Chapter

Chapter 268

2004 -- H 7462 SUBSTITUTE A

Enacted 07/02/04

A N A C T

RELATING TO INSURANCE -- HEALTH COVERAGE

Introduced By: Representatives Anguilla, T Brien, Ajello, Malik, and McNamara

Date Introduced: February 03, 2004

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:

27-18-63. Dental insurance assignment of benefits. - - Every entity providing a policy

of accident and sickness insurance as defined in chapter 27-18 shall allow, as a provision in a

group or individual policy, contract or health benefit plan for coverage of dental services, any

person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy

or contract, be paid directly to a dental care provider who has not contracted with the entity to

provide dental services to persons covered by the entity but otherwise meets the credentialing

criteria of the entity and has not previously been terminated by such entity as a participating

provider. If written direction to pay is executed and written notice of the direction to pay is

provided to such entity, the insuring entity shall pay the benefits directly to the dental care

provider. Any efforts to modify the amount of benefits paid directly to the dental care provider

under this section may include a reduction in benefits paid of no more than five percent (5%) less

than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a

direction to pay duly executed by the subscriber, shall have the right to review the records of the

dentist receiving such payment that relate exclusively to that particular subscriber/patient to

determine that the service in question was rendered. Provided, however, this section shall not

apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2)

disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited

benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident

or both; and (9) other limited benefit policies.

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

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

27-19-54. Dental insurance assignment of benefits. - - Every entity providing a contract

of insurance subject to chapter 27-19 shall allow, as a provision in a group or individual policy,

contract or health benefit plan for coverage of dental services, any person insured by such entity

to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to

a dental care provider who has not contracted with the entity to provide dental services to persons

covered by the entity but otherwise meets the credentialing criteria of the entity and has not

previously been terminated by such entity as a participating provider. If written direction to pay is

executed and written notice of the direction to pay is provided to such entity, the insuring entity

shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of

benefits paid directly to the dental care provider under this section may include a reduction in

benefits paid of no more than five percent (5%) less than the benefits paid to participating

dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the

subscriber, shall have the right to review the records of the dentist receiving such payment that

relate exclusively to that particular subscriber/patient to determine that the service in question

was rendered.

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

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

27-20-49. Dental insurance assignment of benefits. -- Every entity providing a contract

of insurance as defined in chapter 27-20 shall allow, as a provision in a group or individual

policy, contract or health benefit plan for coverage of dental services, any person insured by such

entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid

directly to a dental care provider who has not contracted with the entity to provide dental services

to persons covered by the entity but otherwise meets the credentialing criteria of the entity and

has not previously been terminated by such entity as a participating provider. If written direction

to pay is executed and written notice of the direction to pay is provided to such entity, the

insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify

the amount of benefits paid directly to the dental care provider under this section may include a

reduction in benefits paid of no more than five percent (5%) less than the benefits paid to

participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed

by the subscriber, shall have the right to review the records of the dentist receiving such payment

that relate exclusively to that particular subscriber/patient to determine that the service in question

was rendered.

SECTION 4. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

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

27-20.1-18. Dental insurance assignment of benefits. -- Every entity providing

nonprofit dental service plan as defined in chapter 27-20.1 shall allow, as a provision in a group

or individual policy, contract or health benefit plan for coverage of dental services, any person

insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or

contract, be paid directly to a dental care provider who has not contracted with the entity to