Bill Summary for H 704 (2019-2020)
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View NCGA Bill Details | 2019-2020 Session |
AN ACT TO ESTABLISH THE RURAL HEALTH CARE STABILIZATION PROGRAM.Intro. by Lewis, Murphy, Dobson, Wray.
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Bill summary
House committee substitute to the 1st edition makes the following changes.
Deletes proposed GS 58-50-291, which prohibited an insurer providing a health benefit plan for dental services from using more than 25% of its prepaid charges or premiums for marketing and administrative expenses.
Amends proposed GS 58-50-292, by removing the provisions prohibiting insurers who provide health benefit plans for dental services from providing a third party access to a dental provider network contract or information pertaining to discounts for services pursuant to that dental provider network contract. Instead, allows an insurer to grant access to its provider network contract (defined as a contract between an insurer and a dental services provider specifying the rights and responsibilities of the insurer and the provider for delivery of and payment for dental services) to a third party if: (1) at the time the contract is entered into and at the time the contract is renewed, the insurer allows any provider who is part of the carrier's provider network to choose not to participate in third party access to the provider network contract; (2) the insurer includes on its website a listing identifying all third parties who have been granted such access; and (3) the third party accessing the provider network contract agrees to comply with all of the provider network contract's terms. Amends the definition of the term third party by adding that it does not include an employer group or other group for which the insurer provides administrative services. Specifies that the statute does not apply to the assignment of or access to a provider network contract to an entity operating under the same brand licensee program as the contracting entity or any of its affiliates.
Deletes the provisions that removed dental plans from the kinds of insurance not included in the definition of health benefit plan under GS 58-3-200 (miscellaneous insurance and managed care coverage and network provisions) and GS 58-3-190 (coverage required for emergency care).
Amends GS 58-3-200 to prohibit an insurer who has determined that services, supplies, or other items are covered under its dental plan from subsequently retracting its determination after the services, supplies, or other items have been provided or reducing payments for a service, supply, or other item furnished in reliance on such a determination, unless the determination was based on a material misrepresentation about the insured's health condition. Defines a pretreatment estimate as a voluntary request for a projection of dental benefits or payment that does not require authorization and a pretreatment estimate for dental services is not considered a coverage determination.
Changes the act's effective date to January 1, 2020 (was, October 1, 2019).