APPROVED 04/29/2010

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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.

  1. 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.
  2. 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
  3. 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.

  1. 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

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