2022 -- S 2697

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LC005090

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

DENTAL INSURANCE

     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:

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

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

     27-18-89. Dental insurance requirements.

     Every entity providing a dental service plan pursuant to this chapter, commencing January

1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage

of dental services, shall comply with the following requirements:

     (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any

preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-

rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to

restorative or elective dental treatment.

     (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant,

partial or removable dentures, or major reconstructive care regardless of a pre-existing condition

or any earlier treatment.

     (3) Within four (4) months after a claim for dental insurance coverage has been submitted,

the insurer shall provide payment or a written, email and/or other digital notification that the claim

has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment

or a late written, email and/or other digital notification of denial in an amount not to exceed one

thousand dollars ($1,000) or fifty percent (50%) of the claim, whichever is higher, to be paid by

the insurer within ninety (90) days.

     (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer

must provide written, email and/or other digital notification that the request has been approved or

denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email

and/or other digital notification response, to approve or deny a pre-authorization, in an amount not

to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever

is higher, to be paid by the insurer within ninety (90) days.

     (5) Dental insurance coverage shall include a rollover provision for unused benefits to their

annual maximum during the current COVID-19 pandemic or any other pandemic named by the

United States Centers for Disease Control and Prevention (CDC) and continuing for an additional

twelve (12) months following a public announcement by the CDC and the Rhode Island department

of health (DOH) that the COVID-19 pandemic or any other pandemic has ended.

     (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or any

other pandemic and continuing for an additional twelve (12) months following a public

announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19

pandemic or any other pandemic has ended.

     (7) Insurers shall submit an annual report to the department of health's board of examiners

in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media

and digital platforms, entitled "the fair dental healthcare portal," that shall include the following

information:

     (i) The exact number of non-preventive claims received;

     (ii) The number of claims denied;

     (iii) The insurer's net-profit after all claims have been paid;

     (iv) The total cost of all claims denied;

     (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3)

and (4) of this section; and

     (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner

to submit a charge to the insurer by United States mail or via email or digitally.

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

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

     27-19-81. Dental insurance requirements.

     Every entity providing a dental service plan pursuant to this chapter, commencing January

1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage

of dental services, shall comply with the following requirements:

LC005090 - Page 2 of 9

     (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any

preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-

rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to

restorative or elective dental treatment.

     (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant,

partial or removable dentures, or major reconstructive care regardless of a pre-existing condition

or any earlier treatment.

     (3) Within four (4) months after a claim for dental insurance coverage has been submitted,

the insurer shall provide payment or a written, email and/or other digital notification that the claim

has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment

or a late written, email and/or other digital notification of denial in an amount not to exceed one

thousand ($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by

the insurer within ninety (90) days.

     (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer

must provide written, email and/or other digital notification that the request has been approved or

denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email

and/or other digital notification response, to approve or deny a pre-authorization, in an amount not

to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever

is higher, to be paid by the insurer within ninety (90) days.

     (5) Dental insurance coverage shall include a rollover provision for unused benefits to their

annual maximum during the current COVID-19 pandemic or any other pandemic named by the

United States Centers for Disease Control and Prevention (CDC) and continuing for an additional

twelve (12) months following a public announcement by the CDC and the Rhode Island department

of health (DOH) that the COVID-19 pandemic or any other pandemic has ended.

     (6) Insurers shall waive all deductibles during the current COVID-19 pandemic and any

other pandemic and continuing for an additional twelve (12) months following a public

announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19

pandemic or any other pandemic has ended.

     (7) Insurers shall submit an annual report to the department of health's board of examiners

in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media

and digital platforms, entitled "the fair dental healthcare portal," that shall include the following

information:

     (i) The exact number of non-preventive claims received;

     (ii) The number of claims denied;

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     (iii) The insurer's net-profit after all claims have been paid;

     (iv) The total cost of all claims denied;

     (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3)

and (4) of this section; and

     (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner

to submit a charge to the insurer by United States mail or via email or digitally.

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

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

     27-20-77. Dental insurance requirements.

     Every entity providing a dental service plan pursuant to this chapter, commencing January

1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage

of dental services, shall comply with the following requirements:

     (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any

preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-

rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to

restorative or elective dental treatment.

     (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant,

partial or removable dentures, or major reconstructive care regardless of a pre-existing condition

or any earlier treatment.

     (3) Within four (4) months after a claim for dental insurance coverage has been submitted,

the insurer shall provide payment or a written, email and/or other digital notification that the claim

has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment

or a late written, and/or digital notification of denial in an amount not to exceed one thousand

($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer

within ninety (90) days.

     (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer

must provide written, email and/or other digital notification that the request has been approved or

denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email

and/or other digital notification response, to approve or deny a pre-authorization, in an amount not

to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever

is higher, to be paid by the insurer within ninety (90) days.

     (5) Dental insurance coverage shall include a rollover provision for unused benefits to their

annual maximum during the current COVID-19 pandemic or any other pandemic named by the

United States Centers for Disease Control and Prevention (CDC) and continuing for an additional

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twelve (12) months following a public announcement by the CDC and the Rhode Island department

of health (DOH) that the COVID-19 pandemic or any other pandemic has ended.

     (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or any

other pandemic and continuing for an additional twelve (12) months following a public

announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19

pandemic or any other pandemic has ended.

     (7) Insurers shall submit an annual report to the department of health's board of examiners

in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media

and digital platforms, entitled "the fair dental healthcare portal," that shall include the following

information:

     (i) The exact number of non-preventive claims received;

     (ii) The number of claims denied;

     (iii) The insurer's net-profit after all claims have been paid;

     (iv) The total cost of all claims denied;

     (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3)

and (4) of this section; and

     (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner

to submit a charge to the insurer by United States mail or via email or digitally.

     SECTION 4. 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. Dental insurance requirements.

     Every entity providing a dental service plan pursuant to this chapter, commencing January

1, 2023, as a provision in a group or individual policy, contract or health benefit plan for coverage

of dental services, shall comply with the following requirements:

     (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any

preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-

rays, cephalometric x-rays and consultations; provided, however, a deductible may be applied to

restorative or elective dental treatment.

     (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant,

partial or removable dentures, or major reconstructive care regardless of a pre-existing condition

or any earlier treatment.

     (3) Within four (4) months after a claim for dental insurance coverage has been submitted,

the insurer shall provide payment or a written email and/or other digital notification that the claim

has been denied. A licensed dentist or dental practitioner may charge the insurer for a late payment

LC005090 - Page 5 of 9

or a late written and/or digital notification of denial in an amount not to exceed one thousand

($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer

within ninety (90) days.

     (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer

must provide written, email and/or other digital notification that the request has been approved or

denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email

and/or other digital notification response, to approve or deny a pre-authorization, in an amount not

to exceed one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever

is higher, to be paid by the insurer within ninety (90) days.

     (5) Dental insurance coverage shall include a rollover provision for unused benefits to their

annual maximum during the current COVID-19 pandemic or during any other pandemic named by

the United States Centers for Disease Control and Prevention (CDC) and continuing for an

additional twelve (12) months following a public announcement by the CDC and the Rhode Island

department of health (DOH) that the COVID-19 pandemic or any other pandemic has ended.

     (6) Insurers must waive all deductibles during the current COVID-19 pandemic or during

any other pandemic and continuing for an additional twelve (12) months following a public

announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19

pandemic or any other pandemic has ended.

     (7) Insurers shall submit an annual report to the department of health's board of examiners

in dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media

and digital platforms, entitled "the fair dental healthcare portal," that shall include the following

information:

     (i) The exact number of non-preventive claims received;

     (ii) The number of claims denied;

     (iii) The insurer's net-profit after all claims have been paid;

     (iv) The total cost of all claims denied;

     (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3)

and (4) of this section; and

     (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner

to submit a charge to the insurer by United States mail or via email or digitally.

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

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

     27-41-94. Dental insurance requirements.

     Every entity providing a dental service plan pursuant to this chapter, commencing January 1,

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2023, as a provision in a group or individual policy, contract or health benefit plan for coverage of

dental services, shall comply with the following requirements:

     (1) Dental insurance coverage shall be provided and deductibles shall not be applied to any

preventive service, including healthy mouth cleanings, exams, full-mouth x-rays, panoramic x-rays,

cephalometric x-rays and consultations; provided, however, a deductible may be applied to restorative

or elective dental treatment.

     (2) Dental insurance coverage shall include coverage for restorative, endodontic, implant,

partial or removable dentures, or major reconstructive care regardless of a pre-existing condition or

any earlier treatment.

     (3) Within four (4) months after a claim for dental insurance coverage has been submitted,

the insurer must provide payment or a written, and/or other digital notification that the claim has been

denied. A licensed dentist or dental practitioner may charge the insurer for a late payment or a late

written, email and/or other digital notification of denial in an amount not to exceed one thousand

($1,000) dollars or fifty percent (50%) of the claim, whichever is higher, to be paid by the insurer

within ninety (90) days.

     (4) Within sixty (60) days after a pre-authorization request has been submitted, the insurer

must provide written, email and/or other digital notification that the request has been approved or

denied. A licensed dentist or dental practitioner may charge the insurer for a late written, email and/or

other digital notification response, to approve or deny a pre-authorization, in an amount not to exceed

one thousand ($1,000) dollars or fifty percent (50%) of the requested amount, whichever is higher, to

be paid by the insurer within ninety (90) days.

     (5) Dental insurance coverage shall include a rollover provision for unused benefits to their

annual maximum during the current COVID-19 pandemic or during any other pandemic named by

the United States Centers for Disease Control and Prevention (CDC) and continuing for an additional

twelve (12) months following a public announcement by the CDC and the Rhode Island department

of health (DOH) that the COVID-19 pandemic or other pandemic has ended.

     (6) Insurers shall waive all deductibles during the current COVID-19 pandemic or during any

other pandemic and continuing for an additional twelve (12) months following a public

announcement by the CDC and the Rhode Island department of health (DOH) that the COVID-19

pandemic or other pandemic has ended.

     (7) Insurers shall submit an annual report to the department of health's board of examiners in

dentistry, the Rhode Island office of the health commissioner (OHIC) and publicly on all media and

digital platforms, entitled "the fair dental healthcare portal," that shall include the following

information:

LC005090 - Page 7 of 9

     (i) The exact number of non-preventive claims received;

     (ii) The number of claims denied;

     (iii) The insurer's net-profit after all claims have been paid;

     (iv) The total cost of all claims denied;

     (v) All charges by dentists and dental practitioners to insurers pursuant to subsections (3) and

(4) of this section; and

     (vi) A pdf form that may be downloaded and printed to allow a dentist or dental practitioner

to submit a charge to the insurer by United States mail or via email or digitally.

     SECTION 6. This act shall take effect upon passage.

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LC005090

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES--

DENTAL INSURANCE

***

     This act would require dental insurance plans to include coverage without deductible for

any preventive service, and would require coverage for restorative, endodontic, implant, partial or

removable dentures, or major reconstructive care regardless of a pre-existing condition or any

earlier treatment, commencing January 1, 2023. It would further require: (1) Payment or written,

email and/or other digital denial within four (4) months after a claim has been submitted; (2)

Written, email and/or other digital notification of approval or denial within sixty (60) days after

pre-authorization has been submitted; (3) A rollover provision for unused benefits during a global

pandemic; and (4) An annual report filed by the insurer with the department of health's board of

examiners in dentistry, the department of insurance, office of the health commissioner and posted

publically on all media platforms that shall include: the number of non-preventive claims received;

the number of claims denied; and the insurer's net-profit after all claims have been paid.

     This act would take effect upon passage.

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LC005090

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