2026 -- H 7722

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LC005036

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES-

DENTAL INSURANCE COVERAGE

     Introduced By: Representative Joseph M. McNamara

     Date Introduced: February 12, 2026

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-63 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-63. Dental insurance assignment of benefits.

     (a) Every entity providing a policy of accident and sickness insurance as defined in this

chapter 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. Any entity as defined and

licensed in this chapter shall allow, as a provision in any group or individual policy, contract, or

health benefit plan for coverage of dental services, any person insured by the entity to direct, in

writing, that their benefits, and the corresponding reimbursement to the dental care provider for

covered services, from a health benefit plan, policy, or contract be paid directly to any dental care

provider who has or has not contracted with the entity.

     (b) Upon receipt of a duly executed written direction to pay and written notice thereof, the

entity shall pay the benefits and compensation directly to the dental care provider. The amount of

benefits paid under this section shall be no less than the highest reimbursement amount actually

paid to any participating provider for the same covered dental service, as listed in the entity's benefit

allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.

     (c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the

highest reimbursement amount listed for that procedure code among all participating provider

categories.

     (d) The entity shall not use tiered reimbursement structures, geographic modifiers, or

network classifications to reduce the benchmark amount for purposes of calculating payment under

this section. The entity shall not create or designate new provider categories or reimbursement tiers

for the purpose of reducing the benchmark amount under this section.

     (e) The entity shall not reduce, modify, or condition the benefit amount based on the

provider's non-participation. The entity may review the provider's records related exclusively to the

subscriber/patient to verify that the service was rendered and to verify such treatment meets the

entity's criteria for benefit payment.

     (f) 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. Section 27-19-54 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-54. Dental insurance assignment of benefits.

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     (a) Every entity providing a contract of insurance subject to this chapter 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 the 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 the entity as a

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

pay is provided to the 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 the payment that relate exclusively to that particular subscriber/patient to determine that

the service in question was rendered. Any entity as defined and licensed in this chapter shall allow,

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

dental services, any person insured by the entity to direct, in writing, that their benefits, and the

corresponding reimbursement to the dental care provider for covered services, from a health benefit

plan, policy, or contract be paid directly to any dental care provider who has or has not contracted

with the entity.

     (b) Upon receipt of a duly executed written direction to pay and written notice thereof, the

entity shall pay the benefits and compensation directly to the dental care provider. The amount of

benefits paid under this section shall be no less than the highest reimbursement amount actually

paid to any participating provider for the same covered dental service, as listed in the entity's benefit

allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.

     (c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the

highest reimbursement amount listed for that procedure code among all participating provider

categories.

     (d) The entity shall not use tiered reimbursement structures, geographic modifiers, or

network classifications to reduce the benchmark amount for purposes of calculating payment under

this section. The entity shall not create or designate new provider categories or reimbursement tiers

for the purpose of reducing the benchmark amount under this section.

     (e) The entity shall not reduce, modify, or condition the benefit amount based on the

provider's non-participation. The entity may review the provider's records related exclusively to the

subscriber/patient to verify that the service was rendered and to verify such treatment meets the

LC005036 - Page 3 of 6

entity's criteria for benefit payment.

     SECTION 3. Section 27-41-66 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-66. Dental insurance assignment of benefits.

     (a) Every entity licensed under this chapter shall allow, as a provision of any evidence of

coverage of dental services, any person covered by the 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 the entity

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

to pay is provided to the 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. Any entity as defined and licensed in this chapter shall allow,

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

dental services, any person insured by the entity to direct, in writing, that their benefits, and the

corresponding reimbursement to the dental care provider for covered services, from a health benefit

plan, policy, or contract be paid directly to any dental care provider who has or has not contracted

with the entity.

     (b) Upon receipt of a duly executed written direction to pay and written notice thereof, the

entity shall pay the benefits and compensation directly to the dental care provider. The amount of

benefits paid under this section shall be no less than the highest reimbursement amount actually

paid to any participating provider for the same covered dental service, as listed in the entity's benefit

allowance tables or fee schedules, including any incentive-based or performance-tiered schedules.

     (c) In cases where multiple tiers or schedules exist, the applicable benchmark shall be the

highest reimbursement amount listed for that procedure code among all participating provider

categories.

     (d) The entity shall not use tiered reimbursement structures, geographic modifiers, or

network classifications to reduce the benchmark amount for purposes of calculating payment under

this section. The entity shall not create or designate new provider categories or reimbursement tiers

for the purpose of reducing the benchmark amount under this section.

LC005036 - Page 4 of 6

     (e) The entity shall not reduce, modify, or condition the benefit amount based on the

provider's non-participation. The entity may review the provider's records related exclusively to the

subscriber/patient to verify that the service was rendered and to verify such treatment meets the

entity's criteria for benefit payment.

     SECTION 4. This act shall take effect on January 1, 2027.

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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 COVERAGE

***

     This act would clarify the manner in which certain dental insurance benefits are paid

directly to the provider.

     This act would take effect on January 1, 2027.

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