§1157. Dental reimbursement or payments
A. As used in this Section, the following definitions shall apply:
(1)"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
healthcare services rendered or authorized by a licensed dentist.
(2)"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.
(3)"Credit card payment" means
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§1157. Dental reimbursement or payments
A. As used in this Section, the following definitions shall apply:
(1) "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
healthcare services rendered or authorized by a licensed dentist.
(2) "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.
(3) "Credit card payment" means a type of electronic funds transfer in which a dental
plan or its contracted vendor issues a single-use series of numbers associated with the
payment of healthcare services performed by a dentist chargeable for a predetermined dollar
amount, requiring the dentist to be responsible for processing the payment by a credit card
terminal or internet portal. "Credit card payment" includes a virtual or online credit card
payment, in which no physical credit card is presented to the healthcare provider and the
single-use credit card expires upon payment processing.
(4) "Dental plan" means any insurance policy, benefit plan, or dental service contract
providing for the payment of benefits for dental healthcare services.
(5) "Electronic funds transfer" means an electronic funds transfer through the federal
Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, standard
automated clearinghouse network.
B. 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.
C. Nothing in this Section shall prohibit a dental service contractor or insurer from
offering a dentist optional agreements 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:
(1) 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.
(2) 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.
D.(1) No dental plan that is delivered, renewed, issued for delivery, or otherwise
contracted for in this state shall restrict methods of payment from the dental plan to the
dentist for the purpose of making a credit card payment the only means of payment
acceptable for healthcare services provided by the dentist to an insured.
(2) If initiating or changing payments to a dentist using electronic funds transfers or
credit card payments, a dental plan shall do both of the following:
(a) Notify the dentist if any fees are associated with a particular payment method.
(b) Advise the dentist of all the available methods of payment and provide clear
instructions to the dentist on how to select an alternative payment method.
(3) The provisions of this Subsection shall not be waived by contract, and any
contractual clause in conflict with the provisions of this Subsection or that purports to waive
any requirements of this Subsection is void.