Bill Text: GA HB189 | 2011-2012 | Regular Session | Comm Sub
Bill Title: Noncovered Dental Services Act; enact
Spectrum: Slight Partisan Bill (Republican 5-2)
Status: (Passed) 2011-07-01 - Effective Date [HB189 Detail]
Download: Georgia-2011-HB189-Comm_Sub.html
11 HB
189/CSFA
House
Bill 189 (COMMITTEE SUBSTITUTE) (AM)
By:
Representatives Wilkinson of the
52nd,
Maxwell of the
17th,
Shaw of the
176th,
Hembree of the
67th,
Mitchell of the
88th,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia
Annotated, relating to general provisions regarding insurance, so as to provide
that no contract or agreement between a dental insurer or network and a dentist
shall require the dentist to accept an amount for dental care services that are
not covered dental services under a dental benefit plan; to provide that no
dental insurer shall publish or otherwise communicate that discounts are
available for noncovered dental services; to provide for a short title; to
provide for definitions; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
This
Act shall be known and may be cited as the "Noncovered Dental Services
Act."
SECTION
2.
Article
1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating
to general provisions regarding insurance, is amended by adding a new Code
section to read as follows:
"33-24-59.14.
(a)
As used in this Code section:
(1)
'Covered dental services' means dental care services for which a reimbursement
is available under a covered person's dental benefit plan, or for which a
reimbursement would be available but for the application of contractual
limitations such as deductibles, copayments, coinsurance, waiting periods,
annual or lifetime maximums, frequency limitations, alternative benefit
payments, or any other limitation.
(2)
'Covered person' means any subscriber, enrollee, member, beneficiary, or
participant, or his or her dependent, for whom benefits are payable when that
covered person receives dental care services rendered or authorized by a dentist
licensed under Chapter 11 of Title 43.
(3)
'Dental benefit plan' means any individual or group plan, policy, contract, or
subscription agreement which includes or is for dental care services that is
issued, delivered, issued for delivery, or renewed in this state whether by a
health care insurer, health maintenance organization, preferred provider
organization, accident and sickness insurer, fraternal benefit society,
nonprofit hospital service corporation, nonprofit medical or dental service
corporation, health care plan, or any other person, firm, corporation, joint
venture, or other similar business entity that pays for, purchases, or furnishes
dental care services to patients, insureds, beneficiaries, or covered dependents
in this state.
(4)
'Dental insurer' means any person, firm, corporation, joint venture, or other
similar business entity that offers dental benefit plans in consideration of
periodic payments.
(b)
No contract between a dental insurer and a dentist shall require a dentist to
accept an amount set by the dental insurer as payment for dental care services
that are not covered dental services under the covered person's dental benefit
plan.
(c)
A dental insurer or other person or entity providing third-party administrator
services shall not make available any providers in its dentist network to a plan
that sets dental fees for any services except covered services.
(d)
A dental insurer shall not draft, publish, disseminate, or circulate explanation
of benefit forms that include language which directly or indirectly implies that
a dentist may or should extend discounts to patients for noncovered dental
services. Statements by a dental insurer which are prohibited by this Code
section include but are not limited to, 'Our members value the services you
provide and we encourage you to continue extending the discount on noncovered
services.'"
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.