ENROLLED SENATE
BILL NO. 975	By:	Johnson (Rob), Bass and Shortey of the Senate

			and

		Kirby and Pittman of the House

An Act relating to insurance; amending 36 O.S. 2011, Section 7301, which relates to dental plan fee regulation; specifying certain contract requirements for services rendered by a dentist; and providing an effective date.

SUBJECT:  Health and dental policy requirements

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

SECTION 1.     AMENDATORY     36 O.S. 2011, Section 7301, is amended to read as follows:

Section 7301.  A.  No contract between a dental plan of a health benefit plan and a dentist for the provision of services to patients may require that a dentist provide services to its subscribers at a fee set by the health benefit plan unless the services are covered services under the applicable subscriber agreement.

B.  As used in this section:

1.  "Covered services" means services reimbursable under the applicable subscriber agreement, subject to the contractual limitations on subscriber benefits as may apply, including, for example, deductibles, waiting period or frequency limitations;

2.  "Dental plan" means and shall include any policy of insurance which is issued by a health benefit plan which provides for coverage of dental services not in connection with a medical plan; and

3.  "Health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes this title or any dental service corporation authorized pursuant to Section 2671 of Title 36 of the Oklahoma Statutes this title.

C.  A health benefit plan or dental plan shall establish and maintain appeal procedures for any claim by a dentist or a subscriber that is denied based on lack of medical necessity.  Any such denial shall be based upon a determination by a dentist who holds a nonrestricted license in the United States.  Any written communication to a dentist that includes or pertains to a denial of benefits for all or part of a claim on the basis of a lack of medical necessity shall include the identifier and license number together with state of issuance, and a contact telephone number of the licensed dentist making the adverse determination.  The dentist who reviewed the claim shall only be contacted at the telephone number provided in the written communication about the denial during business hours.

SECTION 2.  This act shall become effective November 1, 2013.

Passed the Senate the 6th day of March, 2013.

	
	Presiding Officer of the Senate

Passed the House of Representatives the 11th day of April, 2013.

	
	Presiding Officer of the House
	of Representatives

OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________ day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________ day of ___________________, 20_______, at _______ o'clock _______ M.

	_________________________________
	Governor of the State of Oklahoma

OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________ day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________