTION 3. Section 27-41-66 of the General Laws in Chapter 27-41 entitled "Health
3
Maintenance Organizations" is hereby amended to read as follows:
4

27-41-66. Dental insurance assignment of benefits.
5

(a)

Every entity licensed under this chapter shall allow, as a provision of any evidence of
6
coverage of dental services, any person covered by the entity to direct, in writing, that benefits from
7
a health benefit plan, policy, or contract, be paid directly to a dental care provider who has not
8
contracted with the entity to provide dental services to persons covered by the entity but otherwise
9
meets the credentialing criteria of the entity and has not previously been terminated by the entity
10
as a participating provider. If written direction to pay is executed and written notice of the direction
11
to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care
12
provider. Any efforts to modify the amount of benefits paid directly to the dental care provider
13
under this section may include a reduction in benefits paid of no more than five percent (5%) less
14
than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction
15
to pay duly executed by the subscriber, shall have the right to review the records of the dentist
16
receiving such payment that relate exclusively to that particular subscriber/patient to determine that
17
the service in question was rendered.

Any entity as defined and licensed in this chapter shall allow,
18
as a provision in any group or individual policy, contract, or health benefit plan for coverage of
19
dental services, any person insured by the entity to direct, in writing, that their benefits, and the
20
corresponding reimbursement to the dental care provider for covered services, from a health benefit
21
plan, policy, or contract be paid directly to any dental care provider who has or has not contracted
22
with the entity.
23

(b) Upon receipt of a duly executed written direction to pay and written notice thereof, the
24
entity shall pay the benefits and compensation directly to the dental care provider. The amount of
25
benefits paid under this section shall be no less than the highest reimbursement amount actually
26
paid to any participating provider for the same covered dental service, as listed in the entity's benefit
27
allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.
28

(c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the
29
highest reimbursement amount listed for that procedure code among all participating provider
30
categories.
31

(d) The entity shall not use tiered reimbursement structures, geographic modifiers, or
32
network classifications to reduce the benchmark amount for purposes of calculating payment under
33
this section. The entity shall not create or designate new provider categories or reimbursement tiers
34
for the purpose of reducing the benchmark amount under this section.

LC005036 - Page 4 of 6
1

(e) The entity shall not reduce, modify, or condition the benefit amount based on the
2
provider's non-participation. The entity may review the provider's records related exclusively to the
3
subscriber/patient to verify that the service was rendered and to verify such treatment meets the
4
entity's criteria for benefit payment.
5
SECTION 4. This act shall take effect on January 1, 2027.
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LC005036
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LC005036 - Page 5 of 6
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-
DENTAL INSURANCE COVERAGE
***
1
This act would clarify the manner in which certain dental insurance benefits are paid
2
directly to the provider.
3
This act would take effect on January 1, 2027.
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LC005036
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LC005036 - Page 6 of 6