Chief Sponsor: Allen M. Christensen
House Sponsor: Raymond P. Ward

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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:


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

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