Dental Insurance Guy

Resources>State Regulations>Utah

If you would like more information on how to implement these laws within your state, join today or login to view.

LONG TITLE

General Description:

This bill regulates certain contract provisions for dental services.

Highlighted Provisions:

This bill:

defines terms;
prohibits a dental insurer from setting fees for dental services that are not covered services under dental insurance; and
applies to dental plans entered into or renewed on or after January 1, 2018.

Utah Code Sections Affected:

ENACTS:

31A-22-645, Utah Code Annotated 1953

Be it enacted by the Legislature of the state of Utah:

Section 1. Section 31A-22-645 is enacted to read:

31A-22-645. Dental insurance -- Contract provision for noncovered services.

(1) For purposes of this section:
- (a) "Covered services" means dental services for which reimbursement:
  - (i) (A) is available under an enrollee's dental plan; or
    - (B) would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation; and
  - (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (b) "Dental plan" means:
  - (i) a health benefit plan that includes coverage for dental services; and
  - (ii) a policy or certificate that provides coverage solely for dental services.
- (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
(2) (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
(3) A contract between a dental plan and a dentist to provide contracted services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
  - (i) the dental services are covered services under the dental plan; or
  - (ii) (A) the dental services are not reimbursed by the dental plan;
    - (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
    - (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the

LONG TITLE

General Description:

This bill regulates certain contract provisions for dental services.

Highlighted Provisions:

This bill:

defines terms;
prohibits a dental insurer from setting fees for dental services that are not covered services under dental insurance; and
applies to dental plans entered into or renewed on or after January 1, 2018.

Utah Code Sections Affected:

ENACTS:

31A-22-645, Utah Code Annotated 1953

Be it enacted by the Legislature of the state of Utah:

Section 1. Section 31A-22-645 is enacted to read:

31A-22-645. Dental insurance -- Contract provision for noncovered services.

(1) For purposes of this section:
- (a) "Covered services" means dental services for which reimbursement:
  - (i) (A) is available under an enrollee's dental plan; or
    - (B) would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation; and
  - (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (b) "Dental plan" means:
  - (i) a health benefit plan that includes coverage for dental services; and
  - (ii) a policy or certificate that provides coverage solely for dental services.
- (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
(2) (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
(3) A contract between a dental plan and a dentist to provide contracted services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
  - (i) the dental services are covered services under the dental plan; or
  - (ii) (A) the dental services are not reimbursed by the dental plan;
    - (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
    - (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the

LONG TITLE

General Description:

This bill regulates certain contract provisions for dental services.

Highlighted Provisions:

This bill:

defines terms;
prohibits a dental insurer from setting fees for dental services that are not covered services under dental insurance; and
applies to dental plans entered into or renewed on or after January 1, 2018.

Utah Code Sections Affected:

ENACTS:

31A-22-645, Utah Code Annotated 1953

Be it enacted by the Legislature of the state of Utah:

Section 1. Section 31A-22-645 is enacted to read:

31A-22-645. Dental insurance -- Contract provision for noncovered services.

(1) For purposes of this section:
- (a) "Covered services" means dental services for which reimbursement:
  - (i) (A) is available under an enrollee's dental plan; or
    - (B) would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation; and
  - (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (b) "Dental plan" means:
  - (i) a health benefit plan that includes coverage for dental services; and
  - (ii) a policy or certificate that provides coverage solely for dental services.
- (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
(2) (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
(3) A contract between a dental plan and a dentist to provide contracted services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
  - (i) the dental services are covered services under the dental plan; or
  - (ii) (A) the dental services are not reimbursed by the dental plan;
    - (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
    - (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the

LONG TITLE

General Description:

This bill regulates certain contract provisions for dental services.

Highlighted Provisions:

This bill:

defines terms;
prohibits a dental insurer from setting fees for dental services that are not covered services under dental insurance; and
applies to dental plans entered into or renewed on or after January 1, 2018.

Utah Code Sections Affected:

ENACTS:

31A-22-645, Utah Code Annotated 1953

Be it enacted by the Legislature of the state of Utah:

Section 1. Section 31A-22-645 is enacted to read:

31A-22-645. Dental insurance -- Contract provision for noncovered services.

(1) For purposes of this section:
- (a) "Covered services" means dental services for which reimbursement:
  - (i) (A) is available under an enrollee's dental plan; or
    - (B) would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation; and
  - (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (b) "Dental plan" means:
  - (i) a health benefit plan that includes coverage for dental services; and
  - (ii) a policy or certificate that provides coverage solely for dental services.
- (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
(2) (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
(3) A contract between a dental plan and a dentist to provide contracted services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
  - (i) the dental services are covered services under the dental plan; or
  - (ii) (A) the dental services are not reimbursed by the dental plan;
    - (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
    - (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the

LONG TITLE

General Description:

This bill regulates certain contract provisions for dental services.

Highlighted Provisions:

This bill:

defines terms;
prohibits a dental insurer from setting fees for dental services that are not covered services under dental insurance; and
applies to dental plans entered into or renewed on or after January 1, 2018.

Utah Code Sections Affected:

ENACTS:

31A-22-645, Utah Code Annotated 1953

Be it enacted by the Legislature of the state of Utah:

Section 1. Section 31A-22-645 is enacted to read:

31A-22-645. Dental insurance -- Contract provision for noncovered services.

(1) For purposes of this section:
- (a) "Covered services" means dental services for which reimbursement:
  - (i) (A) is available under an enrollee's dental plan; or
    - (B) would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation; and
  - (ii) is not merely nominal, for the purpose of avoiding the requirements of this section.
- (b) "Dental plan" means:
  - (i) a health benefit plan that includes coverage for dental services; and
  - (ii) a policy or certificate that provides coverage solely for dental services.
- (c) "Dentist" means an individual licensed under Tile 58, Chapter 69, Dentist and Dental Hygienist Practice Act.
(2) (a) This section applies to:
- (i) a dental plan that is entered into or renewed on or after January 1, 2018; and
- (ii) an administrator providing third-party administration services or a provider network for a dental plan.
- (b) This section does not apply to a self-insured dental plan that is regulated by federal law.
(3) A contract between a dental plan and a dentist to provide contracted services may not:
- (a) require, directly or indirectly, that a dentist provide dental services to a covered individual at a fee set by, or a fee subject to the approval of, the dental plan unless:
  - (i) the dental services are covered services under the dental plan; or
  - (ii) (A) the dental services are not reimbursed by the dental plan;
    - (B) the dental services are discounted for individuals who are part of a discount dental rates plan; and
    - (C) the dentist who provided the dental services has elected to participate in the discount dental rates plan; and
- (b) prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the

UTAH

Our Dental Community Sponsors