SENATE COMMITTEE SUBSTITUTE FOR

SENATE, No. 1915

STATE OF NEW JERSEY

ADOPTED JUNE 12, 1997

Sponsored by Senators SINAGRA, ADLER, Matheussen, Bryant, Codey, Bark, Kenny and Palaia

An Act concerning the assignment of dental benefits and supplementing P.L.1968, c.305 (C.17:48C-1 et seq.), P.L.1979, c.478 (C.17:48D-1 et seq.) and P.L.1985, c.236 (C.17:48E-1 et seq.).

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

      1. 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 Banking and Insurance on or after the effective date of this act that provides for out-of-network benefits, shall provide that in the event a person covered under the contract uses an out-of-network dentist, the person may assign reimbursement for dental services directly to the dentist providing those services.

      b. 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.

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

      2. 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 Banking and Insurance on or after the effective date of this act that provides for out-of-network benefits, shall provide that in the event an enrollee under the contract uses an out-of-network dentist, the enrollee may assign reimbursement for dental services directly to the dentist providing those services.

      b. 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.

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

      3. a. Every 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 Banking and Insurance on or after the effective date of this act that provides for out-of-network benefits, shall provide that in the event a person covered under the contract uses an out-of-network dentist, the person may assign reimbursement for dental services directly to the dentist providing those services.

      b. 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.

      c. 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. This act shall take effect immediately.