HF 1474

as introduced - 94th Legislature (2025 - 2026) Posted on 02/24/2025 03:27pm

A bill for an act
relating to insurance; changing definition of covered services for dental care;
amending Minnesota Statutes 2024, section 62Q.78, subdivision 6.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, 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 limitation deleted text end new text begin that are reimbursed in whole or in part under a dental
provider agreement new text end .

new text begin (d) A dentist may not charge more than the dentist's usual and customary rate for services
or procedures that are not covered services.
new text end

new text begin (e) Prior to providing a patient with dental services that are not a covered service under
the terms of a dental plan contract, the dentist should provide to the patient a treatment plan
that includes each anticipated service or procedure to be provided and the estimate cost of
each service or procedure.
new text end

new text begin (f) 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