AN ACT TO CLARIFY CERTAIN PROVIDER AND PATIENT RIGHTS REGARDING HEALTH BENEFIT PLAN CONTRACTS FOR THE PROVISION OF DENTAL SERVICES.
Adds to GS 58-50-290, prohibiting agreements between insurers or other entities and dental service providers contracting for the provision of dental services from containing restrictions on the methods of claim payment whereby the only acceptable payment method from the insurer or entity to the provider is a credit card payment.
Enacts GS 58-50-291, prohibiting an insurer who provides a health benefit plan for dental services from using more than 25% of its prepaid charges or premiums for marketing and administrative expenses. Requires marketing and administrative expenses to be defined by rule by the Commissioner of Insurance for purposes of the statute. Clarifies that the statute does not affect the applicability of the Chapter's provisions.
Enacts GS 58-50-292, 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. Defines dental provider network contract to mean a contract between an insurer and a dental services provider specifying the rights and responsibilities of the insurer and the provider for the delivery of and payment for dental services. Defines insurer and third party. Establishes that no provider is bound or required to perform services under a dental provider network contract that has been provided to a third party in violation of the statute. Deems an insurer's willful failure to comply with the statute an unfair and deceptive trade practice actionable under GS Chapter 75. Clarifies that the statute does not foreclose other available remedies under law.
Removes 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).
Applies to health and benefit contracts issued, renewed, or amended on or after October 1, 2019.
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