2020 -- H 7774

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LC004960

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2020

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A N   A C T

RELATING TO INSURANCE

     Introduced By: Representatives Kennedy, Corvese, Azzinaro, Johnston, and Casey

     Date Introduced: February 26, 2020

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-85. Third-party access to provider network.

      (a) No contract between a dentist and a health insurance carrier for the provision of

services to subscribers shall grant to a third party access to a provider network contract, a provider’s

dental services or contractual discounts, or both unless the contract allows the participating dentist

to choose to or not to participate in third-party access.

     (b) “Third party” as used herein means any organization, qualified entity, affiliate entity,

or an entity operating under common control with or under the same brand licensee program as the

contracting entity, or that operates under or enters into a contract with a contracting entity or with

another third-party to gain access to a provider network contract.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-77. Third-party access to provider network.

     (a) No contract between a dentist and a nonprofit hospital service corporation for the

provision of services to subscribers shall grant to a third party access to a provider network contract,

a provider’s dental services or contractual discounts, or both unless the contract allows the

participating dentist to choose to or not to participate in third-party access.

     (b) “Third party” as used herein means any organization, qualified entity, affiliate entity,

or an entity operating under common control with or under the same brand licensee program as the

contracting entity, or that operates under or enters into a contract with a contracting entity or with

another third-party to gain access to a provider network contract.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-73. Third-party access to provider network.

     (a) No contract between a dentist and a nonprofit medical service corporation for the

provision of services to subscribers shall grant to a third-party access to a provider network contract,

a provider’s dental services or contractual discounts, or both unless the contract allows the

participating dentist to choose to or not to participate in third party access.

     (b) “Third party” as used herein means any organization, qualified entity, affiliate entity,

or an entity operating under common control with or under the same brand licensee program as the

contracting entity, or that operates under or enters into a contract with a contracting entity or with

another third-party to gain access to a provider network contract.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-90. Third-party access to provider network.

     (a) No contract between a dentist and a health maintenance organization for the provision

of services to subscribers shall grant to a third-party access to a provider network contract, a

provider’s dental services or contractual discounts, or both unless the contract allows the

participating dentist to choose to or not to participate in third party access.

     (b) “Third party” as used herein means any organization, qualified entity, affiliate entity,

or an entity operating under common control with or under the same brand licensee program as the

contracting entity, or that operates under or enters into a contract with a contracting entity or with

another third-party to gain access to a provider network contract.

     SECTION 5. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

Corporations" is hereby amended by adding thereto the following section:

     27-20.1-23. Third-party access to provider network.

     (a) No contract between a dentist and a nonprofit dental service corporation for the

provision of services to subscribers shall grant to a third-party access to a provider network contract,

a provider’s dental services or contractual discounts, or both unless the contract allows the

participating dentist to choose to or not to participate in third party access.

     (b) “Third party” as used herein means any organization, qualified entity, affiliate entity,

or an entity operating under common control with or under the same brand licensee program as the

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contracting entity, or that operates under or enters into a contract with a contracting entity or with

another third-party to gain access to a provider network contract.

     SECTION 6. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE

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     This act would provide that participating dentists have the right to not participate in third-

party benefit agreements between nonprofit dental service corporations and outside dental benefit

plans.

     This act would take effect upon passage.

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LC004960

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