This bill amends existing laws regarding dental insurance assignment of benefits within the context of accident and sickness insurance policies, nonprofit hospital service corporations, and health maintenance organizations. It establishes that any entity licensed under these chapters must allow insured individuals to direct, in writing, that their dental benefits and corresponding reimbursements for covered services be paid directly to any dental care provider, regardless of whether the provider has contracted with the insurance entity.

The bill specifies that upon receipt of a duly executed written direction to pay, the insurance entity must pay the benefits directly to the dental care provider. The amount paid to the provider must be no less than the highest reimbursement amount actually paid to any participating provider for the same covered dental service, as listed in the entity's benefit allowance tables or fee schedules. It also prohibits the use of tiered reimbursement structures, geographic modifiers, or network classifications to reduce this benchmark amount.

Furthermore, the bill ensures that the insurance entity cannot reduce, modify, or condition the benefit amount based on the provider's non-participation. It allows for the review of the provider's records related exclusively to the specific patient to verify that services were rendered and that such treatment meets the entity's criteria for benefit payment. The act is set to take effect on January 1, 2027, and aims to clarify the payment process for dental insurance benefits.

Statutes affected:
2887: 27-18-63, 27-19-54, 27-41-66