§4261. Fees for covered dental services
1.
Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A.
"Covered dental service" means a dental service for which reimbursement is available under an individual or group contract or for which 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 similar limitation.
[PL 2025, c. 298, §4 (NEW).]
B.
"Dental provider" means a person licensed under Title 32, chapter 143, subchapter 3.
[PL 2025, c. 298, §4 (NEW).]
[PL 2025, c. 298, §4 (NEW).]
2.
Prohibition of required fees for dental services not covered.
A health maintenance organization that issues individual or group dental insurance or individual or group contracts that include coverage for dental services may not require, directly or indirectly, that a participating dental provider provide dental services at a fee set by, or subject to the approval of, the health maintenance organization for a service that is not a covered dental service.
[PL 2025, c. 298, §4 (NEW).]
3.
Fees for covered dental services.
A fee for a covered dental service must be set by the health maintenance organization in good faith and may not be nominal.
[PL 2025, c. 298, §4 (NEW).]
SECTION HISTORY
PL 2025, c. 298, §4 (NEW).