To enact R.S. 22:1157, relative to contracts with dental providers; to provide that no dental plan may require that a dentist provide dental health care services to a covered person at a particular fee unless such services are covered services for which benefits are paid under a contract with such dentist; and to provide for related matters.
Be it enacted by the Legislature of Louisiana:
Section 1. R.S. 22:1157 is hereby enacted to read as follows:
§1157. Dental reimbursement or payments
As used in this Section, the following definitions shall apply:
- "Covered person" means any subscriber, enrollee, member, or participant in a dental plan, or his dependent, for whom benefits are payable when that person receives dental health care services rendered or authorized by a licensed dentist.
- "Covered service" means any dental service rendered or authorized by a licensed dentist on a covered person for which a dental service contractor or insurer is required to pay benefits to the dentist under a contractual agreement with such dentist. Such a service includes any service on which reimbursement is limited by a deductible, copayment, coinsurance, waiting period, annual maximum, or frequency limitation.
- "Dental plan" means any insurance policy, benefit plan, or dental service contract providing for the payment of benefits for dental health care services.
- No dental plan that is delivered, renewed, issued for delivery, or otherwise contracted for in this state may require that a dentist provide dental health care services to a covered person at a particular fee unless such services are covered services for which benefits are paid under a contract with such dentist.
Nothing in this Section shall prohibit a dental service contractor or insurer from offering a dentist optional agreement for participation in a dental plan in which a dentist may choose to participate either with or without a provision to provide discounts to covered persons for non-covered services provided that all of the following apply:
- No dental service contractor or insurer may restrict in any manner the choice of any dentist to participate in the plan with or without an optional agreement providing for discounts on non-covered services except that the option for any dentist choosing to participate in the plan under such an optional agreement to cease providing such discounts under said optional agreement but still continue participating in the plan may be limited to each time said optional agreement is up for renewal.
- The provision for discounts on non-covered services shall be the only material difference between agreements entered into with a dentist who accepts such an optional agreement and those with a dentist who accepts a contract without said optional agreement.
Section 2. This Act shall become effective January 1, 2011.
Section 3. The provisions of this Act shall not apply to contracts already in existence 19 until the renewal or extension date of such contracts.