Bill Text: IA SSB1078 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A study bill for an act relating to insurance coverage for dental care services.
Spectrum: Unknown
Status: (N/A - Dead) 2013-03-07 - Voted - Commerce. [SSB1078 Detail]
Download: Iowa-2013-SSB1078-Introduced.html
Senate
Study
Bill
1078
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
COMMERCE
BILL
BY
CHAIRPERSON
McCOY)
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
dental
care
services.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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1343XC
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Section
1.
NEW
SECTION
.
514C.3C
Dental
coverage
——
1
assignment
of
health
insurance
benefits.
2
A
person
who
is
the
owner
of
any
rights
or
benefits
under
a
3
policy
or
contract
of
insurance
which
provides
for
coverage
of
4
dental
care
services
shall
be
permitted
to
assign
all
or
any
5
part
of
that
person’s
rights
and
privileges
under
the
policy
or
6
contract,
including
but
not
limited
to
the
right
to
designate
7
a
beneficiary
and
to
have
an
individual
policy
or
contract
8
issued
in
accordance
with
the
terms
of
the
policy
or
contract.
9
Such
assignment
shall
be
without
prejudice
to
the
insurer
on
10
account
of
any
payment
the
insurer
makes
or
individual
policy
11
or
contract
the
insurer
issues
before
receiving
notice
of
the
12
assignment,
provided
that
the
insurer
was
acting
in
good
faith.
13
If
written
proof
of
an
assignment
of
benefits
is
presented
to
14
an
insurer,
health
maintenance
organization,
managed
care
plan,
15
health
care
plan,
preferred
provider
organization,
or
other
16
third-party
payor,
then
payment
shall
be
made
directly
to
the
17
health
care
professional
or
health
care
facility
providing
the
18
dental
services.
Nothing
in
this
section
shall
be
construed
to
19
prevent
any
persons
from
reconciling
duplicate
payments.
20
Sec.
2.
NEW
SECTION
.
514C.3D
Uniform
coordination
of
21
benefits.
22
A
policy
or
contract
of
insurance
which
provides
for
23
coverage
of
dental
care
services
shall
provide
for
coordination
24
of
benefits
in
a
manner
so
that
the
policy
or
contract
pays
the
25
same
amount
for
the
dental
care
services
provided
regardless
26
of
the
existence
of
other
coverage
for
the
dental
care
27
services,
so
long
as
the
total
amount
paid
does
not
exceed
one
28
hundred
percent
of
the
amount
of
the
applicable
claim.
Such
29
coordination
of
benefits
shall
be
effected
consistent
with
30
rules
adopted
by
the
commissioner
of
insurance
under
chapter
31
17A,
based
upon
similar
model
rules
developed
by
the
national
32
association
of
insurance
commissioners.
33
Sec.
3.
NEW
SECTION
.
514C.3E
Freedom
of
choice
of
dentists
34
in
dental
plans.
35
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1.
A
dental
plan
which
is
delivered,
renewed,
issued
for
1
delivery,
or
otherwise
contracted
for
in
this
state
on
or
after
2
July
1,
2013,
shall
not
do
either
of
the
following:
3
a.
Prevent
any
person
who
is
a
party
to
or
a
beneficiary
4
of
such
dental
plan
from
selecting
the
dentist
of
the
person’s
5
choice
to
furnish
the
dental
care
services
offered
by
the
6
dental
plan,
or
interfere
with
such
selection.
7
b.
Deny
any
dentist
the
right
to
participate
as
a
8
contracting
provider
for
the
dental
plan.
9
2.
The
payment
or
reimbursement
for
a
noncontracting
10
provider
by
a
dental
plan
shall
be
the
same
as
or
greater
11
than
the
payment
or
reimbursement
for
a
contracting
provider.
12
However,
a
dental
plan
is
not
required
to
make
a
payment
or
13
reimbursement
in
an
amount
that
is
greater
than
the
amount
14
specified
in
the
dental
plan
or
that
is
greater
than
the
fee
15
charged
by
the
dentist
for
the
dental
care
services
rendered.
16
3.
Any
provision
in
a
dental
plan
which
is
delivered,
17
renewed,
issued
for
delivery,
or
otherwise
contracted
for
in
18
this
state
on
or
after
July
1,
2013,
which
is
contrary
to
this
19
section
is,
to
the
extent
of
the
conflict,
void.
20
4.
For
the
purposes
of
this
section:
21
a.
“Contracting
provider”
means,
with
respect
to
any
dental
22
plan,
a
dentist
who
has
entered
into
a
contract
with
the
dental
23
plan
for
the
provision
of
dental
care
services
to
covered
24
individuals
under
the
dental
plan.
25
b.
“Dental
care
services”
means
any
services
furnished
to
a
26
person
for
the
purpose
of
preventing,
alleviating,
curing,
or
27
healing
human
dental
abnormalities,
accidents,
or
diseases.
28
c.
“Dental
plan”
means
any
policy
or
contract
of
insurance
29
which
provides
for
coverage
of
dental
care
services
not
in
30
connection
with
a
medical
plan
that
provides
for
the
coverage
31
of
medical
services.
32
d.
“Dentist”
means
any
person
who
furnishes
dental
care
33
services
and
who
is
licensed
as
a
dentist
pursuant
to
chapter
34
153.
35
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e.
“Noncontracting
provider”
means,
with
respect
to
any
1
dental
plan,
a
dentist
who
has
not
entered
into
a
contract
with
2
the
dental
plan
for
the
provision
of
dental
care
services
to
3
covered
individuals
under
the
dental
plan.
4
Sec.
4.
Section
514J.103,
subsection
1,
Code
2013,
is
5
amended
to
read
as
follows:
6
1.
Except
as
provided
in
subsection
2
,
this
chapter
shall
7
apply
to
all
health
carriers
,
including
health
carriers
issuing
8
a
policy
or
certificate
that
provides
coverage
for
dental
care
.
9
Sec.
5.
Section
514J.103,
subsection
2,
paragraph
a,
Code
10
2013,
is
amended
to
read
as
follows:
11
a.
A
policy
or
certificate
that
provides
coverage
only
for
a
12
specified
disease,
specified
accident
or
accident-only,
credit,
13
disability
income,
hospital
indemnity,
long-term
care,
dental
14
care,
vision
care,
or
any
other
limited
supplemental
benefit.
15
EXPLANATION
16
This
bill
relates
to
insurance
coverage
for
dental
care
17
services.
18
New
Code
section
514C.3C
provides
that
a
person
who
owns
19
rights
or
benefits
under
a
policy
or
contract
of
insurance
20
which
provides
for
coverage
of
dental
care
services
must
be
21
allowed
to
assign
any
or
part
of
that
person’s
rights
and
22
privileges
under
the
policy
or
contract,
including
the
right
23
to
designate
a
beneficiary
and
to
have
an
individual
policy
or
24
contract
issued.
The
assignment
is
without
prejudice
to
an
25
insurer
that
makes
a
payment
in
good
faith
under
the
policy
26
or
contract
before
receiving
notice
of
the
assignment.
If
27
written
proof
of
the
assignment
of
benefits
is
presented
to
an
28
insurer,
health
maintenance
organization,
managed
care
plan,
29
health
care
plan,
preferred
provider
organization,
or
other
30
third-party
payor,
the
payment
for
coverage
of
dental
care
31
services
shall
be
made
directly
to
the
health
care
provider
32
providing
the
services.
The
section
shall
not
be
construed
to
33
prevent
reconciliation
of
duplicate
payments.
34
New
Code
section
514C.3D
provides
that
a
policy
or
contract
35
-3-
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S.F.
_____
of
insurance
which
provides
for
coverage
of
dental
care
1
services
shall
provide
for
coordination
of
benefits
in
a
2
manner
so
that
the
policy
or
contract
pays
the
same
amount
3
for
the
dental
care
services
provided
regardless
of
whether
4
there
is
other
coverage
for
the
services,
so
long
as
the
total
5
amount
paid
does
not
exceed
100
percent
of
the
amount
of
the
6
claim.
The
commissioner
of
insurance
shall
adopt
rules
to
7
provide
for
such
coordination
of
benefits,
based
on
similar
8
model
rules
developed
by
the
national
association
of
insurance
9
commissioners.
10
New
Code
section
514C.3E
provides
that
a
policy
or
contract
11
of
insurance
which
provides
for
coverage
of
dental
care
12
services
not
in
connection
with
a
medical
plan
that
covers
13
medical
services,
shall
not
prevent
a
party
or
beneficiary
14
of
the
dental
plan
from
selecting
a
dentist
of
the
person’s
15
choice
to
furnish
dental
care
services
provided
by
the
plan
16
or
deny
any
dentist
the
right
to
participate
as
a
contracting
17
dentist
for
the
dental
plan.
The
payment
or
reimbursement
for
18
a
noncontracting
dentist
by
a
dental
plan
must
be
the
same
or
19
greater
than
the
payment
or
reimbursement
for
a
contracting
20
dentist.
However,
a
dental
plan
is
not
required
to
make
a
21
payment
or
reimbursement
in
an
amount
greater
than
the
amount
22
specified
in
the
plan
or
that
is
greater
than
the
fee
charged
23
by
the
dentist.
A
provision
in
a
dental
plan
that
is
contrary
24
to
the
new
Code
section
is
void.
New
Code
section
514C.3E
is
25
applicable
to
a
dental
plan
that
is
delivered,
renewed,
issued
26
for
delivery,
or
otherwise
contracted
for
in
this
state
on
or
27
after
July
1,
2013.
28
Code
section
514J.103
is
amended
to
provide
that
decisions
29
of
health
carriers
issuing
a
policy
or
certificate
that
30
provides
coverage
for
dental
care
are
subject
to
the
external
31
review
provisions
of
Code
chapter
514J,
and
the
chapter
is
also
32
applicable
to
a
policy
or
certificate
that
provides
coverage
33
only
for
dental
care.
34
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