Introduced Version






SENATE BILL No. 87

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DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-8-11-4.7; IC 27-13-34-15.2.

Synopsis: Contracts for dental services. Prohibits dental insurers and health maintenance organizations from requiring dentists to accept certain payments.

Effective: July 1, 2011.





Leising




    January 5, 2011, read first time and referred to Committee on Health and Provider Services.







Introduced

First Regular Session 117th General Assembly (2011)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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SENATE BILL No. 87



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 27-8-11-4.7; (11)IN0087.1.1. -->     SECTION 1. IC 27-8-11-4.7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 4.7. (a) As used in this section, "covered services" means health care services for which any reimbursement is available under an insured's policy, regardless of whether the reimbursement is contractually limited by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or another limitation.
    (b) An insurer may not, under an agreement under section 3 of this chapter, require a dentist to accept an amount set by the insurer as payment for health care services provided to an insured unless the health care services are covered services under the insured's policy.

    (c) This section does not apply to a discount medical card program provider agreement regulated under IC 27-17.
SOURCE: IC 27-13-34-15.2; (11)IN0087.1.2. -->     SECTION 2. IC 27-13-34-15.2 IS ADDED TO THE INDIANA

CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 15.2. (a) As used in this section, "covered services" means limited health services for which any coverage is available under an enrollee's individual contract or group contract, regardless of whether the coverage is contractually limited by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or another limitation.
    (b) A limited service health maintenance organization may not, under a contract described in section 15 of this chapter, require a dentist to accept an amount set by the limited service health maintenance organization as payment for limited health services provided to an enrollee unless the limited health services are covered services under the enrollee's individual contract or group contract.

    (c) This section does not apply to a discount medical card program provider agreement regulated under IC 27-17.