Bill Text: NJ S2853 | 2020-2021 | Regular Session | Amended
Bill Title: Prohibits carrier from precluding dentist from billing covered person under certain circumstances.
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-06-02 - Reported out of Asm. Comm. with Amendments, and Referred to Assembly Appropriations Committee [S2853 Detail]
Download: New_Jersey-2020-S2853-Amended.html
Sponsored by:
Senator NELLIE POU
District 35 (Bergen and Passaic)
SYNOPSIS
Prohibits certain provisions in agreements between insurance carriers and dentists.
CURRENT VERSION OF TEXT
As reported by the Senate Commerce Committee on October 22, 2020, with amendments.
An Act concerning dental insurance and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier shall not include in an agreement between the carrier and a participating dentist a provision that:
(1) allows the carrier to deny payment to a participating dentist for a 1covered1 procedure performed or for a 1covered1 service provided on behalf of a covered person; and
(2) prohibits the dentist from collecting the amount owed from the covered person for that procedure or service.
b. 1Nothing this act shall exempt or limit a participating dentist from the provisions of the "Insurance Fraud Prevention Act," P.L.1983, c.320 (C.17:33A-1 et seq.).
c.1 As used in this section:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization or health maintenance organization authorized to issue dental contracts 1, policies,1 or plans in this State.
1"Covered person" means a person on whose behalf a carrier offering a dental plan is obligated to pay benefits for or provide dental procedures or services pursuant to the plan.
"Covered procedure or service" means a dental care procedure or service for which a reimbursement is available under a covered person's dental plan, or for which a reimbursement would be available but for the application of contractual limitations including, but not limited to, deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation, or services not reimbursable by the carrier due a provision in the dental plan.
"Dental plan" means a benefits plan, policy, or contract which pays or provides dental expense benefits for covered procedures or services and is delivered or issued for delivery in this State by or through a carrier either on a stand-alone basis or as part of other coverage including, but not limited to, health benefits coverage.
For the purposes of this act, dental plan shall not include the following plans, policies, or contracts: accident only, credit disability, long-term care, Medicare supplement coverage; TRICARE supplement coverage, coverage for Medicare services pursuant to a contract with the United States government, the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), coverage arising out of a worker's compensation or similar law, the State Health Benefits Program, the School Employees' Health Benefits Program, or a self-insured health benefits plan governed by the provisions of the federal "Employee Retirement Income Security Act of 1974," 29 U.S.C. s.1001 et seq., coverage under a policy of private passenger automobile insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity coverage.1
"Participating dentist" means a dentist who has entered into a contract with a carrier to provide dental services to covered persons for a predetermined fee or set of fees.
2. This act shall take effect on the 90th day next following enactment, and shall apply to dental contracts or plans issued or renewed after the effective date.
