Minnesota Legislature
HF 1155
as introduced - 93rd Legislature (2023 - 2024) Posted on 03/08/2023 12:12pm
1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 2.1 2.2 2.3 2.4 2.5
A bill for an act
relating to insurance; changing definition of covered services for dental care;
amending Minnesota Statutes 2022, section 62Q.78, subdivision 6.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2022, section 62Q.78, subdivision 6, is amended to read:
Subd. 6.
Payment for covered services.
(a) No contract of any dental plan or dental
organization that covers any dental services or dental provider agreement with a dentist
may require, directly or indirectly, that a dentist provide services to an enrolled participant
at a fee set by, or at a fee subject to the approval of, the dental plan or dental organization
unless the dental services are covered services.
(b) A dental plan or dental organization or other person 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.
(c) "Covered services" means dental care services deleted text begin for which a reimbursement is available
under an enrollee's plan contract, or for which a reimbursement would be available but for
the application of contractual limitations such as deductibles, co-payments, coinsurance,
waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit
payments, or any other limitationdeleted text end new text begin that are reimbursed in whole or in part under a dental
provider agreementnew text end .
new text begin
(d) Nothing in this section shall be construed as limiting the ability of a dental plan or
dental organization or other person providing third party administrator services to restrict
any of the following as they relate to covered services:
new text end
new text begin
(1) balance billing;
new text end
new text begin
(2) waiting periods;
new text end
new text begin
(3) frequency limitations;
new text end
new text begin
(4) deductibles; or
new text end
new text begin
(5) maximum annual benefits.
new text end