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AN ACT to amend Tennessee Code Annotated, Title 56, Chapter 7, Part 10, relative to dental services.
BE IT ENACTED BYTHE GENERAL ASSEMBLY OFTHE STATEOFTENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 56, Chapter 7, Part 10, is amended by adding a new section as follows:
- 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 plan.
- No dentist participating in a dental network of a health care service contractor or other person providing third party administrator services shall, based on the dentist's participation in such network, be required to provide services to covered individuals in a plan that sets dental fees for any services unless such services are covered services under the plan.
For the purposes of this section:
- “Covered services” means services reimbursed under the dental plan that pays at least fifty percent (50%) of the dentist's prevailing fee, administered consistently with policies traditionally governing covered services; and
- “Dental plan” means any plan 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:
- Balance billing;
- Waiting periods;
- Frequency limitations;
- Deductibles; and
- Maximum annual benefits.
- An insurer is prohibited from using a third-party administrator to circumvent subdivision (a)(1).
- No benefit arrangement may impose a deductible, copayment, coinsurance, or any other requirement in such a way as to provide de minimus reimbursement and avoid the impact of this section.
- The commissioner shall investigate all complaints arising from this section.
SECTION 2. This act shall take effect upon becoming a law, the public welfare requiring it.