GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2009

 

 

SESSION LAW 2010-138

HOUSE BILL 144

 

 

AN ACT to prohibit health benefit plans and insurers from limiting or fixing the fee a dentist may charge patients for services unless the services are covered for reimbursement under the plan or insurer contract with the dentist.

 

The General Assembly of North Carolina enacts:

 

SECTION 1.  Chapter 58 of the General Statutes is amended by adding a new section to read:

"§ 58‑50‑290.  Health benefit plans or insurers contracting for provision of dental services; no limitation on fees for noncovered services.

(a)        No agreement between an insurer or an entity that writes stand‑alone dental insurance and a dentist for the provision of dental services on a preferred or in‑network basis to plan members or insurance subscribers in connection with coverage under a stand‑alone dental plan, but not in connection with or incidental to coverage under a medical plan or health insurance policy, may require that a dentist provide services at a fee limited or set by the plan or insurer, unless the services are reimbursed as covered services under the contract.

(b)        For purposes of this section, "covered services" means a service for which  reimbursement is available under an insurer's policy, without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or other limitation."

SECTION 2.  G.S. 58‑65‑2 reads as rewritten:

"§ 58‑65‑2.  Other laws applicable to service corporations.

The following provisions of this Chapter are applicable to service corporations that are subject to this Article:

G.S. 58‑2‑125.                           Authority over all insurance companies; no exemptions from license.

G.S. 58‑2‑150.                           Oath required for compliance with law.

G.S. 58‑2‑155.                           Investigation of charges.

G.S. 58‑2‑160.                           Reporting and investigation of insurance and reinsurance fraud and the financial condition of licensees; immunity from liability.

G.S. 58‑2‑162.                           Embezzlement by insurance agents, brokers, or administrators.

G.S. 58‑2‑185.                           Record of business kept by companies and agents; Commissioner may inspect.

G.S. 58‑2‑190.                           Commissioner may require special reports.

G.S. 58‑2‑195.                           Commissioner may require records, reports, etc., for agencies, agents, and others.

G.S. 58‑2‑200.                           Books and papers required to be exhibited.

G.S. 58‑3‑50.                             Companies must do business in own name; emblems, insignias, etc.

G.S. 58‑3‑100(c),(e).                  Insurance company licensing provisions.

G.S. 58‑3‑115.                           Twisting with respect to insurance policies; penalties.

G.S. 58‑7‑46.                             Notification to Commissioner for president or chief executive officer changes.

Part 7 of Article 10.                     Annual Financial Reporting.

G.S. 58‑50‑35.                           Notice of nonpayment of premium required before forfeiture.

G.S. 58‑50‑290.                         Health benefit plans or insurers contracting for the provision of dental services; no limitation on fees for noncovered services.

G.S. 58‑51‑15(a)(2)b.                 Accident and health policy provisions.

G.S. 58‑51‑17                            Portability for accident and health insurance.

G.S. 58‑51‑25.                           Policy coverage to continue as to mentally retarded or physically handicapped children.

G.S. 58‑51‑95(h),(i),(j).              Approval by Commissioner of forms, classification and rates; hearings; exceptions."

SECTION 3.  This act is effective when it becomes law and applies to contracts between dentists and heath benefit plans or insurers delivered, amended, or renewed on or after that date.

In the General Assembly read three times and ratified this the 9^th day of July, 2010.

 

 

                                                                    s/  Walter H. Dalton

                                                                         President of the Senate

 

 

                                                                    s/  Joe Hackney

                                                                         Speaker of the House of Representatives

 

 

                                                                    s/  Beverly E. Perdue

                                                                         Governor

 

 

Approved 5:35 p.m. this 21^st day of July, 2010