INDIANA

SENATE ENROLLED ACT No. 136

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AN ACT to amend the Indiana Code concerning insurance. Be it enacted by the General Assembly of the State of Indiana:

SECTION 1. IC 27-7-17.5 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2022]:

Chapter 17.5. Dental Plans Setting Fees for Dental Services Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to:

(1) dental services; or

(2) coverage of dental services.

Sec. 2. As used in this chapter, "covered service" means a dental service for which a reimbursement:

(1) is available under a dental plan; or

(2) would be available under a dental plan but for the application of contractual limitations such as: (A) deductibles;

(B) copayments;

(C) coinsurance;

(D) waiting periods;

(E) annual or lifetime maximums;

(F) frequency limitations;

(G) alternative benefit payments; or

(H) any other limitation; under the dental plan

Sec. 3. (a) As used in this chapter, "dental plan" means any of the following:

(1) A policy issued by an insurer (as defined in IC 27-1-2-3(x)) that provides coverage for dental services.

(2) A contract under which a health maintenance organization (as defined in IC 27-13-1-19) provides or covers dental services.

(3) A preferred provider plan (as defined in IC 27-8-11-1(g)) that provides or covers dental services.

(b) The term does not include the following:

(1) A policy providing comprehensive coverage described in Class 1(b) and Class 2(a) of IC 27-1-5-1.

(2) Accident only, Medicare supplement, long term care, or disability income insurance.

(3) Coverage issued as a supplement to liability insurance.

(4) Automobile medical payment insurance.

(5) A specified disease policy.

(6) Worker's compensation or similar insurance.

(7) A student health plan.

(8) A supplemental plan that always pays in addition to other coverage.

Sec. 4. As used in this chapter, "dental service" means any service provided by a dentist within the scope of the dentist's licensure under IC 25-14.

Sec. 5. As used in this chapter, "person" means an individual, a corporation, a limited liability company, a partnership, or any other legal entity.

Sec. 6. As used in this chapter, "provider" means:

(1) a dentist licensed under IC 25-14; or

(2) a dental office through which one (1) or more dentists licensed under IC 25-14 provide dental services.

Sec. 7. A dental plan may not directly or indirectly require a provider to provide a dental service to a covered individual at a fee amount that is:

(1) set by the dental plan; or

(2) subject to the approval of the dental plan; unless the dental service is a covered service.

Sec. 8. A third party administrator or other person that:

(1) is not a dental plan; but

(2) arranges for providers to provide dental services through dental plans or through another sort of network arrangement; shall not arrange for a provider to provide dental services for a dental plan that sets the amount of the fee for the dental services unless the dental services are covered services under the dental plan.

Sec. 9. (a) If:

(1) an insurer (as defined in IC 27-1-2-3(x));

(2) a health maintenance organization (as defined in IC 27-13-1-19);

(3) a preferred provider plan (as defined in IC 27-8-11-1(g)); or

(4) any other person; violates this chapter, the insurance commissioner may enter an order requiring the person to cease and desist from violating this chapter.

(b) If a person violates a cease and desist order issued under subsection (a), the insurance commissioner, after notice and hearing under IC 4-21.5, may:

(1) impose a civil penalty upon the person of not more than ten thousand dollars ($10,000) for each day of violation; (2) suspend or revoke the person's certificate of authority, if the person holds a certificate of authority under this title; or (3) both impose a civil penalty upon the person under subdivision (1) and suspend or revoke the person's certificate of authority under subdivision (2).

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