Sponsored by:
Assemblywoman PAMELA R. LAMPITT
District 6 (Burlington and Camden)
Assemblyman GORDON M. JOHNSON
District 37 (Bergen)
SYNOPSIS
Prohibits certain provisions in agreements between insurance carriers and dentists.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning dental insurance and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier shall not include in an agreement between the carrier and a participating dentist a provision that:
(1) allows the carrier to deny payment to a participating dentist for a procedure performed or for a service provided on behalf of a covered person; and
(2) prohibits the dentist from collecting the amount owed from the covered person for that procedure or service.
b. As used in this section:
“Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization or health maintenance organization authorized to issue dental contracts or plans in this State.
“Participating dentist” means a dentist who has entered into a contract with a carrier to provide dental services to covered persons for a predetermined fee or set of fees.
2. This act shall take effect on the 90th day next following enactment, and shall apply to dental contracts or plans issued or renewed after the effective date.
STATEMENT
This bill prohibits certain provisions in agreements between insurance carriers and dentists.
Specifically, the bill prohibits a carrier from including in an agreement between the carrier and a participating dentist a provision that:
(1) allows the carrier to deny payment to a participating dentist for a procedure performed or for a service provided on behalf of a covered person; and
(2) prohibits the dentist from collecting the amount owed from the covered person for that procedure or service.