2022 -- S 2697 | |
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LC005090 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
____________ | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-- | |
DENTAL INSURANCE | |
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Introduced By: Senators Mendes, Calkin, Bell, Anderson, Mack, and Acosta | |
Date Introduced: March 17, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance |
2 | Policies" is hereby amended by adding thereto the following section: |
3 | 27-18-89. Dental insurance requirements. |
4 | Every entity providing a dental service plan pursuant to this chapter, commencing January |
5 | 1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage |
6 | of dental services, shall comply with the following requirements: |
7 | (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any |
8 | preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x- |
9 | rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to |
10 | restorative or elective dental treatment. |
11 | (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant, |
12 | partial or removable dentures, or major reconstructive care regardless of a pre-existing condition |
13 | or any earlier treatment. |
14 | (3) Within four (4) months after a claim for dental insurance coverage has been submitted, |
15 | the insurer shall provide payment or a written, email and/or other digital notification that the claim |
16 | has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment |
17 | or a late written, email and/or other digital notification of denial in an amount not to exceed one |
18 | thousand dollars ($1,000) or fifty percent (50%) of the claim, whichever is higher, to be paid by |
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1 | the insurer within ninety (90) days. |
2 | (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer |
3 | must provide written, email and/or other digital notification that the request has been approved or |
4 | denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email |
5 | and/or other digital notification response, to approve or deny a pre-authorization, in an amount not |
6 | to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever |
7 | is higher, to be paid by the insurer within ninety (90) days. |
8 | (5) Dental insurance coverage shall include a rollover provision for unused benefits to their |
9 | annual maximum during the current COVID-19 pandemic or any other pandemic named by the |
10 | United States Centers for Disease Control and Prevention (CDC) and continuing for an additional |
11 | twelve (12) months following a public announcement by the CDC and the Rhode Island department |
12 | of health (DOH) that the COVID-19 pandemic or any other pandemic has ended. |
13 | (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or any |
14 | other pandemic and continuing for an additional twelve (12) months following a public |
15 | announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19 |
16 | pandemic or any other pandemic has ended. |
17 | (7) Insurers shall submit an annual report to the department of health's board of examiners |
18 | in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media |
19 | and digital platforms, entitled "the fair dental healthcare portal," that shall include the following |
20 | information: |
21 | (i) The exact number of non-preventive claims received; |
22 | (ii) The number of claims denied; |
23 | (iii) The insurer's net-profit after all claims have been paid; |
24 | (iv) The total cost of all claims denied; |
25 | (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) |
26 | and (4) of this section; and |
27 | (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner |
28 | to submit a charge to the insurer by United States mail or via email or digitally. |
29 | SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service |
30 | Corporation" is hereby amended by adding thereto the following section: |
31 | 27-19-81. Dental insurance requirements. |
32 | Every entity providing a dental service plan pursuant to this chapter, commencing January |
33 | 1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage |
34 | of dental services, shall comply with the following requirements: |
| LC005090 - Page 2 of 9 |
1 | (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any |
2 | preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x- |
3 | rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to |
4 | restorative or elective dental treatment. |
5 | (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant, |
6 | partial or removable dentures, or major reconstructive care regardless of a pre-existing condition |
7 | or any earlier treatment. |
8 | (3) Within four (4) months after a claim for dental insurance coverage has been submitted, |
9 | the insurer shall provide payment or a written, email and/or other digital notification that the claim |
10 | has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment |
11 | or a late written, email and/or other digital notification of denial in an amount not to exceed one |
12 | thousand ($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by |
13 | the insurer within ninety (90) days. |
14 | (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer |
15 | must provide written, email and/or other digital notification that the request has been approved or |
16 | denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email |
17 | and/or other digital notification response, to approve or deny a pre-authorization, in an amount not |
18 | to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever |
19 | is higher, to be paid by the insurer within ninety (90) days. |
20 | (5) Dental insurance coverage shall include a rollover provision for unused benefits to their |
21 | annual maximum during the current COVID-19 pandemic or any other pandemic named by the |
22 | United States Centers for Disease Control and Prevention (CDC) and continuing for an additional |
23 | twelve (12) months following a public announcement by the CDC and the Rhode Island department |
24 | of health (DOH) that the COVID-19 pandemic or any other pandemic has ended. |
25 | (6) Insurers shall waive all deductibles during the current COVID-19 pandemic and any |
26 | other pandemic and continuing for an additional twelve (12) months following a public |
27 | announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19 |
28 | pandemic or any other pandemic has ended. |
29 | (7) Insurers shall submit an annual report to the department of health's board of examiners |
30 | in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media |
31 | and digital platforms, entitled "the fair dental healthcare portal," that shall include the following |
32 | information: |
33 | (i) The exact number of non-preventive claims received; |
34 | (ii) The number of claims denied; |
| LC005090 - Page 3 of 9 |
1 | (iii) The insurer's net-profit after all claims have been paid; |
2 | (iv) The total cost of all claims denied; |
3 | (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) |
4 | and (4) of this section; and |
5 | (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner |
6 | to submit a charge to the insurer by United States mail or via email or digitally. |
7 | SECTION 3. Chapter 27-20 of the General Laws entitled “Nonprofit Medical Service |
8 | Corporations” is hereby amended by adding thereto the following section: |
9 | 27-20-77. Dental insurance requirements. |
10 | Every entity providing a dental service plan pursuant to this chapter, commencing January |
11 | 1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage |
12 | of dental services, shall comply with the following requirements: |
13 | (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any |
14 | preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x- |
15 | rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to |
16 | restorative or elective dental treatment. |
17 | (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant, |
18 | partial or removable dentures, or major reconstructive care regardless of a pre-existing condition |
19 | or any earlier treatment. |
20 | (3) Within four (4) months after a claim for dental insurance coverage has been submitted, |
21 | the insurer shall provide payment or a written, email and/or other digital notification that the claim |
22 | has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment |
23 | or a late written, and/or digital notification of denial in an amount not to exceed one thousand |
24 | ($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer |
25 | within ninety (90) days. |
26 | (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer |
27 | must provide written, email and/or other digital notification that the request has been approved or |
28 | denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email |
29 | and/or other digital notification response, to approve or deny a pre-authorization, in an amount not |
30 | to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever |
31 | is higher, to be paid by the insurer within ninety (90) days. |
32 | (5) Dental insurance coverage shall include a rollover provision for unused benefits to their |
33 | annual maximum during the current COVID-19 pandemic or any other pandemic named by the |
34 | United States Centers for Disease Control and Prevention (CDC) and continuing for an additional |
| LC005090 - Page 4 of 9 |
1 | twelve (12) months following a public announcement by the CDC and the Rhode Island department |
2 | of health (DOH) that the COVID-19 pandemic or any other pandemic has ended. |
3 | (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or any |
4 | other pandemic and continuing for an additional twelve (12) months following a public |
5 | announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19 |
6 | pandemic or any other pandemic has ended. |
7 | (7) Insurers shall submit an annual report to the department of health's board of examiners |
8 | in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media |
9 | and digital platforms, entitled "the fair dental healthcare portal," that shall include the following |
10 | information: |
11 | (i) The exact number of non-preventive claims received; |
12 | (ii) The number of claims denied; |
13 | (iii) The insurer's net-profit after all claims have been paid; |
14 | (iv) The total cost of all claims denied; |
15 | (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) |
16 | and (4) of this section; and |
17 | (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner |
18 | to submit a charge to the insurer by United States mail or via email or digitally. |
19 | SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service |
20 | Corporations" is hereby amended by adding thereto the following section: |
21 | 27-20.1-23. Dental insurance requirements. |
22 | Every entity providing a dental service plan pursuant to this chapter, commencing January |
23 | 1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage |
24 | of dental services, shall comply with the following requirements: |
25 | (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any |
26 | preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x- |
27 | rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to |
28 | restorative or elective dental treatment. |
29 | (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant, |
30 | partial or removable dentures, or major reconstructive care regardless of a pre-existing condition |
31 | or any earlier treatment. |
32 | (3) Within four (4) months after a claim for dental insurance coverage has been submitted, |
33 | the insurer shall provide payment or a written email and/or other digital notification that the claim |
34 | has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment |
| LC005090 - Page 5 of 9 |
1 | or a late written and/or digital notification of denial in an amount not to exceed one thousand |
2 | ($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer |
3 | within ninety (90) days. |
4 | (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer |
5 | must provide written, email and/or other digital notification that the request has been approved or |
6 | denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email |
7 | and/or other digital notification response, to approve or deny a pre-authorization, in an amount not |
8 | to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever |
9 | is higher, to be paid by the insurer within ninety (90) days. |
10 | (5) Dental insurance coverage shall include a rollover provision for unused benefits to their |
11 | annual maximum during the current COVID-19 pandemic or during any other pandemic named by |
12 | the United States Centers for Disease Control and Prevention (CDC) and continuing for an |
13 | additional twelve (12) months following a public announcement by the CDC and the Rhode Island |
14 | department of health (DOH) that the COVID-19 pandemic or any other pandemic has ended. |
15 | (6) Insurers must waive all deductibles during the current COVID-19 pandemic or during |
16 | any other pandemic and continuing for an additional twelve (12) months following a public |
17 | announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19 |
18 | pandemic or any other pandemic has ended. |
19 | (7) Insurers shall submit an annual report to the department of health's board of examiners |
20 | in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media |
21 | and digital platforms, entitled "the fair dental healthcare portal," that shall include the following |
22 | information: |
23 | (i) The exact number of non-preventive claims received; |
24 | (ii) The number of claims denied; |
25 | (iii) The insurer's net-profit after all claims have been paid; |
26 | (iv) The total cost of all claims denied; |
27 | (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) |
28 | and (4) of this section; and |
29 | (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner |
30 | to submit a charge to the insurer by United States mail or via email or digitally. |
31 | SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance |
32 | Organizations" is hereby amended by adding thereto the following section: |
33 | 27-41-94. Dental insurance requirements. |
34 | Every entity providing a dental service plan pursuant to this chapter, commencing January 1, |
| LC005090 - Page 6 of 9 |
1 | 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage of |
2 | dental services, shall comply with the following requirements: |
3 | (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any |
4 | preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-rays, |
5 | cephalometric x-rays and consultations; provided, however, a deductible may be applied to restorative |
6 | or elective dental treatment. |
7 | (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant, |
8 | partial or removable dentures, or major reconstructive care regardless of a pre-existing condition or |
9 | any earlier treatment. |
10 | (3) Within four (4) months after a claim for dental insurance coverage has been submitted, |
11 | the insurer must provide payment or a written, and/or other digital notification that the claim has been |
12 | denied. A licensed dentist or dental practitioner may charge the insurer for a late payment or a late |
13 | written, email and/or other digital notification of denial in an amount not to exceed one thousand |
14 | ($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer |
15 | within ninety (90) days. |
16 | (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer |
17 | must provide written, email and/or other digital notification that the request has been approved or |
18 | denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email and/or |
19 | other digital notification response, to approve or deny a pre-authorization, in an amount not to exceed |
20 | one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever is higher, to |
21 | be paid by the insurer within ninety (90) days. |
22 | (5) Dental insurance coverage shall include a rollover provision for unused benefits to their |
23 | annual maximum during the current COVID-19 pandemic or during any other pandemic named by |
24 | the United States Centers for Disease Control and Prevention (CDC) and continuing for an additional |
25 | twelve (12) months following a public announcement by the CDC and the Rhode Island department |
26 | of health (DOH) that the COVID-19 pandemic or other pandemic has ended. |
27 | (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or during any |
28 | other pandemic and continuing for an additional twelve (12) months following a public |
29 | announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19 |
30 | pandemic or other pandemic has ended. |
31 | (7) Insurers shall submit an annual report to the department of health's board of examiners in |
32 | dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media and |
33 | digital platforms, entitled "the fair dental healthcare portal," that shall include the following |
34 | information: |
| LC005090 - Page 7 of 9 |
1 | (i) The exact number of non-preventive claims received; |
2 | (ii) The number of claims denied; |
3 | (iii) The insurer's net-profit after all claims have been paid; |
4 | (iv) The total cost of all claims denied; |
5 | (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) and |
6 | (4) of this section; and |
7 | (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner |
8 | to submit a charge to the insurer by United States mail or via email or digitally. |
9 | SECTION 6. This act shall take effect upon passage. |
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LC005090 | |
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| LC005090 - Page 8 of 9 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-- | |
DENTAL INSURANCE | |
*** | |
1 | This act would require dental insurance plans to include coverage without deductible for |
2 | any preventive service, and would require coverage for restorative, endodontic, implant, partial or |
3 | removable dentures, or major reconstructive care regardless of a pre-existing condition or any |
4 | earlier treatment, commencing January 1, 2023. It would further require: (1) Payment or written, |
5 | email and/or other digital denial within four (4) months after a claim has been submitted; (2) |
6 | Written, email and/or other digital notification of approval or denial within sixty (60) days after |
7 | pre-authorization has been submitted; (3) A rollover provision for unused benefits during a global |
8 | pandemic; and (4) An annual report filed by the insurer with the department of health's board of |
9 | examiners in dentistry, the department of insurance, office of the health commissioner and posted |
10 | publically on all media platforms that shall include: the number of non-preventive claims received; |
11 | the number of claims denied; and the insurer's net-profit after all claims have been paid. |
12 | This act would take effect upon passage. |
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LC005090 | |
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