OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
HB. 160 Bill Analysis
135th General Assembly
Click here for H.B. 160’s Fiscal Note
Version: As Reported by House Insurance
Primary Sponsor: Rep. Santucci
Effective Date:
Logan Briggs, Attorney
SUMMARY
 Requires health plan issuers to notify covered persons that they may incur out-of-pocket
expenses for dental care services that are not covered services.
 Prohibits a contracting entity from requiring a dental care provider to accept a payment
amount set by the contracting entity for dental care services unless those services are
covered services.
 Makes a violation of the above provisions an unfair and deceptive act in the business of
insurance.
 Requires dental care providers to disclose pricing and certain other information for
dental care services that are not covered services.
 Subjects providers who violate the bill’s disclosure requirements to professional
discipline.
DETAILED ANALYSIS
Overview
The bill modifies the law governing health plan issuers, health care contracts, and dental
care providers to include several contract and disclosure requirements related to the provision
of dental care services that are not covered by insurance. The bill requires health pan issuers to
notify covered persons of potential out-of-pocket costs, prohibits inclusion of certain terms in
contracts between contracting entities and dental care providers, and requires certain pricing
disclosures by dental care providers. The bill’s requirements for dental care services are similar,
in some respects, to current law requirements for vision care services. However, unlike vision
care, where the requirements apply to both services and materials, the bill’s dental care
requirements apply only to services. The bill does not address insurance contracts that
exclusively cover dental care materials.
May 9, 2024
Office of Research and Drafting LSC Legislative Budget Office
Health Plan Issuers
Notifications
The bill imposes disclosure requirements on any health care policy, contract,
agreement, or plan of a (1) health insuring corporation, (2) sickness and accident insurer,
(3) multiple employer welfare arrangement, or (4) public employee benefit plan (collectively,
health plan issuers) covering dental care services. The bill requires the following notification to
be made to all individuals covered by such a health benefit plan:
IMPORTANT: If you opt to receive dental care services that are not
covered benefits under this plan, a participating dental care
provider may charge you his or her normal fee for such services.
Prior to providing you with dental care services that are not
covered benefits, the dental care provider will provide you with
an estimated cost for each service.1
Similarly, health plan issuers must explain to covered persons that they may incur out-
of-pocket expenses as a result of the purchase of dental care services that are not covered. The
explanation must be provided in a manner similar to that in which the health plan issuer
provides a covered person with information on a health benefit plan’s coverage levels and out-
of-pocket expenses.2
Unfair and deceptive practice
Under continuing law, a continuous or repeated practice by a health plan issuer of
violating notice requirements is an unfair and deceptive practice. This classification also applies
to the bill’s new requirements related to dental care services.3 Under continuing law, a person
who is found to have committed an unfair and deceptive practice in the business of insurance is
subject to any or all of the following sanctions:
 Suspension or revocation of the person’s license to engage in the business of insurance;
 Prohibition on an insurance company or insurance agency employing the person or
permitting the person to serve the company or agency in any capacity for a period of
time;
 Return of any payments received by the person as a result of the violation;
 Fees for attorneys and other costs of any investigation into the violations committed by
the person.4
1 R.C. 1751.85(B)(2) and 3923.86(B)(2); R.C. 1739.05, not in the bill.
2 R.C. 1751.85(B)(4) and 3923.86(B)(4); R.C. 1739.05, not in the bill.
3 R.C. 1751.85(C), 3901.21(BB), and 3923.86(C); R.C. 1739.05, not in the bill.
4 R.C. 3901.22, not in the bill.
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Health Care Contracts
Provider contract terms
The bill also prohibits certain terms from being included in health care contracts
between a dental care provider and a contracting entity (i.e., any person that has the primary
business purpose of contracting with participating providers for the delivery of health care
services). Under the bill such contracts must not require, or be made contingent upon, a dental
care provider accepting an amount set by the contracting entity as payment for dental care
services other than covered services. A dental care provider may choose to accept an amount
set by the contracting entity as payment for noncovered dental care services. Furthermore, a
covered entity may communicate to covered persons which dental care providers have made
such a choice. However, other than noting the provider’s decision, the bill requires contracting
entities to treat all participating, in-network dental care providers equally in provider
directories, locators, and other marketing materials.
In addition, the bill prohibits a contracting entity from requiring a dental care provider
to contract with a benefit plan offering supplemental or specialty health care services as a
condition of contracting with a plan offering basic health care services.
The bill states that these provisions apply to contracts entered into, amended, or
renewed on or after January 1, 2024.5 However, the bill could be vulnerable to challenge as
applied to contracts that are entered into before its effective date, and that are not renewed or
amended after that date. The Ohio Constitution prohibits “retroactive laws, or laws impairing
the obligation of contracts . . . .”6 Similarly, the U.S. Constitution prohibits states from passing
an “ex post facto Law, or Law impairing the Obligation of Contracts . . . .”7
Dental care provider disclosures
The bill requires a dental care provider that chooses not to accept a payment amount
set by a contracting entity for dental services, other than covered services, to provide pricing
and reimbursement information for those services. The information must include the estimated
fee or discounted price suggested by the contracting entity, the estimated fee charged by the
dental care provider, the amount the dental care provider expects to be reimbursed by the
contracting entity, and estimated pricing and reimbursement information for any covered
services that are also expected to be provided during the covered person’s visit. Furthermore,
the dental care provider must post, in a conspicuous place, a notice stating the following:
IMPORTANT: This dental care provider does not accept the fee
schedule set by your insurer for dental care services that are not
covered benefits under your plan and instead charges his or her
5 R.C. 3963.01 (E) and (G) and 3963.02(F)(1).
6 Ohio Constitution, Article II, Section 28, not in the bill.
7 U.S. Constitution, Article I, Section10, Cl. 1, not in the bill.
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normal fee for those services. This dental care provider will
provide you with an estimated cost for each noncovered service.8
Meaning of provisions
The bill specifies that its health care contract provisions are not to be construed as doing
any of the following:
 Restricting or limiting a contracting entity’s ability to enter into an agreement with
another contracting entity or an affiliate of another contracting entity;
 Restricting or limiting a health care plan’s ability to enter into an agreement with a
dental care plan to deliver routine dental care services that are covered under a covered
person’s plan;
 Restricting or limiting a dental care plan network from acting as a network for a health
care plan;
 Prohibiting a participating dental care provider from accepting as payment an amount
that is the same as the amount set by the contracting entity for dental care services that
are not covered dental services.9
Furthermore, the bill specifies that continuing law’s requirements relating to the
termination of health care contracts are not to be construed as authorizing the Superintendent
of Insurance to exercise regulatory authority over dental care providers.10
Enforcement
Health Care Contract Law
The health care contract provisions described above are part of Ohio’s Health Care
Contract Law. Continuing law authorizes the Superintendent of Insurance to conduct a market
investigation of any person regulated by the Department of Insurance under Ohio’s Insurance
Law or Ohio’s Corporation and Partnership Law to determine whether any violation of the
Health Care Contract Law has occurred. When conducting such an examination, the
Superintendent can assess the costs of the examination against the person examined.
The Superintendent may enter into a consent agreement to impose any administrative
assessment or fine for conduct discovered that may be a violation of the Health Care Contract
Law. In addition, a series of violations of the Health Care Contract Law by any person regulated
by the Department of Insurance that, taken together, constitute a pattern or practice of
violating that Law may constitute an unfair and deceptive insurance practice.11
8 R.C. 3963.02(F)(2).
9 R.C. 3963.02(F)(3).
10 R.C. 3963.02(G)(5).
11 R.C. 3963.09, not in the bill.
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As Reported by House Insurance
Office of Research and Drafting LSC Legislative Budget Office
The bill also specifies that a violation of its dental care services provisions is an unfair or
deceptive practice in the business of insurance (see “Unfair and deceptive practice”
above for a description of possible sanctions).12
Professional licensing law
In addition, the bill subjects a dental care provider that engages in a pattern of
continuous or repeated violations of the bill’s disclosure, pricing, and notice requirements to
discipline by the State Dental Board. Such discipline may include suspension or revocation of
the provider’s license to practice dentistry, formal censure, or other corrective actions.13
Definitions
The bill makes the following definitions:
“Covered dental services” means dental care services for which reimbursement is
available under an enrollee’s health care contract, or for which a reimbursement would be
available but for the application of contractual limitations, such as a deductible, copayment,
coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative
benefit payment, or any other limitation.
“Dental care provider” means a dentist licensed by the State Dental Board. “Dental care
provider” does not include a dental hygienist.14
HISTORY
Action Date
Introduced 04-26-23
Reported, H. Insurance 05-08-24
ANHB0160RH-135/ar
12 R.C. 3901.21(BB).
13 R.C. 4715.30(A)(19) and (C).
14 R.C. 3963.01(E) and (G).
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Statutes affected:
As Introduced: 1751.85, 1753.09, 3901.21, 3923.86, 3963.01, 3963.02, 3963.03, 4715.30
As Reported By House Committee: 1751.85, 1753.09, 3901.21, 3923.86, 3963.01, 3963.02, 3963.03, 4715.30