2021 -- S 0709

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LC001436

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE – DENTAL INSURANCE

     Introduced By: Senators Mendes, Mack, Bell, Calkin, and Anderson

     Date Introduced: March 26, 2021

     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:

     27-18-85. Dental insurance requirements.

     (a) Every entity providing a dental service plan pursuant to chapter 18 of title 27, 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) Insurance coverage must be provided and deductibles shall not be applied to any

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

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

restorative or elective dental treatment.

     (2) 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 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

notification of denial in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

percent 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 notification that the request has been approved or denied. A licensed dentist

or dental practitioner may charge the insurer for a late written notification response, to approve or

deny a pre-authorization, in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

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

     (5) Insurance coverage must include a rollover provision for unused benefits to their annual

maximum during the current COVID-19 pandemic and continuing for an additional twelve (12)

months following a public announcement by the United States Centers for Disease Control (CDC)

and the Rhode Island department of health (RIDOH) that the COVID-19 pandemic has ended.

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

continuing for an additional twelve (12) months following a public announcement by the United

States Centers for Disease Control (CDC) and the Rhode Island department of health (RIDOH) that

the COVID-19 pandemic has ended.

     (7) The insurer must 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 publically

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.

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

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

     27-19-77. Dental insurance requirements.

     (a) Every entity providing a dental service plan pursuant to chapter 19 of title 27, 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) Insurance coverage must be provided and deductibles shall not be applied to any

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

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

restorative or elective dental treatment.

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     (2) 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 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

notification of denial in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

percent 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 notification that the request has been approved or denied. A licensed dentist

or dental practitioner may charge the insurer for a late written notification response, to approve or

deny a pre-authorization, in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

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

     (5) Insurance coverage must include a rollover provision for unused benefits to their annual

maximum during the current COVID-19 pandemic and continuing for an additional twelve (12)

months following a public announcement by the United States Centers for Disease Control (CDC)

and the Rhode Island department of health (RIDOH) that the COVID-19 pandemic has ended.

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

continuing for an additional twelve (12) months following a public announcement by the United

States Centers for Disease Control (CDC) and the Rhode Island department of health (RIDOH) that

the COVID-19 pandemic has ended.

     (7) The insurer must 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 publically

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.

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

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

     27-20-73. Dental insurance requirements.

     (a) Every entity providing a dental service plan pursuant to chapter 20 of title 27, 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) Insurance coverage must be provided and deductibles shall not be applied to any

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

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

restorative or elective dental treatment.

     (2) 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 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

notification of denial in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

percent 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 notification that the request has been approved or denied. A licensed dentist

or dental practitioner may charge the insurer for a late written notification response, to approve or

deny a pre-authorization, in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

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

     (5) Insurance coverage must include a rollover provision for unused benefits to their annual

maximum during the current COVID-19 pandemic and continuing for an additional twelve (12)

months following a public announcement by the United States Centers for Disease Control (CDC)

and the Rhode Island department of health (RIDOH) that the COVID-19 pandemic has ended.

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

continuing for an additional twelve (12) months following a public announcement by the United

States Centers for Disease Control (CDC) and the Rhode Island department of health (RIDOH) that

the COVID-19 pandemic has ended.

     (7) The insurer must 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 publically

on all media and digital platforms, entitled "the fair dental healthcare portal", that shall include the

following information:

LC001436 - Page 4 of 8

     (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.

     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.

     (a) Every entity providing a dental service plan pursuant to chapter 20.1 of title 27, 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) Insurance coverage must be provided and deductibles shall not be applied to any

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

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

restorative or elective dental treatment.

     (2) 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 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

notification of denial in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

percent 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 notification that the request has been approved or denied. A licensed dentist

or dental practitioner may charge the insurer for a late written notification response, to approve or

deny a pre-authorization, in an amount not to exceed one thousand ($1,000) dollars or fifty (50%)

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

     (5) Insurance coverage must include a rollover provision for unused benefits to their annual

maximum during the current COVID-19 pandemic and continuing for an additional twelve (12)

months following a public announcement by the United States Centers for Disease Control (CDC)

LC001436 - Page 5 of 8

and the Rhode Island department of health (RIDOH) that the COVID-19 pandemic has ended.

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

continuing for an additional twelve (12) months following a public announcement by the United

States Centers for Disease Control (CDC) and the Rhode Island department of health (RIDOH) that

the COVID-19 pandemic has ended.

     (7) The insurer must 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 publically

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.

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

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

     27-41-90. Dental insurance requirements.

     (a) Every entity providing a dental service plan pursuant to chapter 41 of title 27, 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) Insurance coverage must be provided and deductibles shall not be applied to any

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

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

or elective dental treatment.

     (2) 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 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 notification

of denial in an amount not to exceed one thousand ($1,000) dollars or fifty (50%) percent of the claim,

LC001436 - Page 6 of 8

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 notification that the request has been approved or denied. A licensed dentist or

dental practitioner may charge the insurer for a late written notification response, to approve or deny

a pre-authorization, in an amount not to exceed one thousand ($1,000) dollars or fifty (50%) of the

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

     (5) Insurance coverage must include a rollover provision for unused benefits to their annual

maximum during the current COVID-19 pandemic and continuing for an additional twelve (12)

months following a public announcement by the United States Centers for Disease Control (CDC)

and the Rhode Island department of health (RIDOH) that the COVID-19 pandemic has ended.

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

continuing for an additional twelve (12) months following a public announcement by the United

States Centers for Disease Control (CDC) and the Rhode Island department of health (RIDOH) that

the COVID-19 pandemic has ended.

     (7) The insurer must 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 publically 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.

     SECTION 6. This act shall take effect upon passage.

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LC001436

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE – DENTAL INSURANCE

***

     This act would require dental insurance plan 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. It would further require: (1) Payment or written denial within 4 months after a

claim has been submitted; (2) Written notification of approval or denial within 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, the department of

insurance and 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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LC001436

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