Bill Text: AZ SB1418 | 2010 | Forty-ninth Legislature 2nd Regular | Introduced
Bill Title: Dental insurance; coordination of benefits
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-02-04 - Referred to Senate HEALTH Committee [SB1418 Detail]
Download: Arizona-2010-SB1418-Introduced.html
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REFERENCE TITLE: dental insurance; coordination of benefits |
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State of Arizona Senate Forty-ninth Legislature Second Regular Session 2010
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SB 1418 |
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Introduced by Senator Verschoor
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AN ACT
Amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20‑847; amending section 20‑1019, Arizona Revised Statutes; relating to Coordination of dental benefits.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-847, to read:
20-847. Dental service corporations; notice; coordination of benefits
A. A dental service corporation shall specify in its contracts with providers and subscribers how the corporation coordinates claims payments with one or more health care benefit plans covering the subscriber.
B. A dental service corporation shall pay full benefits according to its subscription contract with the subscriber if the corporation is primarily responsible to pay benefits and is coordinating its benefits with one or more carriers that are secondarily responsible. A carrier that is secondarily responsible to pay a claim shall pay any cost to the subscriber or to the provider after payment has been made by the primary carrier, not to exceed the contract's allowance of benefit in the subscriber's contract or the full fee for the provided service, whichever is less.
Sec. 2. Section 20-1019, Arizona Revised Statutes, is amended to read:
20-1019. Order of benefit determination for dental care; notice; coordination of benefits
A. If a person receiving dental care is a member of a prepaid dental plan and is an insured or certificate holder under an indemnity health insurance policy which that provides benefits for the same treatment as the person's prepaid dental plan, the indemnity health insurance policy, if issued after the effective date of this section September 15, 1989, shall pay benefits to its insured or certificate holder or the assignee thereof without regard to the existence of the prepaid dental plan.
B. Notwithstanding subsection A, the indemnity plan insurer is not obligated to pay any amount for a procedure covered without charge to the member of the prepaid dental plan or to pay in excess of the amount of the member's obligation under the prepaid dental plan.
C. In the event that If the member's copayment obligation under the prepaid dental plan has been met, then the indemnity insurer shall remit any payments due under this section directly to its insured or certificate holder.
D. A prepaid dental plan organization shall specify in its contracts with providers and enrollees how the organization coordinates claims payments with one or more health care benefit plans covering the enrollee.
E. A prepaid dental plan organization shall pay full benefits according to its contract with the enrollee if the organization is primarily responsible to pay benefits and is coordinating its benefits with one or more carriers that are secondarily responsible. A carrier that is secondarily responsible to pay a claim shall pay any cost to the enrollee or to the provider after payment has been made by the primary carrier, not to exceed the plan's allowance of benefit in the enrollee's contract or the full fee for the provided service, whichever is less.
D. F. The director may adopt rules to enforce this section.
