§ 26.1-47-02.2 — Dental networks

North Dakota § 26.1-47-02.2

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-47: Preferred Provider Organizations

Text

1. As used in this section:
a. "Affiliate" means a person that directly or indirectly through one or more
intermediaries controls, or is under the control of, or is under common control
with, the person specified.
b. "Contracting entity" means a person that enters a direct contract with a dental
provider for the delivery of dental services.
c. "Network" means a group of preferred dental providers providing services under a
network plan.
d. "Network plan" means a dental benefit plan that requires a covered individual to
use, or creates incentives, including financial incentives, for a covered individual
to use a dental provider managed by, owned by, under contract with, or employed
by the dental insurer.
e. "Third party" means an entity that is not a party to a contracting entity's dental
provider network.
2. A contracting entity may grant a third party access to a dental provider network
contract, or a provider's dental services or contractual discounts provided pursuant to
a dental provider network contract, if all of the following are met:
a. The contract specifically states the contracting entity may enter an agreement
with a third party allowing the third party to obtain the contracting entity's rights
and responsibilities as if the third party were the contracting entity.
b. If the contracting entity is a dental insurer, the dental provider may opt out of the
third-party access at the time the dental provider network contract was entered or
renewed.
c. The contracting entity identifies, in writing or electronic form to the dental
provider, all third parties in existence as of the date the contract is entered or
renewed.
d. The contracting entity notifies dental network providers that a new third party is
leasing or purchasing the network at least thirty days in advance of the
relationship taking effect.
e. The contracting entity makes available a copy of the dental provider network
contract relied on in the adjudication of a claim to a participating dental provider
within thirty days of a request from the dental provider.
3. A dental provider's refusal to agree in writing to the third-party access to the dental
provider network does not permit the contracting entity to end the contractual
relationship with the dental provider.
4. The provisions of this section do not apply if access to a provider network contract is
granted to a dental carrier or an entity operating in accordance with the same brand
licensee program as the contracting entity or to an entity that is an affiliate of the
contracting entity.