Bill Text: NJ A3672 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires insurance carriers offering dental benefit plans to provide certain level of coverage and reimbursement.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-02-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A3672 Detail]
Download: New_Jersey-2024-A3672-Introduced.html
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.
