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).
