SENATE, No. 438

STATE OF NEW JERSEY

INTRODUCED JANUARY 18, 1996

By Senator KYRILLOS

AN Act concerning the assignment of dental benefits and supplementing various parts of statutory law.

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

    1. a. Every individual or group contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the contract may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the hospital service corporation, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the hospital service corporation to provide those dental services, and any applicable interest. Any hospital service corporation making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.

    2. a. Every individual or group contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the contract may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the medical service corporation, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the medical service corporation to provide those dental services, and any applicable interest. Any medical service corporation making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.

    3. a. Every individual or group contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the contract may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the health service corporation, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the health service corporation to provide those dental services, and any applicable interest. Any health service corporation making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.

    4. a. Every policy that is delivered, issued, executed or renewed in this State pursuant to Chapter 26 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the policy may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the insurer, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the insurer to provide those dental services, and any applicable interest. Any insurer making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the insurer has reserved the right to change the premium.

    5. a. Every policy that is delivered, issued, executed or renewed in this State pursuant to Chapter 27 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the policy may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the insurer, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the insurer to provide those dental services, and any applicable interest. Any insurer making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the insurer has reserved the right to change the premium.

    6. a. Every enrollee agreement which is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that an enrollee may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the health maintenance organization, when authorized by the enrollee, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the health maintenance organization to provide those dental services, and any applicable interest. Any health maintenance organization making a payment to an enrollee, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.

    7. a. Every contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1968, c.305 (C.17:48C-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that a person covered under the contract may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the dental service corporation, when authorized by the covered person, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the dental service corporation to provide those dental services, and any applicable interest. Any dental service corporation making a payment to a covered person, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the dental service corporation has reserved the right to change the premium.

    8. a. Every contract that is delivered, issued, executed or renewed in this State pursuant to P.L.1979, c.478 (C.17:48D-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act shall provide that an enrollee under the contract may assign reimbursement for dental services directly to the dentist providing those services. In such assignment the dental plan organization, when authorized by the enrollee, shall pay directly to the dentist the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the dentist who has contracted with the dental plan organization to provide those dental services, and any applicable interest. Any dental plan organization making a payment to an enrollee, after the rights of reimbursement have been assigned to the dentist, shall be liable to the dentist for the payment, and the payment, plus interest and reasonable attorney's fees, may be recovered in a court of competent jurisdiction.

    b. The provisions of this section shall apply to all contracts in which the dental plan organization has reserved the right to change the premium.

    9. This act shall take effect immediately.

STATEMENT

    This bill provides that a person covered under a health or dental insurance contract or policy may assign reimbursement for dental services to the dentist providing those services. The health or dental insurer must pay directly to the dentist providing those dental services the amount of the claim, under the same criteria and payment schedule that would have been paid to the dentist who has contracted with the health or dental insurer to provide those dental services. If the health or dental insurer reimburses the covered person for the dental services rendered after assignment has been authorized by the covered person, it would still be liable for such reimbursement to the dentist providing the services.

    The provisions of the bill apply to hospital service corporations, medical service corporations, health service corporations, commercial health insurers, health maintenance organizations, dental service corporations and dental plan organizations.