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AN ACT prohibiting the imposition by a dental plan of fee schedules for the provision of dental services that are not covered by the plan.
Be It Enacted by the General Assembly of the State of Iowa:
Section 1. NEW SECTION. 514C.3B Dental coverage—fee schedules.
- A contract between a dental plan and a dentist for the provision of services to covered individuals under the plan shall not require that a dentist provide services to those covered individuals at a fee set by the dental plan unless such services are covered services under the dental plan.
- A person or entity providing third-party administrator services shall not make available any dentists in its dentist network to a dental plan that sets fees for dental services that are not covered
- For the purpose of this section:
a. “Covered services” means services reimbursed under the dental plan.
b. “Dental plan” means any policy or contract of insurance which provides for coverage of dental services not in connection with a medical plan that provides for the coverage of medical services.
- Nothing in this section shall be construed as limiting the ability of an insurer or a third-party administrator to restrict any of the following as they relate to covered services:
a. Balance billing.
b. Waiting periods.
c. Frequency limitations.
d. Deductibles
e. Maximum annual benefits
