SB1138 - 542R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 20-847, Arizona Revised Statutes, is amended to read:

START_STATUTE20-847. Contracts; dentists; covered services; website; overpayments; predetermination of benefits; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a dental service corporation and a dentist who is licensed to practice in this state shall not require the dentist to provide services a service to an individual covered under a subscription contract based on a fee set by the dental service corporation unless the service for which the fee applies is a covered service under the individual's subscription contract.

B. This section does not restrict the ability of a dental service corporation to establish dental benefits for services offered by plans that are administered but not insured by the dental service corporation.

C. A dental service corporation shall establish an internet website to provide resources and information to dentists and subscribers. The website shall:

1. Include information about each type of subscription contract that is sufficient enough to allow subscribers and dentists to determine the covered services under each subscription contract and the payment or reimbursement amounts for those covered services.

2. be accessible at no charge to subscribers and dentists.

D. A dental service corporation may not deduct the amount of an overpayment of a claim from a payment or reimbursement of another claim unless both claims were for covered services provided to the same subscriber by the same dentist.

E. A dental service corporation that provides a written predetermination of benefits to a dentist for a covered service that includes a specific benefit payment or reimbursement amount may not pay or reimburse the dentist for providing that service in an amount that is less than the amount set forth in the predetermination.

C. F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a subscription contract without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation. END_STATUTE

Sec. 2. Section 20-1057.12, Arizona Revised Statutes, is amended to read:

START_STATUTE20-1057.12. Contracts; dentists; covered services; website; overpayments; predetermination of benefits; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a health care services organization and a dentist who is licensed to practice in this state shall not require the dentist to provide services a service to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the services service for which the fee applies is a covered service under the individual's evidence of coverage.

B. This section does not restrict the ability of a health care services organization to establish dental benefits for services offered by plans that are administered but not insured by the health care services organization.

C. A health care services organization shall establish an internet website to provide resources and information to dentists and enrollees. The website shall:

1. Include information about each type of evidence of coverage that is sufficient enough to allow enrollees and dentists to determine the covered services under each evidence of coverage and the payment or reimbursement amounts for those covered services.

2. be accessible at no charge to enrollees and dentists.

D. A health care services organization may not deduct the amount of an overpayment of a claim from a payment or reimbursement of another claim unless both claims were for covered services provided to the same enrollee by the same dentist.

E. A health care services organization that provides a written predetermination of benefits to a dentist for a covered service that includes a specific benefit payment or reimbursement amount may not pay or reimburse the dentist for providing that service in an amount that is less than the amount set forth in the predetermination.

C. F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation. END_STATUTE

Sec. 3. Section 20-1342.06, Arizona Revised Statutes, is amended to read:

START_STATUTE20-1342.06. Contracts; dentists; covered services; website; overpayments; predetermination of benefits; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services a service to an individual covered under a disability insurance policy based on a fee set by the disability insurer unless the services service for which the fee applies is a covered service under the individual's disability insurance policy.

B. This section does not restrict the ability of a disability insurer to establish dental benefits for services offered by plans that are administered but not insured by the disability insurer.

C. A disability insurer shall establish an internet website to provide resources and information to dentists and insureds. The website shall:

1. Include information about each type of disability policy that is sufficient enough to allow insureds and dentists to determine the covered services under each policy and the payment or reimbursement amounts for those covered services.

2. be accessible at no charge to insureds and dentists.

D. A disability insurer may not deduct the amount of an overpayment of a claim from a payment or reimbursement of another claim unless both claims were for covered services provided to the same insured by the same dentist.

E. A disability insurer that provides a written predetermination of benefits to a dentist for a covered service that includes a specific benefit payment or reimbursement amount may not pay or reimburse the dentist for providing that service in an amount that is less than the amount set forth in the predetermination.

C. F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a disability insurance policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation. END_STATUTE

Sec. 4. Section 20-1402.04, Arizona Revised Statutes, is amended to read:

START_STATUTE20-1402.04. Contracts; dentists; covered services; website; overpayments; predetermination of benefits; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a group disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services a service to an individual covered under a group disability policy based on a fee set by the group disability insurer unless the services service for which the fee applies is a covered service under the individual's group disability policy.

B. This section does not restrict the ability of a group disability insurer to establish dental benefits for services offered by plans that are administered but not insured by the group disability insurer.

C. A group disability insurer shall establish an internet website to provide resources and information to dentists and insureds. The website shall:

1. Include information about each type of group disability policy that is sufficient enough to allow insureds and dentists to determine the covered services under each policy and the payment or reimbursement amounts for those covered services.

2. be accessible at no charge to insureds and dentists.

D. A group disability insurer may not deduct the amount of an overpayment of a claim from a payment or reimbursement of another claim unless both claims were for covered services provided to the same insured by the same dentist.

E. A group disability insurer that provides a written predetermination of benefits to a dentist for a covered service that includes a specific benefit payment or reimbursement amount may not pay or reimburse the dentist for providing that service in an amount that is less than the amount set forth in the predetermination.

C. F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a group disability policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation. END_STATUTE

Sec. 5. Section 20-1404.04, Arizona Revised Statutes, is amended to read:

START_STATUTE20-1404.04. Contracts; dentists; covered services; website; overpayments; predetermination of benefits; definition

A. A contract, entered into or renewed on or after January 1, 2011, between a blanket disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services a service to an individual covered under a blanket disability policy based on a fee set by the blanket disability insurer unless the services service for which the fee applies is a covered service under the individual's blanket disability policy.

B. This section does not restrict the ability of a blanket disability insurer to establish dental benefits for services offered by plans that are administered but not insured by the blanket disability insurer.

C. A blanket disability insurer shall establish an internet website to provide resources and information to dentists and insureds. The website shall:

1. Include information about each type of blanket disability policy that is sufficient enough to allow insureds and dentists to determine the covered services under each policy and the payment or reimbursement amounts for those covered services.

2. be accessible at no charge to insureds and dentists.

D. A blanket disability insurer may not deduct the amount of an overpayment of a claim from a payment or reimbursement of another claim unless both claims were for covered services provided to the same insured by the same dentist.

E. A blanket disability insurer that provides a written predetermination of benefits to a dentist for a covered service that includes a specific benefit payment or reimbursement amount may not pay or reimburse the dentist for providing that service in an amount that is less than the amount set forth in the predetermination.

C. F. For the purposes of this section, "covered service" means a service for which any reimbursement is available under a blanket disability policy without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation. END_STATUTE