Introduced Version
SENATE BILL No. 87
_____
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)
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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.